Foot Infection by Clostridium sordellii: Case Report and Review of 15 Cases in France

Abstract

dWe report a case of foot infection by Clostridium sordellii and review 15 human infections registered at a Reference Center in France during the period 1998 to 2011. All strains were found nontoxigenic, lacking the lethal toxin gene coding for TcsL. Like Clostridium septicum, several C. sordellii infections were associated with intestinal neoplasms. CASE REPORTA 78-year-old patient living alone under bad cognitive and hygienic conditions in a rural village of South of France was hospitalized for 4 days in August 2008 for confusion, major asthenia, and fever (38.2°C). Dehydration was marked, and diabetes mellitus and dyslipemia were discovered that necessitated insulin therapy. A burn on the foot (caused by exposure to boiling water) was colonized with a methicillin-resistant Staphylococcus aureus strain that necessitated only local treatment. Previous history was unremarkable, with treated arterial hypertension, episodes of painful constipation in 2005, acute epigastralgy 2 years before in 2006 with ultrasound echographic and nuclear magnetic resonance imaging (MRI), as well as endoscopic gastroscopy and Helicobacter pylori investigation all negative. Fifteen days later, the patient was admitted to the emergency ward with confusion, vertigo, fever (39°C), and abdominal pain beginning at the right hypocondrium and later at the epigastrium. There was neither shock (arterial tension of 17/7.2), nor were there pulmonary, urologic, clinical, or biological signs. Computed tomography scan examination revealed neither angiocholitis nor appendicitis. At the time of admission, there were 18,300 leukocytes/mm 3 , including 16,300 polymorphonuclear leukocytes (PMNs). The C-reactive protein level was slightly elevated (42 mg/liter, increasing 2 days later to 160 mg/liter). Coagulation was normal (prothrombin index, partial prothrombin time [PTT], and fibrinogen). Biochemistry was unremarkable (ionogram, glycemia, troponin, and pancreatic, muscular, and hepatic enzymes). Only renal clearance was slightly disturbed (60 ml/min/1.73 m 2 , as estimated by the Modification of Diet in Renal Disease [MDRD] Study equation), although in the same range as before, and more remarkably, the bilirubin level was elevated (24 mol/liter; normal, 2 to 22 mol/ liter): all bilirubin was constituted of free indirect bilirubin, meaning hemolysis. Bilirubinemia was normal (14 mol/liter) at the preceding hospitalization 3 weeks before. The patient had hemoconcentration (hemoglobin, 153 g/liter [usually 12 to 13 g/liter before and at late controls]; total proteins, 80 g/liter [usually around 65 g/liter]). Blood cultures were rapidly drawn, but the malleolar lesion, still present and now painful, was not sampled, and antibiotherapy started less than 3 h after admission, with metronidazole given at 500 mg three times a day (t.i.d.) and ceftriaxone given at 1 g/day. A Gram-positive spore-forming (subterminal or terminal spores) rod-shaped bacterium was evidenced within 11 h from anaerobic blood cultures (BacT/Alert FN; bioMérieux, Durham, NC). Colonies...

Clostridium sordelli as a cause of gas gangrene in a trauma patient

“…[8] The prevalence of C. sordellii causing gas gangrene infections are reported in 4% of patients, globally. [9] While in trauma patients, only six case reports of gas gangrene caused by C. sordellii had been published worldwide till date [Table 1]. C. sordelli gas gangrene carries a high mortality in trauma patients as reported in the literature.…”

Clostridium sordellii Pathogenicity Locus Plasmid pCS1-1 Encodes a Novel Clostridial Conjugation Locus

“…Although virulence studies indicate that TcsL is a major virulence factor of C. sordellii -mediated infection ( 18 , 20 ), a low rate of tcsL or tcsH carriage of ~5% to 12% is reported for C. sordellii strains ( 30 , 31 , 43 ). Clinical reports and laboratory observations indicate that the majority of disease-causing C. sordellii isolates are likely to encode the LCTs but that they are quickly lost upon collection and subculture, suggesting that they may be encoded on unstable mobile genetic elements ( 30 , 44 ). It has previously been hypothesized that the C. sordellii PaLoc may be present in different genomic locations, with the pCS1 plasmids representing stable variants of a highly unstable plasmid ( 30 ).…”

Non-lethalClostridium sordelliibacteraemia in an immunocompromised patient with pleomorphic sarcoma

“…Clinically, intravascular depletion is responsible for the TSS-like presentation of many C. sordellii infections 7. Despite a high mortality rate, a French case series identified 15 non-lethal C. sordellii foot infections with all C. sordellii isolates lacking the TscL gene 8. Seven of these patients had isolated bacteraemia.…”