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Discitis due to Clostridium perfringens.

Diagnosis of the infectious process of the intervertebral disc is often delayed due to the lack of specifity of the clinical picture. This delay in diagnosis and consequently in treatment can lead to severe neurologic sequela. In these cases, punction biopsy of the intervertebral disc is of special value. The authors found no mention in the literature concerning Chlostridium perfringens discitis verified by aspiration and fluid culture extracted by intervertebral disc puncture.

Adult↗

Fulminant sepsis after invasive prenatal diagnosis.

BACKGROUND: Sepsis is extremely rare after invasive prenatal diagnosis. CASE: A patient, who had undergone amniocentesis at 15 weeks, cordocentesis at 20 weeks, and repeat cordocentesis 24 hours before presentation, was admitted at 21 weeks gestation with vaginal bleeding, rupture of membranes, and intrauterine demise. Although clinical and laboratory findings were unremarkable at presentation, she rapidly developed septic syndrome with disseminated intravascular coagulation and eventually multiple organ failure. The fetus was disintegrated and the uterus had to be removed. She was discharged from the intensive care unit after 34 days. Cultures of the uterine content grew Clostridium perfringens. Review of the literature revealed 10 more cases of sepsis after transabdominal prenatal diagnosis. CONCLUSION: Sepsis after prenatal diagnosis can be devastating, unless promptly diagnosed and treated.

Adult↗

Lung isolation in a child with unilateral necrotizing Clostridium perfringens pneumonia.

OBJECTIVE: To describe lung isolation and the selective application of continuous positive airway pressure using an endobronchial blocker in a patient with sickle cell disease and unilateral necrotizing Clostridium perfringens pneumonia. DESIGN: Case report. SETTING: Pediatric intensive care unit. PATIENT: A 12-yr-old male with sickle cell disease developed persistent necrotizing pneumonia of the left lung following exchange transfusion for acute chest syndrome and hyper-hemolytic syndrome. INTERVENTIONS: An endobronchial blocker was placed into the left main stem bronchus for lung isolation and application of continuous positive airway pressure to the left lung for 48 hrs. MEASUREMENTS AND MAIN RESULTS: After 14 days of persistent atelectasis of the left lung despite thorascopic decortication and multiple bronchoscopies, our patient had substantial lung aeration within 48 hrs of continuous positive airway pressure applied via the endobronchial blocker. Lung resection was avoided and the patient was successfully extubated 2 days after removal of the blocker. CONCLUSIONS: This case report demonstrates a therapeutic application of prolonged lung isolation and differential ventilation in a patient with an airway too small for commercially available double-lumen endotracheal tubes. The apparent success of this intervention suggests the feasibility of selective ventilation in pediatric patients and highlights a novel application of the bronchial blocker.

Anti-Bacterial Agents↗

Production of a non-toxic site-directed mutant of Clostridium perfringens epsilon-toxin which induces protective immunity in mice.

A panel of ten site-directed mutants of Clostridium perfringens epsilon-toxin was generated. All of the mutated proteins expressed in Escherichia coli were recognized in immunoblots by a neutralizing mAb raised against wild-type native epsilon-toxin. The cytotoxicity of the site-directed mutated toxins was assayed in vitro against MDCK cells. One mutation resulting in loss of activity in the assay was identified. This non-toxic protein was derived by substituting a proline for the histidine at residue 106 of the toxin. Immunization of mice with the non-toxic mutated epsilon-toxin resulted in the induction of a specific antibody response and immunized mice were protected against 1000 LD50 doses of wild-type recombinant epsilon-toxin.

Amino Acid Substitution↗

Production of phospholipase C (alpha-toxin), haemolysins and lethal toxins by Clostridium perfringens types A to D.

To obtain high yields of extracellular enzymes and toxins for immunological analysis, type culture collection strains of Clostridium perfringens types A to D and 28 fresh isolates of C. perfringens type A from humans were grown in fermenters under controlled conditions in a pre-reduced proteose peptone medium. The type culture collection strains all showed different characteristics with respect to growth rates and pH optima for growth. Production of phospholipase C (alpha-toxin), haemolysin and lethal activity varied considerably between the different types. Growth and extracellular protein production in fermenters with pH control and static or stirred cultures were compared. Production of all extracellular proteins measured was markedly improved by cultivation in fermenters with pH control. Strain ATCC13124 produced five times more phospholipase C than any of 28 freshly isolated strains of C. perfringens type A, grown under identical conditions. Haemolytic and lethal activities of the ATCC strain were equal or superior to the activities of any of the freshly isolated strains. There were no differences in the bacterial yields and in the production of extracellular toxins between type A strains isolated from clinical cases of gas gangrene and abdominal wounds, and those isolated from faecal samples from healthy persons.

Abdominal Injuries↗

Enterotoxigenic Clostridium perfringens as a cause of sporadic cases of diarrhoea.

The purpose of this study was to investigate the incidence of cases of sporadic diarrhoea associated with enterotoxigenic Clostridium perfringens. Cases were identified by detection of C. perfringens enterotoxin with the Oxoid RPLA kit, with confirmation by ELISA, in faecal specimens from isolated incidents of diarrhoea and from which no other enteropathogen had been isolated. In a 2-month study, 65 (18%) of 370 specimens were enterotoxin positive. There was no predominant age group or sex in the enterotoxin-positive group, but higher proportion (79%) was resident in the community than were enterotoxin-negative cases (34%). Only four of the 65 enterotoxin-positive patients had received antibiotic therapy. Spore counts in most enterotoxin-positive patients were < 10(5)/g, indicating that detection of high numbers of C. perfringens is not useful in determining the aetiology of sporadic diarrhoea. Diagnosis should be confirmed by the detection of enterotoxin, but further work is required to assess whether an acceptable accuracy is obtained with the RPLA kit or whether ELISA is needed in all cases.

Acute Disease↗

Detection of Clostridium difficile cytotoxin and Clostridium perfringens enterotoxin in cases of diarrhoea in the community.

Faecal specimens from 843 cases of diarrhoea in the community were tested for the presence of Clostridium difficile cytotoxin and Clostridium perfringens enterotoxin. C. difficile cytotoxin was detected in faecal specimens from 0.6 % of cases aged at least 2 years by using a Vero cell assay. Factors associated with detection of C. difficile cytotoxin were antibiotic therapy, age over 60 years and living in a home with other elderly people. Three methods were used for the detection of C. perfringens enterotoxin: a Vero cell assay, a commercial (TechLab) enzyme immunoassay (EIA) and an in-house EIA. The lower level of detection of pure C. perfringens enterotoxin in buffer was 0.01 micro g ml(-1) by the TechLab EIA and 1.0 micro g ml(-1) by the Vero cell assay. C. perfringens enterotoxin was detected by using the TechLab EIA in faecal specimens from 2.5 % of cases. This commercial EIA was less sensitive than the in-house EIA, detecting only 31 % of positive cases, but was specific and could be used for outbreak investigation by routine diagnostic laboratories. Age over 60 years was a factor associated with C. perfringens enterotoxin detection; this age group may be targeted for testing.

Adolescent↗

A case of infant botulism with a possible link to infant formula milk powder: evidence for the presence of more than one strain of Clostridium botulinum in clinical specimens and food.

Infant botulism was confirmed in a 5-month-old female by both isolation of Clostridium botulinum type B and by detection of type B botulinum neurotoxin in rectal washout and faeces. DNA fingerprinting of nine isolates from faeces yielded two different amplified-fragment length polymorphism (AFLP) patterns. C. botulinum was isolated from two of 14 food and drink items from the patient's home: C. botulinum type A was recovered from an opened container of dried rice pudding and C. botulinum type B from opened infant formula milk powder. Ten C. botulinum type B isolates from the opened infant formula yielded four AFLP patterns, two of which were indistinguishable from the clinical isolates. Fifteen unopened foods were tested and C. botulinum type B of a unique AFLP pattern was recovered from one unopened infant formula of the same batch as the opened container. It is suggested that multiple C. botulinum were present in both food and the intestine during infant botulism.

Botulinum Toxins↗

Modeling growth of Clostridium perfringens in pea soup during cooling.

Clostridium perfringens is a pathogen that mainly causes food poisoning outbreaks when large quantities of food are prepared. Therefore, a model was developed to predict the effect of different cooling procedures on the growth of this pathogen during cooling of food: Dutch pea soup. First, a growth rate model based on interpretable parameters was used to predict growth during linear cooling of pea soup. Second, a temperature model for cooling pea soup was constructed by fitting the model to experimental data published earlier. This cooling model was used to estimate the effect of various cooling environments on average cooling times, taking into account the effect of stirring and product volume. The growth model systematically overestimated growth of C. perfringens during cooling in air, but this effect was limited to less than 0.5 log N/ml and this was considered to be acceptable for practical purposes. It was demonstrated that the growth model for C. perfringens combined with the cooling model for pea soup could be used to sufficiently predict growth of C. perfringens in different volume sizes of pea soup during cooling in air as well as the effect of stirring, different cooling temperatures, and various cooling environments on the growth of C. perfringens in pea soup. Although fine-tuning may be needed to eliminate inaccuracies, it was concluded that the combined model could be a useful tool for designing good manufacturing practices (GMP) procedures.

Animals↗

Clostridium perfringens septicemia and acute leukemia.

Three cases of fatal clostridial septicemia in patients with acute leukemia are described. Predisposing factors and treatment are discussed. Clostridium septicemia should always be suspected when a patient with neutropenia suddenly develops diffuse abdominal pain, fever, and tachycardia over 120/min. The importance of early treatment with penicillin or another adequate antibiotic is discussed.

Adult↗