Clostridium subterminalesepsis in adult acute lymphoblastic leukemia

Clostridium subterminale septicemia in an immunocompetent patient

“…are the second most common cause of anaerobic bacteremia after Bacteroides spp with C. perfringens being the most commonly isolated species in the blood, followed by C. septicum [2] . To our knowledge, C. subterminale bacteremia has been previously reported only in three immunocompromised adult patients [3] , [4] , [5] .…”

“…The second patient was on chemotherapy for T-cell acute lymphoblastic leukemia and presented with neutropenia, sepsis and hemorrhoidal pain due to ulceration near the anal verge with erythema and induration of the perianal area. C. subterminale was identified in the blood [4] . The third patient had adenocarcinoma of the esophagus with lung and thoracic spine metastases.…”

Clostridium subterminale septicemia in a patient with esophageal cancer

“…Due to his poor prognosis hospice care was offered. After 9 days of intravenous antibiotic therapy, he was discharged to home hospice with oral amoxicillin/clavulanate, and died 1 week after discharge [13] .…”

Anaerobes: not to be forgotten in neutropenic fever

“…The case report by Haussen et al [1] in this issue highlights the serious outcomes that can occur in anaerobic bacterial sepsis in a neutropenic patient. Although Clostridium subterminale is one of hundreds of anaerobic bacteria, this case acts as an important reminder that the spectrum of antimicrobial cover in the treatment of patients with neutropenic fever who remain unstable despite antimicrobial therapy must be broadened to include anaerobic pathogens.…”

“…16S RNA gene sequencing, as demonstrated in the case report by Haussen et al [1], will augment conventional methods to accurately characterize anaerobic pathogens [13], although their use is yet to become standard practice. In summary, anaerobic pathogens, either alone or part of a polymicrobial infection, present a serious clinical problem that requires a high index of suspicion, even if blood cultures are negative.…”