Polymicrobial septicemia withClostridium difficile in acute diverticulitis

Abstract

A case is reported of a patient without previous gastrointestinal symptoms, who presented with polymicrobial septicemia caused by Escherichia coli, Enterococcus faecalis, Clostridium difficile and Bacteroides vulgatus. Septicemia occurred during acute diverticulitis. A strain of Clostridium difficile, which was of the same serogroup C as the blood culture isolate and also produced toxin, was recovered from the stools, but the pathogenic role of this organism in the gastrointestinal symptomatology was not clearly established. Other reported cases of Clostridium difficile septicemia are also reviewed.

Clostridium difficile ribotype 078 cultured from post-surgical non-healing wound in a patient carrying ribotype 014 in the intestinal tract

“…In a recent review encompassing 59 patients with extra-intestinal C. difficile infection (CDI) (Bedimo and Weinsten 2003), three major forms of clinical manifestation were described: bacteraemia with or without focal infection (Bedimo and Weinsten 2003;Feldman et al 1995;Libby and Bearman 2009;Lee et al 2010;Gerard et al 1989;Hemminger et al 2011;Choi et al 2013), intra-abdominal infection, and extraabdominal abscesses (Bedimo and Weinsten 2003), such as a splenic abscess (Stieglbauer et al 1995;Studemeister et al 1987;Saginur et al 1983) and a brain abscess (Gravisse et al 2003). C. difficile has also been associated with reactive arthritis (Loffler et al 2004;Birnbaum et al 2008;Prati et al 2010), osteomyelitis (Al-Najjar et al 2013;Pron et al 1995;Riley and Karthigasu 1982), and prosthetic shoulder and knee joint infection (Pron et al 1995;Ranganath and Midturi 2013;McCarthy and Stingemore 1999).…”

Rapidly Progressive Necrotizing Fasciitis and Gangrene Due to Clostridium difficile: Case Report

“…Since 1982, extraintestinal infections due to C. difficile have been reported, including splenic abscess, peritonitis, diverticulitis, osteomyelitis, and bacteremia [3,4]. However, to our knowledge there has been no report of C. difficile causing necrotizing fasciitis and gas gangrene.…”

“…C. difficile organisms may be isolated from the intestinal tract of healthy neonates, neutropenic patients with hematologic malignancy [1,2], elderly patients with diarrhea in long-stay units, and hospitalized patients. Very few cases of extraintestinal infection due to C. difficile have been reported in the literature [3,4]. Cases have been reported of necrotizing fasciitis due to infection by Clostridium species, including C. perfringens, C. septicum, C. ramosum, and other species.…”

Clostridium difficile bacteremia: Report of two cases in French hospitals and comprehensive review of the literature

“…Gérard et al characterized a serogroup C strain and McGill et al reported two ribotype 106 strains and one ribotype 001 [36], [47]. Another case report detected a ribotype 106 from bacteremia and breast abscess [48].…”