Significance of Clostridium tertium Bacteremia in Neutropenic and Nonneutropenic Patients: Review of 32 Cases

Abstract

In the nonneutropenic host, bacteremia due to Clostridium tertium is rare and of unclear significance. We describe a patient in whom presentation with Clostridium tertium bacteremia was the harbinger of Crohn's disease. In order to understand the significance of C. tertium bacteremia in neutropenic and nonneutropenic hosts, we review all 32 cases of C. tertium bacteremia that occurred at Duke University Medical Center from 1992 to 1999.

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).…”

“…[1] Bacteremia caused by this organism is rare and occurs following intra-abdominal sepsis associated with trauma or surgery; however, the bacteremia may also occur in case of gastrointestinal disorders, pregnancy, and malignancies. [2] Clostridium tertium (C. tertium) has been identified to comprise the normal flora of the lower intestine and was first described in 1917 by Henry who isolated it from war wounds. [3] However, the pathogenicity of this organism was unrecognized until the first report of C. tertium bacteremia in 1963.…”

“…[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.…”

“…Almost all the reported cases of C. tertium bacteremia have occurred in neutropenic patients without any obvious source of infection. [2, 5-7, 9, 10] In contrast, bacteremia in non-neutropenic patients is rare, [2,4,7,8] and Table 1 summarizes all the known cases. A fatal case involving a non-neutropenic patient has been documented; [8] hence, a rapid diagnosis is desirable.…”