Clostridium septicum gas gangrene in a previously healthy 8-year-old female with survival

Pinzon-Guzman, Carolina; Bashir, Dalia; McSherry, George; Beck, Michael; Rocourt, Dorothy V.

doi:10.1016/j.jpedsurg.2013.01.033

Cited by 6 publications

(2 citation statements)

References 9 publications

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“…The addition of clindamycin may be beneficial by inhibiting toxin synthesis. 2,3,17 Likely critical to the survival of our 2 patients was early collection of anaerobic blood culture specimens and prompt initiation of antibiotics. All 3 patients improved after admission, then developed new or worsening fever, tachycardia, WBC counts >25 K/mm 3 , and severe abdominal pain despite reassuring examination.…”

Section: Discussionmentioning

confidence: 99%

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C septicum Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention

et al. 2017

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Clostridium septicum is an anaerobic bacterium that causes rapidly progressive myonecrosis, bacteremia, and central nervous system infection. It has been reported as a complication of Escherichia coli hemolytic uremic syndrome (HUS) in 8 children worldwide; 5 children died, and the 3 reported survivors had surgically treated disease. We present 3 cases of C septicum complicating HUS in children, including the first 2 reported cases of survival without surgical intervention. All patients presented with classic cases of HUS with initial clinical improvement followed by deterioration. Patient 1 had rising fever, tachycardia, and severe abdominal pain 24 hours after admission. She developed large multifocal intraparenchymal cerebral hemorrhages and died 12 hours later. Autopsy revealed C septicum intestinal necrosis, myonecrosis, and encephalitis. Patient 2 had new fever, increasing leukocytosis, and severe abdominal pain on hospital day 4. She was diagnosed with C septicum bacteremia and treated with metronidazole, meropenem, and clindamycin. Patient 3 had new fever and increasing leukocytosis on hospital day 3; blood cultures grew C septicum, and she was treated with penicillin. Patients 2 and 3 improved rapidly and did not require surgery. C septicum is a potential co-infection with E coli. It thrives in the anaerobic environment of E coli–damaged intestinal mucosa and translocates to cause systemic infection. Fever, tachycardia, a rising white blood cell count, and abdominal pain out of proportion to examination are key findings for which physicians should be vigilant. Timely evaluation by anaerobic blood culture and early initiation of antibiotics are necessary to prevent fatalities.

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Section: Discussionmentioning

confidence: 99%

“…2 It may also colonize the ileocecal region of healthy humans. 3 The chief virulence factor of C septicum, α-toxin, causes tissue necrosis and intravascular hemolysis. 4 C septicum disease is rapidly progressive, with symptoms developing 6 to 48 hours after inoculation 5 and death possible within 24 to 48 hours of symptom onset.…”

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C septicum Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention

et al. 2017

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Gas Gangrene

Gupta

Shah

2022

Pediatric Musculoskeletal Infections

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Clostridial Infections in Children: Spectrum and Management

Brook

2015

Curr Infect Dis Rep

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Clostridia can cause unique histotoxic syndromes produced by specific toxins (e.g., gas gangrene and food poisoning) as well as non-syndromic infections (e.g., abscess, local infections, and blood born infection). Clostridia can also be recovered from various body sites as part of polymicrobial aerobic-anaerobic infection. These include intra-abdominal (peritonitis and abscess), biliary tract, female genital tract, abscess (rectal area and oropharyngeal), pleuropulmonary, central nervous system, and skin and soft-tissue infections. Clostridia were recovered from children with bacteremia of gastrointestinal origin, necrotizing enterocolitis, and sickle cell disease. They have also been isolated in acute and chronic otitis media, chronic sinusitis and mastoiditis, peritonsillar abscesses, and neonatal conjunctivitis. Early and aggressive surgical debridement, decompression, and drainage of affected tissues are critical to successful outcome of histotoxic infections. Effective antimicrobials include penicillin, clindamycin, chloramphenicol, third-generation cephalosporins, carbapenems, and vancomycin.

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Clostridium septicum gas gangrene in a previously healthy 8-year-old female with survival

Cited by 6 publications

References 9 publications

C septicum Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention

C septicum Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention

Gas Gangrene

Clostridial Infections in Children: Spectrum and Management

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