<i>Clostridium tertium</i>in Necrotizing Fasciitis and Gangrene

Ray, Pallab; Das, Arunangshu; Singh, Kundan; Bhansali, Anil; Yadav, TD

doi:10.3201/eid0910.030287

Cited by 31 publications

(42 citation statements)

References 9 publications

(14 reference statements)

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“…However, C difficile was never identified on the successive sets of blood and tissue cultures. C difficile is a non-invasive bacterium and rarely induces systemic and serious forms of soft tissue infection unlike other species of clostridium 1 2. Thus, we may conclude C difficile is not the pathogen responsible of the necrotising fasciitis but most probably, the intestinal wall alterations induced by the pseudomenbranous colitis allow translocation of pathogen intestinal bacteria which cause the fasciitis.…”

Section: Discussionmentioning

confidence: 92%

Pseudomembranous colitis due toClostridium difficileas a cause of perineal necrotising fasciitis

et al. 2013

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Although rare, pseudomembranous colitis may be a cause of perineal necrotising fasciitis in a context of immunosuppression, as in the case we report. This origin must be quickly identified because the therapeutic management, especially surgery, is unlikely to be the same as usual. Similarly, antibiotic treatment is also a matter of discussion due to the potential deleterious role of antibiotics in pseudomembranous colitis.

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Section: Discussionmentioning

confidence: 92%

Pseudomembranous colitis due toClostridium difficileas a cause of perineal necrotising fasciitis

et al. 2013

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“…2 Since then there have been several other reports implicating C tertium in a wide variety of clinical processes, including brain abscess, 3 spontaneous bacterial peritonitis, 4 neutropenic enterocolitis, 5 and bacteremia, [6][7][8][9][10][11] as well as septicemia. [12][13][14][15] Moreover, it has been isolated as a pathogen involved in necrotizing soft tissue infections 16,17 requiring extensive surgical debridement, as our case illustrates.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,[8][9][10][11][13][14][15][16]18 There have been isolated reports of infection involving nonneutropenic patients 12,17,18 ; however, these seem to be the exception. Our patient, although diabetic, does not have any other risk factors for or history of neutropenia, hematologic malignancy, or gastrointestinal disorder.…”

Section: Discussionmentioning

confidence: 99%

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

Steensma

Ertl

Burke

2011

The Journal of the American College of Certified Wound Speciali

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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,

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“…C. tertium is associated with bacteremia cases [15] and septic shock [16], but it mainly infects immunocompromised [17] and neutropenic patients [18]. This species has recently been identified as a causal agent of necrotizing fasciitis and gangrene [19], and is also known to cause various pathologies in non-neutropenic patients [20].…”

Section: Introductionmentioning

confidence: 99%

Comparative genomics identifies potential virulence factors inClostridium tertiumandC. paraputrificum

et al. 2019

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Some well-known Clostridiales species such as Clostridium difficile and C. perfringens are agents of high impact diseases worldwide. Nevertheless, other foreseen Clostridiales species have recently emerged such as Clostridium tertium and C. paraputrificum . Three fecal isolates were identified as Clostridium tertium (Gcol.A2 and Gcol.A43) and C. paraputrificum (Gcol.A11) during public health screening for C. difficile infections in Colombia. C. paraputrificum genomes were highly diverse and contained large numbers of accessory genes. Genetic diversity and accessory gene percentage were lower among the C. tertium genomes than in the C. paraputrificum genomes. C. difficile tcdA and tcdB toxins encoding homologous sequences and other potential virulence factors were also identified. EndoA interferase, a toxic component of the type II toxin-antitoxin system, was found among the C. tertium genomes. toxA was the only toxin encoding gene detected in Gcol.A43, the Colombian isolate with an experimentally-determined high cytotoxic effect. Gcol.A2 and Gcol.A43 had higher sporulation efficiencies than Gcol.A11 (84.5%, 83.8% and 57.0%, respectively), as supported by the greater number of proteins associated with sporulation pathways in the C. tertium genomes compared with the C. paraputrificum genomes (33.3 and 28.4 on average, respectively). This work allowed complete genome description of two clostridiales species revealing high levels of intra-taxa diversity, accessory genomes containing virulence-factors encoding genes (especially in C. paraputrificum ), with proteins involved in sporulation processes more highly represented in C. tertium . These finding suggest the need to advance in the study of those species with potential importance at public health level.

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Clostridium tertiumin Necrotizing Fasciitis and Gangrene

Cited by 31 publications

References 9 publications

Pseudomembranous colitis due toClostridium difficileas a cause of perineal necrotising fasciitis

Pseudomembranous colitis due toClostridium difficileas a cause of perineal necrotising fasciitis

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

Comparative genomics identifies potential virulence factors inClostridium tertiumandC. paraputrificum

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