Osteosynthesis-Associated Bone Infection Caused by a Nonproteolytic, Nontoxigenic Clostridium botulinum -Like Strain

Abstract

A nonproteolytic, nontoxigenic Clostridium botulinum strain identified by conventional and molecular techniques as type B-, E-, or F-like (BEF-like) was isolated from a human postsurgical wound. All previous reports of such strains have been from environmental sources. Since toxin production is the main taxonomic denominator for C. botulinum, a new name is needed for nonproteolytic, nontoxigenic BEF-like clinical isolates. CASE REPORTA 50-year-old man was hospitalized in June 2002 for an open supracondylar fracture of the right humerus. His past medical history included several fractures between 1984 and 1999, psoriatic arthritis, and ankylosing spondylitis treated by corticotherapy up to 2001. The fracture was treated by open reduction and internal fixation with a Lecestre-type plate. The following week, the patient presented an inflammatory scar with fistula formation. Laboratory investigations revealed an erythrocyte sedimentation rate of 105 mm/h and a C-reactive protein value of 68 mg/liter. Surgical excision of infected tissues and drainage were performed. The patient was treated with intravenous ofloxacin (200 mg twice daily) and rifampin (1 g twice daily). Biopsy specimens of the triceps and articular capsule revealed after culture the presence of Clostridium perfringens and Sphingomonas paucimobilis. The patient was then treated with intravenous ceftriaxone (2 g once daily) and oral ofloxacin (200 mg twice daily) and metronidazole (200 mg twice daily) for 1 week. The symptoms gradually resolved, and the patient left the hospital on day 29 with trimethoprim-sulfamethoxazole (two tablets three times daily), ofloxacin (200 mg twice daily), and metronidazole (500 mg three times daily) prescribed. One month later, the patient developed an osteosynthesis-associated bone infection. Extensive debridement was performed, and all purulent-appearing bone was resected. The plate was removed and reinserted by using a gentamicin-and vancomycin-loaded spacer. The same antibiotic therapy was continued, and the patient was discharged on day 74. A strictly anaerobic, gram-positive, motile, spore-forming rod, designated AIP 355.02, was the only bacterium isolated from all samples obtained during surgery. It was found to be susceptible to all antibiotics used except for trimethoprim-sulfamethoxazole and gentamicin.Strain AIP 355.02 was characterized according to conventional tests (13). Metabolic end products were assayed by quantitative gas chromatography as described previously (5).The organism was lecithinase negative and lipase positive on egg yolk agar plates. Gelatin was liquefied, and milk was not modified. Production of urease and indole was not detected. Acid was produced from glucose, fructose, maltose, mannose, ribose, starch, and sorbitol. Acid was not produced from arabinose, cellobiose, esculin, galactose, glycerol, inositol, lactose, mannitol, melezitose, melibiose, raffinose, rhamnose, sucrose, salicin, trehalose, and xylose. The strain hydrolyzes starch but not esculin. Abundant gas was produced. The major ...

Prevotella colorans sp. nov., isolated from a human wound

“…The nucleotide sequence of the 16S rRNA gene of strain A1336 T was determined as described previously (Carlier et al, 2004). For comparative phylogenetic and sequence similarity analysis, 16S rRNA gene sequences from all species in the family Prevotellaceae were retrieved from the EzTaxon database (Kim et al, 2012).…”

Jonquetella anthropi gen. nov., sp. nov., the first member of the candidate phylum ‘Synergistetes’ isolated from man

“…Colony morphology and the responses of the strains to special potency disks (Jousimies-Somer et al, 2002) were observed on Columbia sheep blood agar plates. For further characterization, the novel strains were maintained anaerobically in trypticase/glucose/yeast extract (TGY) medium under anaerobic conditions at 37 u C, as described previously (Carlier et al, 2004). Biochemical reactions were performed according to the procedures of the VPI Anaerobe Laboratory Manual (Holdeman et al, 1977) by using trypticase/yeast extract (TY) medium supplemented with 1 % (w/v) of each sterilized substrate.…”

Molecular diversity of Clostridium botulinum and phenotypically similar strains

“…It is interesting that among closely related strains of C. botulinum type B there was also one strain of type E, which confirms panmictic nature of the anaerobe. The high similarity between C. botulinum and C. botulinum-like strains was also observed by Carlier et al (2004) taking into account 16S rDNA sequence. The similarity between C. botulinum type B (ATCC 25765) and C. botulinum-like strain AIP 355.02 reached the level of 93%.…”