Clostridium Tertium Isolated From a Necrotizing Soft Tissue Infection in a Diabetic but Otherwise Nonimmunocompromised Patient

Abstract

Clostridium tertium has historically been regarded as nonpathogenic, and its implication as the primary microbe in infectious etiologies remains unclear. Although there have been several reports of C tertium isolated from blood, tissue, and other specimens, largely this population has consisted of patients with neutropenia, hematologic malignancies, or gastrointestinal disorders. Here we describe a case of a 39-year-old nonimmunocompromised man with a history of type 1 diabetes mellitus and intravenous drug use who presented to our institution with a necrotizing soft tissue infection involving his right upper extremity. The infection had developed after the patient had injected methamphetamines. At surgery, tissue was obtained for Gram stain and culture, yielding C tertium, after an initial misidentification as Lactobacillus species. After undergoing extensive surgical debridement and treatment with an appropriate antibiotic regimen, the patient was able to be discharged home with retained function of his extremity. Although not common, infections involving C tertium can produce severe, potentially life-and limb-threatening disease processes, which may require aggressive therapy even in the nonimmunocompromised patient. Ó 2011 Elsevier Inc. All rights reserved. Case PresentationA 39-year-old man with a past medical history significant for type I diabetes mellitus and intravenous drug use presented to the emergency department with a 3-day history of increasing right upper extremity erythema, edema, and significant pain. On being questioned, the patient admitted to injecting methamphetamines into the right antecubital fossa just prior to the onset of symptoms. At the initial examination, only mild cellulitic changes were identified, and therefore he was given intravenous vancomycin and discharged home on a combination of oral cephalexin and trimethorim/sulfamethoxazole. The following day, however, he represented with worsening symptoms and was admitted initially to the medical service, with surgical consultation obtained.On examination, the patient was noted to be afebrile (97 F [36 C]), with leukocytosis (18,300 WBC/mL) and relative euglycemia (blood glucose 5 114 mg/dL); no evidence of hypotension (150/89 mm Hg), tachycardia (99 beats per minute), or tachypnea (16 breaths/min) was present. The entire length of the right upper extremity,

Microbiome and its role in shaping planetary health

“…CT MALS001 exhibited genomic and phenotypic susceptibility to both ciprofloxacin and vancomycin. This is concordant with the pathogenic profile of C. tertium which is largely considered as a non-pathogenic strain that is occasionally found in clinical cases (Moore and Lacey, 2019;Steensma et al, 2011).…”

Clinical comparison of fournier’s gangrene to other necrotizing soft tissue infections

“…The increased incidence of NSTIs in IVDA has been a world-wide phenomenon in recent years that is supported by several retrospective studies [39][40][41][42][43][44][45][46][47]. Methods of injecting drugs into the subcutaneous region otherwise known as "skin-popping" may explain this phenomenon.…”

Ecological and network analyses identify four microbial species with potential significance for the diagnosis/treatment of ulcerative colitis (UC)

“…Although C. tertium has traditionally been considered non-pathogenic, various studies have reported it to be a significant cause of bacteremia and other infections in neutropenia patients [ 29 , 49 , 50 , 53 , 60 ]. In addition, C. tertium infections in non-neutropenic patients have also been reported recently [ 57 , 58 , 62 ]. Odoribacter splanchnicus ( Bacteroides splanchnicus ) is an anaerobic gram-negative bacterium in Bacteroidetes .…”