[Terramycin in experimental Clostridium welchii infection].
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Clostridium Infections↗
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Treatment of Clostridium difficile infection.
The treatment options for Clostridium difficile infection remain limited, although promising agents are currently being assessed. Metronidazole is the first-line drug of choice for those patients requiring specific anti-C. difficile treatment. Much of the interest in alternative therapies has centred on the difficult management issues posed by patients with multiple symptomatic recurrences of C. difficile infection. However, it is now clear that the majority of these episodes are due to reinfections with new C. difficile strains and not relapses caused by the original bacterium. Hence, the true efficacy of the alternative regimens remains unclear. Individuals susceptible to C. difficile reinfections need to be protected from exposure to C. difficile until their bowel flora recovers. While several biotherapeutic approaches to the treatment and prevention of C. difficile infection have been described, few controlled data are available. Preliminary studies with anti-C. difficile bovine immunoglobulin concentrates for treatment and prevention have produced promising results. Vaccination to prevent C. difficile infection, particularly in high-risk elderly patients managed within institutions where C. difficile is endemic, is a worthwhile therapeutic goal.
Animals↗
Clostridium welchii infection following amniocentesis: a case report and review of the literature.
We report a case of severe Clostridium welchii infection following amniocentesis with septicaemia, haemolysis, DIC, pulmonary oedema and renal failure. Full recovery occurred following aggressive conservative management using antibiotics, endometrial curettage and intensive monitoring. The patient retained her uterus and had a successful pregnancy two years later although caesarean section for uterine rupture was required. Conservative management with conservation of the uterus and ovaries may be a safe and effective option in the management of severe Clostridium infections, using antibiotics, endometrial curettage and multidisciplinary team input.
Abortion, Septic↗
Acute intravascular hemolysis with minimal renal impairment in Clostridium perfringens infection.
We report here a case of post-abortal clostridium prefringens infection in which there was severe intravascular hemolysis with black urine, but only minor abnormalities of the clotting mechanism and mild renal failure. The patient recovered following supportive therapy only.
Abortion, Incomplete↗
Role of alpha-toxin in Clostridium perfringens infection determined by using recombinants of C. perfringens and Bacillus subtilis.
Clostridium perfringens type A strains which differed in alpha-toxin (phospholipase C [PLC]) productivity were inoculated intraperitoneally or intravenously into mice, and then their 50% mouse lethal doses (LD50) were determined. Strain NCTC 8237 produced ninefold higher PLC activity than strain 13. The mean LD50 for the former was 1 log unit lower than that for the latter. Two isogenic strains were constructed from strain 13: strain 13(pJIR418 alpha) (pJIR418 alpha contains the plc gene), which produced ninefold higher PLC activity than strain 13; and strain 13 PLC-, which showed no PLC productivity at all because of transformation-mediated gene disruption. The mean LD50 for strain 13(pJIR418 alpha) was 1 log unit lower than those for strain 13 PLC- and strain 13. These results indicate that PLC functions as a virulence-determining factor when it is produced in a sufficient amount. Such a difference in LD50 was also observed between Bacillus subtilis with and without the cloned plc gene. Inoculation of B. subtilis PLC+ intravenously into mice caused marked thrombocytopenia and leukocytosis. Mice inoculated with B. subtilis at 2 LD50 died because of circulatory collapse. Histological examination revealed that intravascular coagulation and vascular congestion occurred most prominently in the lungs. These results suggest that PLC plays a key role in the systemic intoxication of clostridial myonecrosis, probably by affecting the functions of platelets and phagocytes.
Animals↗
Gastrointestinal disorders and the critically ill. Clostridium difficile infection and pseudomembranous colitis.
Clostridium difficile causes a spectrum of diseases ranging from diarrhoea to pseudomembranous colitis, primarily in the hospitalized elderly, although community-acquired infection is probably under-documented. Host factors are increasingly recognized as critical determinants of disease expression. Exposure to antibiotics, particularly those adversely affecting anaerobic gut flora, appears to create a niche which is exploited by C. difficile. Several retrospective and intervention studies have indicated that third-generation cephalosporins have a high propensity to induce C. difficile diarrhoea. Conversely, some broad-spectrum antibiotics, including ureidopenicillins (e.g. piperacillin-tazobactam) and ciprofloxacin, are less likely to induce C. difficile infection. Effective control of C. difficile in the hospital requires both antibiotic control and prevention of environmental seeding and bacterial spread. Epidemic C. difficile strains are widely distributed in the hospital environment, both as a cause and result of nosocomial diarrhoea. Current treatment options are antibiotic-based, which is less than ideal. Although many biotherapeutic approaches have been tried few have shown real benefit.
Clostridioides difficile↗
A novel presentation of Clostridium piliforme infection (Tyzzer's disease) in nude mice.
Clostridium piliforme infection (Tyzzer's disease) was diagnosed in a colony of nude mice. Because spontaneous Tyzzer's disease had not been reported in nude mice, a study was undertaken to better define the clinicopathologic features of this disease outbreak. Sixty homozygous nude (nu/nu) females, 10 nu/nu males, and 10 heterozygous nude (nu/+) females were observed for signs of disease. Over a 3-month period, 43% of the nu/nu mice died or manifested clinical signs of disease and were euthanized, but nu/+ mice remained healthy. Clinical signs of disease were infrequently observed in nu/nu mice and, when evident, were followed by rapid deterioration and death. Gross and histologic lesions, including severe hepatic and intestinal necrosis associated with C. piliforme, were observed only in clinically affected animals. Clostridium piliforme isolated from diseased livers had marked cytotoxicity in in vitro assays. This outbreak is unique in that, contrary to a previous experimental report, nu/nu mice had increased susceptibility to Tyzzer's disease, suggesting that T cells may play an important role in host defenses against C. piliforme infection. In addition, this is the first report of a toxigenic isolate of C. piliforme recovered from mice. The cytotoxin produced by the isolate may have contributed to the severity of clinical disease and lesions.
Animals↗
Clostridium septicum infection and hemolytic uremic syndrome.
Five cases of Clostridium septicum infection secondary to Escherichia coli O157-induced hemolytic uremic syndrome have been reported. We report on three cases (one of which is included in the above five) of dual Cl. septicum and E. coil infection; all three patients were exposed to farm animals. A common zoonotic source for Cl. septicum and E. coli O157 infections should be considered. Patients with hemolytic uremic syndrome should be treated aggressively and monitored closely for Cl. septicum superinfection.
Aged↗
Nosocomial acquisition of Clostridium difficile infection.
We studied the acquisition and transmission of Clostridium difficile infection prospectively on a general medical ward by serially culturing rectal-swab specimens from 428 patients admitted over an 11-month period. Immunoblot typing was used to differentiate individual strains of C. difficile. Seven percent of the patients (29) had positive cultures at admission. Eighty-three (21 percent) of the 399 patients with negative cultures acquired C. difficile during their hospitalizations. Of these patients, 52 (63 percent) remained asymptomatic and 31 (37 percent) had diarrhea; none had colitis. Patient-to-patient transmission of C. difficile was evidenced by time-space clustering of incident cases with identical immunoblot types and by significantly more frequent and earlier acquisition of C. difficile among patients exposed to roommates with positive cultures. Of the hospital personnel caring for patients with positive cultures, 59 percent (20) had positive cultures for C. difficile from their hands. The hospital rooms occupied by symptomatic patients (49 percent) as well as those occupied by asymptomatic patients (29 percent) were frequently contaminated. Eighty-two percent of the infected cohort still had positive cultures at hospital discharge, and such patients were significantly more likely to be discharged to a long-term care facility. We conclude that nosocomial C. difficile infection, which was associated with diarrhea in about one third of cases, is frequently transmitted among hospitalized patients and that the organism is often present on the hands of hospital personnel caring for such patients. Effective preventive measures are needed to reduce nosocomial acquisition of C. difficile.
Clostridium↗
Clostridium difficile infection: pathophysiology and diagnosis.
Clostridium difficile is a relatively common enteric pathogen encountered most frequently in association with antibiotic use and as a nosocomial pathogen. Four factors dictate clinical expression: (1) acquisition of the organism from environmental sources or previous colonization; (2) distortion of the competing colonic flora by antibiotics; (3) toxin production; and (4) age-related susceptibility. Characteristics of clinical features include inflammatory diarrhea (cramps, fecal leukocytes, systemic response), endoscopic evidence of colitis or pseudomembranous colitis, and protein-losing enteropathy. The usual diagnostic tests are designed to detect toxin B with a tissue culture assay or toxin A with an enzyme immunoassay.
Clostridioides difficile↗
[Bacteriologic diagnosis of Clostridium perfringens infection].
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Animals↗
Massive hemolysis in Clostridium perfringens infections.
Over a 14-month period at the Cleveland Clinic Foundation, 424 strains of Clostridium were isolated; of these, 52 strains were Clostridium perfringens isolated from 41 patients. Eight strains of C. perfringens were isolated from the blood of six patients; five of these patients had neoplastic disease and three developed massive intravascular hemolysis with rapidly developing shock and death. Clinical details are given on three patients with fatal Clostridium perfringens sepsis, and the nature of presentation and pathophysiologic mechanisms are discussed.
Blood Cell Count↗
Clostridium difficile infection associated with levofloxacin treatment.
Nine cases of Clostridium difficile (CD) infection were observed in the period of six months at a nursing home. Eight of them occurred during or after antibiotic treatment. Levofloxacin was used alone in three cases and in combination with another antibiotic in three other cases. CD infection occurred with other antibiotics in two cases. In one case, CD infection occurred without any antibiotic treatment. It is generally accepted that quinolones rarely cause CD infection. Levofloxacin, a new antibiotic of a quinolone group, appears to be an exception. Considering the endemic level of CD infection and the high mortality and morbidity among elderly residents in the long-term care facilities, CD infection should be considered one of the major adverse effects of antibiotic therapy. Physicians are cautioned to prescribe antibiotics judiciously and to anticipate CD infection during and after antibiotic treatment.
Aged↗
Invasive Clostridium septicum infection in association with colorectal carcinoma.
The association between invasive Clostridium septicum infection and colorectal carcinoma is examined by the presentation of three cases and a review of the literature. In the first two cases the patients presented with nontraumatic metastatic clostridial gas gangrene. In the third case a patient with chemotherapy-induced myelosuppression from concomitant multiple myeloma had a necrotizing transmural infection of the right colon. The apparent portal of entry of Clostridium septicum was an occult carcinoma of the ascending colon. The increasing evidence for a strong link between this organism and some cases of neutropenic enterocolitis is reviewed.
Adenocarcinoma, Mucinous↗
Significance of beta 2-toxigenic clostridium perfringens infections in animals and their predisposing factors--a review.
The novel beta 2-toxin of Clostridium perfringens has recently been described as the cause of enteric diseases in animals. The biological activity of beta 2-toxin is similar to that of the beta1-toxin with a possibly weaker cytotoxic activity. However, the production of beta 2-toxin in vitro is not seen in all beta 2-toxin-gene (cpb2)-positive C. perfringens strains, and to deduce a clinical importance solely from the detection of cpb2 is difficult. Detection of cpb2-positive C. perfringens from various animal species with and without enteric diseases demonstrates the wide distribution of cpb2 in nature, and the presence of cpb2 gene is therefore not considered a risk by itself. Predisposing factors like low trypsin activity in the intestinal tract, antibiotic and/or antiphlogistic treatment or changes in diet can result in the selection of beta 2-toxigenic C. perfringens which may lead to enteritis or enterotoxaemia.
Animals↗
Rarity of toxigenic Clostridium difficile infections after hematopoietic stem cell transplantation: implications for symptomatic management of diarrhea.
Diarrhea is a common complication of high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT). The frequent and prolonged use of multiple antibiotics in this setting can predispose to infection with toxigenic Clostridium difficile and the development of pseudomembranous colitis. Anti-motility agents are usually not administered in this setting until C. difficile infection has been excluded. The objective of this study was to determine the incidence of C. difficile toxin (CDT) positivity at the time of initial diarrhea in HSCT recipients, and to see if the practice of ensuring negative CDT assays prior to initiating symptomatic management of diarrhea needs modification. One hundred and nineteen patients with malignant diseases undergoing autologous or allogeneic HSCT were studied to determine the incidence of diarrhea and CDT positivity with initial diarrhea. One hundred and nine (91%) had diarrhea. Of these, only seven (6%) were CDT+ at the time of initial diarrhea. The median interval between onset of diarrhea and starting symptomatic anti-diarrheal therapy was 1 day. There were no significant differences between the patients with CDT+ diarrhea and the others in terms of timing or severity of diarrhea, number or duration of antibiotic usage, or leukocyte count. The infection resolved in all patients with metronidazole therapy. Our data suggest that the incidence of CDT+ diarrhea is low in HSCT recipients. Concern about C. difficile infection should not delay symptomatic therapy of initial diarrhea in HSCT recipients.
Adolescent↗
Review article: antibiotic-induced Clostridium difficile infection.
The great majority of cases of Clostridium difficile infection are hospital-acquired, and the reported incidence in England and Wales has increased sixfold between 1990 and 1993, with at least 17 patients dying in a recent large nosocomial outbreak. C. difficile infection accounts for an average 3-week increased length of stay in hospital. Acquisition of a toxigenic strain of Clostridium difficile may be followed by asymptomatic carriage, diarrhoea, colitis or pseudomembranous colitis. Antibiotic treatment and older age are major risk factors for the development of symptomatic disease, but less well-defined differences in strain virulence and host susceptibility are also probably important. Accurate data on the relative risks of different antibiotics to induce symptomatic C. difficile infection are scarce, but third-generation cephalosporins are frequently implicated. New kits are becoming available for the laboratory diagnosis of C. difficile infection but many of these lack sensitivity. Oral metronidazole or vancomycin are the main treatment options but avoidance of further antibiotics should also be encouraged where possible. The role of environmental C. difficile spores, which are highly resistant to conventional disinfectants, needs to be defined. Proven strategies for the prevention of C. difficile infection are required, in particular protocols to ensure that cross-infection does not occur.
Anti-Bacterial Agents↗
Risk factors for Clostridium piliforme infection in foals.
OBJECTIVE: To determine risk factors for Clostridium piliforme infection in neonatal foals on a Thoroughbred breeding farm in California. DESIGN: Case-control and retrospective cohort studies. ANIMALS: 322 neonatal Thoroughbred foals either born on the study farm or born elsewhere but traveled to the farm with their dam during the 1998, 1999, and 2000 breeding seasons. PROCEDURE: Mare and foal records from 1998, 1999, and 2000 were examined, using case-control design methods to determine variables associated with increased risk of C. piliforme infection in foals. Important risk factors identified in the case-control study were then reevaluated by use of a retrospective cohort design, using data from all neonatal foals present on the farm during the 3-year study period. RESULTS: Foals born between March 13 and April 13 were 7.2 times as likely to develop C. piliforme infection as were those born at any other time of the foaling season. Foals of nonresident (visiting) mares were 3.4 times as likely to develop disease as were foals born to mares that were permanent residents of the study farm. Foals of mares < 6 years of age were 2.9 times as likely to develop disease as were foals born to older mares. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this research can be used to better understand the epidemiologic factors of C. piliforme infection in horses. High-risk foals can be closely monitored to aid in early diagnosis and treatment, resulting in the best possible clinical outcome for affected individuals.
Animals↗