Tetanus and other clostridial and anaerobic infections

Abstract

Abstract Recently, cases of clinical tetanus in the UK are more likely to be associated with injecting drug abuse, presumably from a contaminated batch of heroin currently in circulation. Other clostridial species such as Clostridium botulinum and C. histolyticum are also causing infections such as wound botulism and gangrene respectively in this population. Health-care workers should be alerted to intravenous drug-users presenting with neurological symptoms indicative of tetanus or botulism, and be aware that gangrenous injection-site wounds can lead to serious illness and death. C. difficile continues to cause increasing levels of nosocomial antibiotic-associated diarrhoea and colitis in UK hospitals and is a significant drain on health-care resources. It affects mainly the elderly. The Communicable Disease Surveillance Centre recorded more than 28,000 positive tests for C. difficile toxins in stool samples in hospital in-patients in 2002. Other anaerobic infections remain relatively common, affecting soft tissues in the form of abscess or infections of joints and bone from breaches of mucosal surfaces by surgery or accidental trauma to the gastrointestinal, genitourinary ore respiratory tract. Anaerobes also commonly infect superficial ulcers (eg. genital, decubitus, varicose, diabetic). Fusobacterium necrophorum may cause a serious condition known as Lemierre's disease that classically affects previously healthy young adults. The first symptom is a severe sore throat that progresses to septic thrombophlebitis, metastatic lung abscess and septicaemia, which can be fatal if untreated.