Clostridium sordellii as a Cause of Constrictive Pericarditis with Pyopericardium and Tamponade

Abstract

Systemic infections caused by Clostridium sordellii are rare. They are usually reported in cases of skin and soft tissue infections and sometimes in cases of toxic shock syndrome involving exotoxins. We report here the first case of Clostridium sordellii infection associated with acute constrictive pericarditis and with pyopericardium and tamponade. CASE REPORTThe patient, an 8-month-old infant, was admitted to a local hospital with a history of about 2 months of fever and an abscess in the right thigh that had developed following hepatitis B vaccination. The abscess was drained, and the pus culture revealed Staphylococcus aureus, for which the patient was given vancomycin intravenously per the antimicrobial susceptibility report. The abscess subsequently healed; however, the patient remained sick, with development of a dry cough and swelling of legs. Echocardiography and chest X-ray results showed a pericardial effusion with an increased cardiothoracic ratio, and the patient was referred to our institute. On admission, the patient was afebrile, with mild pedal edema, tender hepatomegaly, and liver palpable to 4 cm below the costal margin. Routine investigations showed hemoglobin at 12.8 g/dl; total leukocyte count at 14,100/l; differential leukocyte counts of neutrophils at 50, lymphocytes at 46, eosinophils at 3, and monocytes at 1; an erythrocyte sedimentation rate at 5 mm in the first hour; blood urea at 35 mg/dl; serum creatinine at 0.4 mg/dl; serum sodium at 128 mEq/liter; serum potassium at 4.3 mEq/liter; serum aspartate transaminase (SGOT) at 115 U/liter; serum glutamic pyruvic transaminase (SGPT) at 235 U/liter; total bilirubin at 1.8 mg/dl; total protein at 5.1 g/dl; and serum albumin at 2.8 g/dl. The urine output was within normal limits. Central nervous system and respiratory system examinations showed no abnormalities. The patient's heart rate was 128 beats per min. Electrocardiogram showed low-voltage complexes, and echocardiography revealed organized pericardial effusions with features of tamponade. A chest X-ray showed a cardiothoracic ratio of 0.65. A computerized tomography (CT) scan of the chest showed features suggestive of effusive constrictive pericarditis, and a diagnosis of constrictive pericarditis with pyopericardium and tamponade was made. Pigtail drainage of pericardial pus was performed, and the patient was empirically administered intravenous piperacillintazobactam and linezolid. On examination, the pericardial fluid was turbid, with protein at 40 mg/dl; sugar at 45 mg/dl; a total leukocyte count of 2,600/l; and differential leukocyte counts of neutrophils at 90 and lymphocytes at 10. Gram staining on a direct smear showed no organisms, and Ziehl-Neelsen staining showed no acid-fast bacilli. Aerobic cultures of pericardial fluid and blood were sterile; however, pericardial fluid was not sent for anaerobic culture. Meanwhile, the patient had stabilized. A follow-up computerized tomography angiogram showed a localized constriction at the atrioventricular groove, and pericardiectomy wa...

The antibiotic susceptibility pattern of gas gangrene-forming Clostridium spp. clinical isolates from South-Eastern Hungary

“…An outbreak of necrotizing fasciitis caused by C. sordelli was reported among nine black-tar heroin users in California in 2004 with four fatalities [9]. C. sordellii may be associated with tissue inflammatory response, severe hypotension, shock, endometritis, fulminant toxic shock syndrome, arthritis, pericarditis and pleuropneumonia [10][11][12][13][14]. C. septicum has been reported to cause emphysematous aortitis, sepsis with meningitis, colon carcinoma and hematological malignancies [15][16][17] and C. bifermentans was cultured from empyema [18].…”

Haemorrhagic toxin and lethal toxin fromClostridium sordelliistrain vpi9048: molecular characterization and comparative analysis of substrate specificity of the large clostridial glucosylating toxins

“…In the last decade, several fatal toxic shock syndromes in women were reported that occurred postpartum and after spontaneous or abortion induced with RU‐486 (Bitti et al ., ; Rorbye et al ., ; Sinave et al ., ; Fischer et al ., ; Couzin, ; Winikoff, ; Cohen et al ., ; Soper, ; Agrawal and Garg, ). Sporadic but often fatal cases of C. sordellii infections resulting in bacteraemia, probably subsequent to a bacterial entry from the gastrointestinal tract, pleuropneumonia, arthritis, or after trauma or surgery have been reported (Buchman et al ., ; Abdulla and Yee, ; Gredlein et al ., ; Wiebe et al ., ; Matten et al ., ; Meites et al ., ; Chaudhry et al ., ; Smith and Goslin, ). More rarely, C. sordellii infections can occur as small outbreaks (Aronoff et al ., ).…”

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