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Clostridium difficile infection of a prosthetic joint presenting 12 months after antibiotic-associated diarrhoea.

Clostridium difficile is a common cause of antibiotic-associated diarrhoea, but it rarely causes extra-colonic disease. An 83-year-old woman who developed culture-positive C. difficile-associated diarrhoea following pneumonia and a total hip replacement was treated successfully with oral metronidazole therapy. She was readmitted 12 months later for revision of the hip prosthesis because of increasing pain. At surgery an abscess associated with the prosthesis was discovered. Culture of the pus grew C. difficile. When the surgical isolate and the cryopreserved faecal isolates were compared using Pulsed Field Gel Electrophoresis (PFGE), an identical banding pattern was observed. This case extends the clinical spectrum of C. difficile infection by documenting a prolonged interval between the initial infection, and diagnosis of the prosthetic joint infection. The importance of molecular typing to show strain relatedness is demonstrated.

Aged↗

Protection of mice against Clostridium chauvoei infection by anti-idiotype antibody to a monoclonal antibody to flagella.

Polyclonal rabbit anti-idiotypic antibody (anti-Id) against the protective monoclonal antibody specific to the flagella of Clostridium chauvoei was produced, purified, and characterized. Anti-Id inhibited the binding of its related monoclonal antibody to the flagellar antigen, suggesting that the anti-Id bore an internal image of the flagellar antigen. When mice were immunized with anti-Id intraperitoneally, the survival rate increased significantly, compared with mice immunized with normal rabbit IgG (P < 0.01), and specific anti-flagellar antibodies were induced.

Animals↗

Clostridium difficile infections in animals with special reference to the horse. A review.

In human medicine, Clostridium (C.) difficile is since many years a well-known cause of nosocomial diarrhea induced by antibiotic treatment. In horses, C. difficile was recently suggested as a possible enteric pathogen. The bacterium is associated with acute colitis in mature horses following treatment with antibiotics. C. difficile, and/or its cytotoxin, is also associated with acute colitis in mares when their foals are being treated with erythromycin and rifampicin for Rhodococcus equi pneumonia. The colitis can have resulted from an accidental ingestion of erythromycin by the mares. In an experimental study it was also demonstrated in mature horses that erythromycin can induce severe colitis associated with proliferation of C. difficile. A new interesting finding was that in healthy foals younger than 14 days, C. difficile was isolated from every third foal whereas older foals proved negative. In this paper the current state of knowledge of C. difficile infections in animals, especially in horses, is reviewed. A short description is given of the historical background of Clostridium difficile and the antibiotic-associated colitis and diarrhea caused by infection with this bacterium. The taxonomy of Clostridium difficile is described extensively. A summary is given of the diseases associated with clostridia infections in animals. Special attention is paid to the pathogenesis, epidemiology, clinical symptoms, laboratory diagnosis, and pathology of Clostridium difficile infections in horses. Finally, some other bacterial causes of colitis in horses are discussed shortly.

Animals↗

Clostridium difficile infection and concurrent vancomycin-resistant Enterococcus stool colonization in a health care worker: case report and review of the literature.

Clostridium Difficile diarrhea was noted in a previously healthy health care worker from the study institution after receiving oral clindamycin therapy; the worker also had vancomycin-resistant Enterococcus stool colonization. Health care workers should be aware that antibiotic therapy may place them at increased risk for colonization and infection with nosocomial pathogens such as Clostridium difficile and vancomycin-resistant Enterococcus.

Adult↗

Suppurative abomasitis associated with Clostridium septicum infection.

A 1-week-old calf and two 1-month-old lambs from different farms in eastern South Dakota had severe abomasitis characterized by diffuse suppurative inflammation, edema, and emphysema. Clostridium septicum in the abomasal wall of each was identified by immunofluorescence and isolation. The lesions and microbiologic findings established the disease as braxy, a condition infrequently reported in the United States and thought to affect sheep only.

Abomasum↗

Spondylodiscitis due to Clostridium ramosum infection in an immunocompetent elderly patient.

The first ever case of spondylodiscitis caused by Clostridium ramosum in an elderly immunocompetent patient has been reported. C. ramosum is usually an intestinal bacterium but may occasionally be isolated in clinical specimens as an opportunistic pathogen. This report shows that this anaerobic organism can cause bone tropism without there having been any contamination due to spinal surgery. The infection cleared after empirical therapy using intravenous amoxicillin and oral metronidazole.

Aged↗

Evaluation of therapy with hyperbaric oxygen for experimental infection with Clostridium perfringens.

The effects of inoculum size and treatment delays on the efficacy of hyperbaric oxygen (HBO) were evaluated in a murine model of Clostridium perfringens myositis in which the infection was treated with an HBO regimen identical to that used for humans. The efficacies of treatment with penicillin, metronidazole, or clindamycin--alone or in combination with HBO--were also assessed. Survival was inversely related to the size of the bacterial inoculum used for challenge, and delays in treatment markedly reduced the efficacies of all single and combination regimens. When animals were challenged with > 10(8) colony-forming units, survival was significantly higher among those treated with clindamycin or metronidazole than among those treated with penicillin. HBO alone did not improve survival at any inoculum tested. However, when administered early, HBO plus metronidazole or penicillin demonstrated significant additive efficacies in animals challenged with > or = 10(9) organisms. Clindamycin was more effective at the higher inocula than penicillin, metronidazole, or HBO, and its superior efficacy was not further enhanced by adjunctive therapy with HBO.

Animals↗