Clostridium tertium bacteremia: contamination or true pathogen? A report of two cases and a review of the literature

Abstract

We observed two cases of Clostridium tertium bacteremia three months apart in the sterile unit of our department of hematology and oncology. One patient was being treated for first-relapse acute myeloblastic leukemia, while the second was receiving high-dose chemotherapy with hematopoietic stem cell support for non-Hodgkin lymphoma. At the time that C. tertium was identified, the first patient was completely asymptomatic, while the second was highly febrile. Both responded biologically and/or clinically to antibiotherapy. We discuss the epidemiology and pathology of C. tertium in the general and cancer patient population.

Postoperative Clostridium tertium septicemia in a non-neutropenic pediatric patient

“…[4] Because of the fact that C. tertium is observed as both gram-positive and -negative bacilli, it can be misidentified as Corynebacterium or Bacillus species; thus, it usually takes considerable time to identify the species using classical bacteriological techniques. [2][3][4][5][6][7][8][9][10] Hence, in our case, we initially misidentified C. tertium as L. grayi.…”

“…[6,10] However, fatal cases of C. tertium bacteremia have been reported [2,5,8] and we believe that treatment must be initiated upon the identification of the bacterium in blood cultures. To date, although most documented cases have involved neutropenic patients, [2,[5][6][7][9][10][11] cases involving non-neutropenic patients have also been described. [2,4,7,8] Salvador et al [11] reported that C. tertium could be rapidly identified using a novel mass spectrometry technology (matrix assisted laser desorption ionization timeof-flight).…”

“…[2,8] Because of its antibiotic resistance profile being different from that of other Clostridium species, a standard C. tertium infection treatment remains to be established. [8][9][10] Although most cases with febrile neutropenia have been treated using third-generation cephems, these agents have almost no effect on C. tertium, which is also non-susceptible to beta-lactams. [5,7,8] Leegaard et al [9] reported that C. tertium is sensitive to PCG, although susceptibility patterns may differ depending on geography.…”

“…[4] Although C. tertium has been isolated from blood in most reported cases of C. tertium infection, it has also been implicated in spontaneous bacterial peritonitis, brain abscesses, nasopharyngeal carcinoma, and pneumonia. [2,[4][5][6][7][8][9][10] However, the pathogenicity of this organism remains unclear. [10] C. tertium can easily be misidentified because of its non-toxinproducing, aerotolerant, and gram-variable properties, which are different to those of other clostridia.…”

“…[2,[4][5][6][7][8][9][10] However, the pathogenicity of this organism remains unclear. [10] C. tertium can easily be misidentified because of its non-toxinproducing, aerotolerant, and gram-variable properties, which are different to those of other clostridia. Almost all the reported cases of C. tertium bacteremia have occurred in neutropenic patients without any obvious source of infection.…”