Clostridium difficile Vertebral Osteomyelitis

Alnajjar, Abeer A; Al‐Rawahi, Ghada N.; Hoang, Linda; Kollmann, Tobias R.

doi:10.1097/inf.0b013e318296b424

Cited by 9 publications

(18 citation statements)

References 19 publications

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“…In a recent review encompassing 59 patients with extra-intestinal C. difficile infection (CDI) (Bedimo and Weinsten 2003), three major forms of clinical manifestation were described: bacteraemia with or without focal infection (Bedimo and Weinsten 2003;Feldman et al 1995;Libby and Bearman 2009;Lee et al 2010;Gerard et al 1989;Hemminger et al 2011;Choi et al 2013), intra-abdominal infection, and extraabdominal abscesses (Bedimo and Weinsten 2003), such as a splenic abscess (Stieglbauer et al 1995;Studemeister et al 1987;Saginur et al 1983) and a brain abscess (Gravisse et al 2003). C. difficile has also been associated with reactive arthritis (Loffler et al 2004;Birnbaum et al 2008;Prati et al 2010), osteomyelitis (Al-Najjar et al 2013;Pron et al 1995;Riley and Karthigasu 1982), and prosthetic shoulder and knee joint infection (Pron et al 1995;Ranganath and Midturi 2013;McCarthy and Stingemore 1999). Necrotizing fasciitis (Bhargava et al 2000;Duburcq et al 2013) and posttraumatic wound infections with C. difficile have been reported in two case reports (Deptula et al 2009;Urbán et al 2010).…”

Section: Discussionmentioning

confidence: 98%

Clostridium difficile ribotype 078 cultured from post-surgical non-healing wound in a patient carrying ribotype 014 in the intestinal tract

et al. 2015

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Extra-intestinal infections caused by Clostridium difficile are rare. The risk of extra-intestinal infections associated with C. difficile may be particularly relevant in environments contaminated with C. difficile spores. This paper describes the case of a non-diarrheic patient colonized with C. difficile ribotype 014 in the intestinal tract who developed a post-surgical wound infection by C. difficile ribotype 078. The infection responded to metronidazole administered first intravenously and then orally. This case indicates that C. difficile may not only be related to diarrheic diseases, but also to infections of non-healing wounds, especially in situations when C. difficile is the only isolated pathogen.

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Section: Discussionmentioning

confidence: 98%

Clostridium difficile ribotype 078 cultured from post-surgical non-healing wound in a patient carrying ribotype 014 in the intestinal tract

et al. 2015

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“…Osteomyelitis due to Clostridium species is quite rare. In the previously reported articles on osteomyelitis due to C. difficile , C. clostridioforme , C. celerecrescens , C. bifermentans , and C. septicum , several have reported an association with trauma (Mischnik et al 2011 ; Al-Najjar et al 2013 ; Scanlan et al 1994 ). The treatment that was most commonly chosen was metronidazole, clindamycin, or β-lactam.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

Osteomyelitis due to Clostridium innocuum in a patient with acute lymphoblastic leukemia: case report and literature review

et al. 2015

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IntroductionClostridium innocuum is an anaerobic Gram-positive bacterium, unable to produce toxins and rarely causes infections. We report the first case of C. innocuum osteomyelitis and bacteremia in a patient with acute lymphoblastic leukemia (ALL). Findings were compared with previously reported cases of C. innocuum infections in immunocompromised patients, e.g., patients with acquired immune deficiency syndrome, leukemia, and organ transplantation.Case descriptionA 32-year-old Japanese male was admitted for persistent low-grade fever and purpura lasting for 1 month. Complete blood counts and cytogenetic analysis identified Ph1-positive ALL, which was successfully treated using chemotherapy. However, the patient developed high fever and lumbar pain during complete remission. Fluorodeoxyglucose-positron emission tomography and computed tomography demonstrated osteomyelitis. C. innocuum was identified as the causative agent and the patient was successfully treated using antibiotic therapy.Discussion and evaluationWe performed a literature review revealing a number of common aspects to the clinical presentation of C. innocuum infection and an association with various comorbidities. Further, we highlight the most efficient diagnostic and treatment strategies for C. innocuum osteomyelitis.ConclusionsClostridium innocuum can be a causative pathogen of osteomyelitis and bacteremia in immunocompromised patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1176-3) contains supplementary material, which is available to authorized users.

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“…Whereas C. difficile bacteremia is rare, the seeding of prosthetic cardiac material with delayed pre sent ation-as in this case, 6 months after treatment-is extraordinarily uncommon. A small number of delayed, recurrent extraintestinal C. difficile infections have been reported in various circumstances: in an aortic aneurysm, 2 in a prosthetic shoulder, 6 in vertebral osteomyelitis associated with prosthetic hardware, 9 and in a prosthetic hip. 10 During the initial surgery, our patient was placed on CPB, because this lesion was presumed to be a pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 99%

Getting to a Man's Heart through His Colon

Samsky¹,

DeVore²,

Durkin³

et al. 2016

Texas Heart Institute Journal

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E valuating the efficacy of the Dor procedure when that procedure is added to coronary artery bypass surgery was one of the 2 major objectives of the Surgical Treatment for Ischemic Heart Failure (STICH) trial, the results of which were reported in 2009.1 The Dor procedure involves removing both akinetic and dyskinetic segments of the anterior wall and reshaping the left ventricle (LV), in order to restore its original elliptical form. Here, we describe the case of a patient who, 10 years after receiving a Dacron epicardial patch as a research subject in the STICH trial, presented with purulent pericarditis from Clostridium difficile. Case ReportIn March 2013, a 69-year-old man presented with a progressively enlarging pulsatile mass in the left side of his chest. He had no constitutional symptoms and reported no symptoms of decompensated heart failure, such as shortness of breath, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, or peripheral edema. Nor did he have abdominal symptoms suggestive of volume overload. Physical examination revealed a temperature of 37.3 °C, a heart rate of 70 beats/min, a blood pressure of 122/58 mmHg, and a large, pulsating mass protruding from his chest wall, surrounded by erythema. His medical comorbidities included ischemic cardiomyopathy with an LV ejection fraction recently measured at 0.15, chronic obstructive pulmonary disease with emphysema, chronic kidney disease, alcohol abuse, and tubulovillous adenoma of the transverse colon. His surgical history included (in 2003) coronary artery bypass grafting combined with the Dor procedure (including placement of a felt-and-Dacron epicardial patch), as well as a transverse colectomy (in 2012).Six months before this presentation, he had been admitted to another hospital for non-ST-segment-elevation myocardial infarction and cardiogenic shock, an admission that was complicated by C. difficile bacteremia without colitis. Two weeks of treatment with metronidazole achieved clearance of blood cultures and clinical resolution. No obvious cause for the C. difficile bacteremia was found; the evaluation included a negative computed tomographic (CT) scan of the abdomen and pelvis.

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Clostridium difficile Vertebral Osteomyelitis

Cited by 9 publications

References 19 publications

Clostridium difficile ribotype 078 cultured from post-surgical non-healing wound in a patient carrying ribotype 014 in the intestinal tract

Clostridium difficile ribotype 078 cultured from post-surgical non-healing wound in a patient carrying ribotype 014 in the intestinal tract

Osteomyelitis due to Clostridium innocuum in a patient with acute lymphoblastic leukemia: case report and literature review

Getting to a Man's Heart through His Colon

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