Intestinal toxemia botulism in two young people, caused by Clostridium butyricum type E.
(9/851)
Two unconnected cases of type E botulism involving a 19-year-old woman and a 9-year-old child are described. The hospital courses of their illness were similar and included initial acute abdominal pain accompanied by progressive neurological impairment. Both patients were suspected of having appendicitis and underwent laparotomy, during which voluminous Meckel's diverticula were resected. Unusual neurotoxigenic Clostridium butyricum strains that produced botulinum-like toxin type E were isolated from the feces of the patients. These isolates were genotypically and phenotypically identical to other neurotoxigenic C. butyricum strains discovered in Italy in 1985-1986. No cytotoxic activity of the strains that might explain the associated gastrointestinal symptoms was demonstrated. The clinical picture of the illness and the persistence of neurotoxigenic clostridia in the feces of these patients suggested a colonization of the large intestine, with in vivo toxin production. The possibility that Meckel's diverticulum may predispose to intestinal toxemia botulism may warrant further investigation. (+info)
Behaviour of Saccharomyces boulardii in recurrent Clostridium difficile disease patients.
(10/851)
BACKGROUND: Despite recent interest in therapeutic microorganisms taken orally, little is known about the pharmacodynamics of these agents in a target population of patients with disease. The present study reports the stool concentrations of Saccharomyces boulardii in a patient population with Clostridium difficile disease (CDD) and correlates stool concentrations with efficacy. METHODS: Patients with recurrent CDD all received a 10-day standard antibiotic regimen together with 28 days of S. boulardii or placebo. Stool samples were collected from patients at various time points and assayed for S. boulardii. RESULTS: The mean concentration of S. boulardii of patients who recurred was 2.5 x 104 CFU/g compared to 1 x 106 CFU/g in patients that did not recur (P=0.02). Patients with low yeast concentrations in their stools (<104/g) recurred more often (14/15, 93%) compared with patients with higher levels (19/35, 54%, P=0.007). Clearance of S. boulardii was rapid; only 4% had positive stools 3 days after stopping dosing. CONCLUSIONS: After chronic dosing of S. boulardii, patients with low stool concentrations had a higher likelihood of recurrence of CDD. Stool concentrations were also lower during periods of diarrhoea. These results show the importance of characterizing the dynamics of a therapeutic microorganism in patients with disease, as kinetic studies in healthy volunteers may not give a true reflection of the disturbed microecology in the disease state. (+info)
Necrotizing soft tissue infections.
(11/851)
Necrotizing soft tissue infections are a group of highly lethal infections that typically occur after trauma or surgery. Many individual infectious entities have been described, but they all have similar pathophysiologies, clinical features, and treatment approaches. The essentials of successful treatment include early diagnosis, aggressive surgical debridement, antibiotics, and supportive intensive treatment unit care. The two commonest pitfalls in management are failure of early diagnosis and inadequate surgical debridement. These life-threatening infections are often mistaken for cellulitis or innocent wound infections, and this is responsible for diagnostic delay. Tissue gas is not a universal finding in necrotizing soft tissue infections. This misconception also contributes to diagnostic errors. Incision and drainage is an inappropriate surgical strategy for necrotizing soft tissue infections; excisional debridement is needed. Hyperbaric oxygen therapy may be useful, but it is not as important as aggressive surgical therapy. Despite advances in antibiotic therapy and intensive treatment unit medicine, the mortality of necrotizing soft tissue infections is still high. This article emphasizes common treatment principles for all of these infections, and reviews some of the more important individual necrotizing soft tissue infectious entities. (+info)
Role of interleukin-6 in determining the course of murine Tyzzer's disease.
(12/851)
Clostridium piliforme is an obligately intracellular bacterium that causes enterohepatic disease in many domestic and laboratory animal species. Susceptibility to infection is known to vary with the host immune status, species and strain, but little is known about specific immune mechanisms that regulate this disease. Subclinical infection was induced in weanling C. piliforme-susceptible DBA/2 or resistant C57BL/6 mice with either a toxic or a non-toxic C. piliforme isolate. Hepatic lesions and bacteria were evident in both mouse strains for 14 days after inoculation with the toxigenic bacterial isolate, but were never demonstrated following inoculation with the non-toxigenic isolate. All mice demonstrated increased interleukin-6 (IL-6) levels that were largely independent of host strain susceptibility to infection or virulence of the bacterial isolate. The severity of C. piliforme-induced hepatic lesions was increased by polyclonal anti-IL-6 treatment in both resistant (DBA/2) and susceptible (C57BL/6) mouse strains. These data indicate that IL-6 is important in mediating the course of murine C. piliforme infections but is not involved in determining host susceptibility to acute infection, nor is it influenced by the virulence of the C. piliforme isolate. (+info)
Occurrence of Clostridium perfringens beta2-toxin amongst animals, determined using genotyping and subtyping PCR assays.
(13/851)
Clostridium perfringens isolates are currently classified into one of five biotypes on the basis of the differential production of alpha-, beta-, epsilon- and iota-toxins. Different biotypes are associated with different diseases of man and animals. In this study a multiple PCR assay was developed to detect the genes encoding these toxins. In addition, detection of the genes encoding the C. perfringens enterotoxin and beta2-toxin allowed subtyping of the bacteria. C. perfringens isolates taken from a variety of animals, including foals, piglets or lambs, were genotyped using this assay. Most of the isolates were found to be genotype A and the gene encoding beta2-toxin [corrected] was present in 50% of the isolates genotyped. A significant association between C. perfringens possessing the beta2-toxin gene and diarrhoea in piglets was identified, suggesting that beta2-toxin may play a key role in the pathogenesis of the disease. (+info)
Polymicrobial septic arthritis due to Clostridium species: case report and review.
(14/851)
Clostridium species are capable of producing several types of infectious processes, many of which have proven to be life-threatening. Septic arthritis caused by Clostridium, however, is not a very frequent finding. Currently, only 37 cases of infectious arthritis due to Clostridium species have been reported. We report a case of septic arthritis in which Clostridium perfringens, Clostridium sordellii, and Clostridium tertium were each isolated from the synovial aspirate. In addition, the 37 previously reported cases are summarized to compare the similarities and differences of the clinical course, treatment, and outcome, in order to help establish guidelines for the proper management of this infectious process. (+info)
Enteritis necroticans (pigbel) in a diabetic child.
(15/851)
BACKGROUND AND METHODS: Enteritis necroticans (pigbel), an often fatal illness characterized by hemorrhagic, inflammatory, or ischemic necrosis of the jejunum, occurs in developing countries but is rare in developed countries, where its occurrence is confined to adults with chronic illnesses. The causative organism of enteritis necroticans is Clostridium perfringens type C, an anaerobic gram-positive bacillus. In December 1998, enteritis necroticans developed in a 12-year-old boy with poorly controlled diabetes mellitus after he consumed pig intestines (chitterlings). He presented with hematemesis, abdominal distention, and severe diabetic ketoacidosis with hypotension. At laparotomy, extensive jejunal necrosis required bowel resection, jejunostomy, and ileostomy. Samples were obtained for histopathological examination. Polymerase-chain-reaction (PCR) assay was performed on paraffin-embedded bowel tissue with primers specific for the cpa and cpb genes, which code for the alpha and beta toxins produced by C. perfringens. RESULTS: Histologic examination of resected bowel tissue showed extensive mucosal necrosis, the formation of pseudomembrane, pneumatosis, and areas of epithelial regeneration that alternated with necrotic segments--findings consistent with a diagnosis of enteritis necroticans. Gram's staining showed large gram-positive bacilli whose features were consistent with those of clostridium species. Through PCR amplification, we detected products of the cpa and cpb genes, which indicated the presence of C. perfringens type C. Assay of ileal tissue obtained during surgery to restore the continuity of the patient's bowel was negative for C. perfringens. CONCLUSIONS: The preparation or consumption of chitterlings by diabetic patients and other chronically ill persons can result in potentially life-threatening infectious complications. (+info)
Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea.
(16/851)
Approximately 15 to 35% of patients with a first episode of Clostridium difficile-associated diarrhea relapse within 2 months. Between 1994 and 1997, strains from 93 hospitalized patients with C. difficile recurrences were fingerprinted by using both serotyping and PCR-ribotyping. The results showed that 48.4% of clinical recurrences were, in fact, reinfections with a different strain of C. difficile. Rates of clinical recurrences could therefore be reduced by implementing strict isolation precautions. (+info)