Clostridial Infection Research Articles

Enterotoxaemia in Cheetal and Chausingha

Enterotoxaemia is a common bacterial disease of healthy domestic and wild animals. The clostridial toxaemia usually develops following overeating, particularly after the onset of monsoon. Overeating of green pasture causes atony of rumen and ileum, thus creating an ideal anaerobic environment for the growth of enterotoxaemia causing clostridia. The toxins produced by these organisms in turn are absorbed in the gut and usually proves fatal. This type of toxaemia occurs mostly in peracute form. The animals graze normally during the day time and are found dead the next day. The enterotoxaemia is mainly considered to be a disease complex of sheep but has also been reported in other domestic and wild animals from time to time. Sudden death in Artiodactylids comprising Chausingha (2) and Cheetal (2) was recorded in the Zoological Park of Jaipur. The animals were in sound health and grazed normally and were also stall fed. Green pasture was provided for feeding. In separate instances these wild captive animals were found dead the following morning. There was no complaint of illness and the only sign of any apparent illness was the soiling of back of animal with loose faeces. Postmortem examination was carried out to acertain the cause of sudden death. The incision at midline revealed severe congestion of abdominal visceral organs. There was a marked ballooning of small and large intestines. The stomach was completely filled with green fodder and was severely congested. The intestinal mucosa showed severe congestion and accumulation of clear mucus and gas. No significant amount of semi-digested or digested feed could be detected in intestines. Kidney, liver and spleen were severely congested. Urinary bladder was found empty. The thoracic cavity revealed the presence of a slight pinkish coloured fluid, congestion of lungs and mycardium. The diaphragmatic wall showed congestion perhaps incluced by excessive ruminal pressure. The microscopic examination of gram stained impression smears from different organs failed to reveal the presence of any bacterial agent. The intestinal contents consisting mainly of fluid and some partially digested feed material were collected in sterile glass vials in ice. Five ml. of intestinal contents were centrifuged at 3000 rpm for 30 minutes and the supernatant was subjected to pass through membrane syringe filter to get rid of any bacteria in supernatant. Each filterate was inoculated in two swiss albino mice intravenously (in tail vein) in 0.2ml. amounts. The mice were kept under observation and mortality was recorded within 4-6 hrs. of inoculation. The death in mice was suggestive of the presence of toxin in the intestinal contents. Further identification of the toxin by neutralisation test could not be carried out. The incidences of various types of clostridial infection has been reported in wildlife from time to time. Parihar et al. (1981) reported Clostridium perfringens type D enterotoxaemia in Giraffe. Arora (1987) recorded haemorrhagic enteritis caused by Clostridium perfringes type C in a fawn. Arora also reported enterotoxaemia in Sloth Bears due to type C (Arora, 1981-84) and type D (Arora, 1991). Rao et al. (1988) recorded enterotoxaemia type C in Brown Bear.

Clostridial Infections in Intravenous Drug Users

Outbreaks of systemic infection with clostridial species have previously been noted among intravenous drug users (IDU), but morbidity and mortality are generally limited. An outbreak of unexplained illness and death among IDU, identified in the U.K. in April and continuing into June 2000, appears to be associated with clostridial disease. Hospitalization, death, or …

Clostridial bacteremia in the community hospital.

Anaerobic infections are not commonly studied in the community hospital. The aim of this study was to determine demographic factors, the portals of entry and underlying disorders for clostridial bacteremia and to determine whether appropriate (recommended) treatment is effective. Medical records were reviewed for 42 patients with clostridial bacteremia at 1 Florida, USA, hospital and 4 Dayton, Ohio, USA, hospitals. Fourteen (33.3%) of the patients had clostridial micro-organisms that were isolated in cultures with polymicrobial isolates. Only about half of the patients had fever at the onset of their bacteremia and only slightly more than half had elevated leukocyte counts. The most common portals of entry for the micro-organisms were gastrointestinal (42.9%), unknown (35.7%) and skin (16.7%). The most common underlying disorders were advanced malignancy (31.0%), diabetes mellitus (14.3%), none determined (12.0%) and acute cholecystitis (9.5%). The mortality rate was 23.8%. Timely appropriate treatment was started in only about half of the instances. Appropriate (recommended) treatment did not significantly affect survival (p = 0.469). Clostridial infections and bacteremia exist in the community hospital most commonly in severely ill patients. The fact that clostridia are commonly cultured in blood cultures positive for other bacterial pathogens and that appropriate treatment for clostridia did not affect patient survival, call into question the significance and pathogenicity of clostridial organisms. On the other hand, if clostridial bacteremia was not considered in half these patients with bacteremia, it is possible that more indolent clostridial infections are being overlooked.

Intracranial infection after missile brain wound: 15 war cases.

The present study describes 15 cases of intracranial infections developed in a group of in patients with missile brain wound (MBW), during the war in Croatia in the region of East Slavonia. The retrospective study included 88 MBW casualties. There were 11 females and 77 males aged 2-80 years. The projectile penetration of the cranial dura was confirmed and the presence of intracranially retained foreign bodies was evaluated with computerized tomography (CT) in all the patients. The wounded were treated according to the modern recommendations of neurotrauma care. However, we extracted only accessible bone/metallic fragments during intracranial debridement. All intracranial infections were documented by cultures, CT, surgery or autopsy. The mean follow-up period of wounded with intracranial infections was 2.4 years (range, 10 days to 7 years). Intracranial infection developed in 14 patients (17%) as "early intracranial infections". Among 14/15 cases, infection developed within the first 8 weeks, and in 1 case 5 months after wounding. We recorded 4 cases of isolated bacterial meningitis, whereas in 9 cases brain abscess had developed. In 6 cases brain abscess was associated with concomitant meningitis and epidural empyema. Local cerebritis developed in one case, as well as subdural empyema with the concomitant meningitis in one case. There were 8 deaths in total of 15 cases. Glasgow Outcome Score 3 was observed in 2 and good outcome in 5/15 cases. The infectious organisms were isolated in 8 cases. Gram-positive bacteria were found in 12 different specimens. Gram-negative bacteria were found in 9 specimens. The most frequently isolated organism was Staphylococcus aureus. beta-hemolytic streptococcal and clostridial infections were not observed. Among the 15 patients with intracranial infection, just one did not have intracranially retained bone and/or metallic fragments. However, among the 73 head injuries without intracranial infections only 10 did not have retained fragments. CSF fistula and/or dehiscence developed in 13/15 patients with intracranial infection. In 67/73 wounded without intracranial infections, wound complications were not registered. The liberal use of post-contrast CT of the brain within the first 2 months after injury, especially if performed early in the clinical course, can lead to a prompt diagnosis of most of "early intracranial infections". The surgical procedures in order to prevent wound CSF fistula/dehiscence development are absolutely necessary. The immediate scalp and dural wound repair in case of wound complications are absolutely indicated and if needed, the procedures can be repeated. However, it seems that retained fragments are not responsible for an increased rate of intracranial infection.

Presumed clostridial and aerobic bacterial infections of the cornea in two horses

Presumed clostridial and aerobic bacterial infections of the cornea in two horses

Clostridium perfringens: : A rare cause of postoperative spinal surgery meningitis

BACKGROUND Clostridium perfringens is a rare cause of central nervous system infections, particularly meningitis. The case of a 76-year-old man who developed fatal C. perfringens meningitis after routine decompressive laminectomy for spinal stenosis is described. CASE REPORT Twelve days after surgery the patient presented with pain and serosangiunous drainage from the surgical incision site. A swab of the drainage revealed Gram-positive bacilli; MRI of the lumbosacral spine showed the appearance of air around the laminectomy site. The patient died within 6 hours of presentation. Autopsy revealed acute cranial and spinal meningitis and choroid plexitis with organisms consistent with C. perfringens. CONCLUSION No significant enteral pathology or source of endogenous infection was determined, suggesting postoperative wound contamination and meningeal seeding with this ubiquitous organism. Clostridial infection, although rare, should be considered in any patient with meningitis with a history of surgical intervention. Survival with minimal neurological deficits was achieved in half of the previously reported cases.

Antibody responses to clostridial infection in humans.

Serum antibody responses to the major toxins produced by Clostridium difficile, Clostridium perfringens, Clostridium septicum, Clostridium tetani, and Clostridium botulinum have been documented following infection. Effective toxoid vaccines for tetanus and enteritis necroticans due to C. perfringens type C demonstrate the potential of antitoxin responses. Although individual serum and mucosal antibody responses to C. difficile enterotoxin (toxin A) vary, one-third of patients with C. difficile diarrhea develop neutralizing serum antibodies. IgA in the serum, not IgG, is typically responsible for this neutralization, suggesting a unique role for serum IgA in response to C. difficile infection, an infection that is usually limited to the intestinal mucosa. The relationship of naturally occurring antitoxin antibodies to the clinical course of C. difficile infection is controversial. However, patients with chronic relapsing C. difficile diarrhea and low levels of IgG to toxin A have shown clinical responses following intravenous therapy with immune globulin. Antibody responses to non-toxin C. difficile proteins also occur, but their significance is only partially known.

Detection of Clostridium chauvoei in formalin-fixed, paraffin-embedded tissues of sheep by the peroxidase-antiperoxidase (PAP) technique.

A peroxidase-antiperoxidase (PAP) technique was used to detect Clostridium chauvoei in tissue sections from sheep inoculated intramuscularly with a pure culture of this microorganism. Samples of various tissues were taken for bacteriology, histopathology and immunohistochemistry. A primary antiserum against C. chauvoei for use in the PAP technique was produced in rabbits. Formalin-fixed, paraffin-embedded sections of muscle samples were positively and specifically stained by the PAP technique. The results were consistent with those obtained by bacteriology, but the PAP test was simpler, quicker and less expensive than the bacteriological procedures. The use of the PAP technique would be appropriate for detecting clostridial infections without the constraints of conventional identification methods, especially where laboratory conditions for anaerobic procedures are not readily available.

Clostridial disease of the gut.

Clostridia are an important cause of morbidity and mortality in humans and animals. Some of the most common clostridial infections are those of the gut. The primary infections in humans are Clostridium perfringens food poisoning and Clostridium difficile-mediated antibiotic-associated diarrhea and colitis. Less common but important infections include non-food poisoning C. perfringens nosocomial diarrhea and C. perfringens type C necrotizing jejunitis (pig-bel). C. perfringens is also the dominant cause of gastrointestinal infections in animals, although Clostridium septicum causing braxy in sheep, Clostridium colinum causing ulcerative enteritis is avian species, and Clostridium spiroforme causing enterotoxemia in rabbits are important exceptions.

Clostridial infection in children.

A survey of the isolation of Clostridium spp. from 1543 specimens sent to anaerobic microbiology laboratories revealed 113 isolates from 107 specimens (7.0% of all specimens) from 96 children. The isolates comprised 43 (38%) unidentified Clostridium spp., 37 (33%) C. perfringens, 13 (12%) C. ramosum, five (4%) C. innocuum, six (5%) C. botulinum, three (3%) C. difficile, two (2%) C. butyricum, and one isolate each of C. bifermentans, C. clostridiiforme, C. limosum and C. paraputrificum. Most clostridial isolates were from abscesses (38), peritonitis (26), bacteraemia (10), and chronic otitis media (7). Predisposing or underlying conditions were present in 31 (32%) cases. These were immunodeficiency (12), malignancy (9), diabetes (7), trauma (7), presence of a foreign body (6) and previous surgery (6). The clostridia were the only bacterial isolates in 14 (15%) cases; 82 (85%) cases had mixed infection. The species most commonly isolated with clostridia were anaerobic cocci (57); Bacteroides spp. (B. fragilis group) (50), Escherichia coli (22), pigmented Prevotella or Porphyromonas spp. (18) and Fusobacterium spp. (10). Most Bacteroides and Escherichia coli isolates with clostridia were from abdominal infections and skin and soft tissue infections adjacent to the rectal area; most pigmented Prevotella and Porphyromonas isolates were from oropharyngeal, pulmonary, and head and neck sites. Antimicrobial therapy was given to all patients, in conjunction with surgical drainage in 34 (35%). Only two patients died. These data illustrate the importance of Clostridium spp. in paediatric infections.

Clostridial Aortic Graft Infection

Aortic graft infection represents one of the most formidable challenges encountered by the vascular surgeon. Current principles of treatment are based on experience primarily derived from infection with Staphylococcus and enteric bacteria. Anaerobic prosthetic infection is a case event. Infection with Clostridium has heretofore been reported only twice. An additional case of clostridial infection of an aortic prosthesis is presented with review of the literature. Its clinical significance and management are discussed.

Clostridium bifermentans Panophthalmitis after Penetrating Eye Injury

Intraocular and orbital anaerobic infections usually result from penetrating eye injuries with soil-contaminated foreign bodies. The outcome of these infections almost always has been loss of the globe, despite appropriate antibiotic and surgical treatment. The most prevalent etiologic microbe of anaerobic panophthalmitis is Clostridium perfringens. To the authors' knowledge, this is the first report of panophthalmitis caused by Clostridium bifermentans after penetrating eye injury. The patient had severe signs and symptoms of intraocular and orbital infection, with early total loss of visual function. Parenteral and intravitreal therapy with penicillin and clindamycin, administered according to antibiotic sensitivity studies of cultures from the anterior chamber and vitreous, did not restore vision. Due to the early devastating outcome, penetrating eye injuries with soil-contaminated foreign bodies should be regarded as being at high risk for clostridial infection and should be treated promptly with vitrectomy and antibiotic therapy for aerobic and anaerobic infection.

A multicenter review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy

To examine the effectiveness of hyperbaric oxygen (HBO) therapy in the treatment of major truncal necrotizing infections, a retrospective (1980 to 1992) analysis of the medical records of 30 patients treated with HBO therapy and 24 patients treated without HBO therapy was undertaken. The two groups were similar; however, there was a selection bias towards more frequent clostridial infections in a younger population in the HBO group. There was no difference in length of hospital stay, intensive care unit (ICU) stay, or duration of antibiotic therapy between groups. The mortality rates were 9 30 (30%) in the HBO group versus 10 24 (42%) (nonsignificant difference) in the non-HBO group. The total number of operations was greater in the HBO-treated group. This study failed to show that the use of HBO in the treatment of major truncal necrotizing infections statistically reduced mortality or the number of débridements. We believe, however, that the apparent selection bias and the trend towards increased survival in the HBO-treated group (12%) justifies the continued use of and research with HBO therapy.

Clostridial Bacteremia: Patterns of Infection

The records of 122 consecutive patients who, after admission to the Brigham and Women's Hospital over a period of 9 years, were found to have clostridial bacteremia, were studied. Clostridium perfringens organisms were recovered in 63% of the cases; Clostridium septicum, Clostridium innocuum, Clostridium rectum, Clostridium bifermentans, or Clostridium sordellii organisms were each isolated from five or more cultures of the blood. The overall fatality rate was 29%. Three groups of patients were identified. There were 37 patients in whom the clostridial bacteremia was self-limited and resolved without appropriate antibiotics. In 12 of these patients, the clostridium isolated was possibly a contaminant, whereas in 25 others, the clostridial bacteremia was presumably transient. Overall, blood samples from 30 of these 37 patients grew C. perfringens in culture. A second group included 35 patients with severe and well-documented clostridial infection. In this group, malignant lesions were present in 62.9%, diseases of the biliary tract were the underlying disorder in 14.3%, and the fatality rate was 65.7%. Immunosuppressed patients were infected most often by non-perfringens species of Clostridium. The third group was composed of those patients with less severe infections, possibly mediated by the effects of appropriate antibiotic treatment.

Clostridial brain abscesses.

Ten patients with clostridial abscesses of the brain are presented. Despite the presence of gas within the cerebral hemispheres and Clostridium welchii cultured from the pus obtained, the outcome of all patients managed with burrhole aspiration of the abscess was good. There were no deaths and eight of the ten patients had no residual deficit. Clostridial infections of the brain, unlike those of the soft tissues of the body, have a good outcome with conservative surgery and appropriate antibiotics.

The differential diagnosis of clostridial soft tissue infections

The prefrontal cortex (PFC) is intimately associated with behavioral characteristics of alcohol use disorders, including high motivation to drink and difficulty with moderation. Thus, continued mechanistic research investigating PFC cells and targets altered by ethanol experiences should inform translational efforts to craft new, efficacious treatments. Inhibitory interneurons expressing parvalbumin (PV-INs) comprise only a minor fraction of cells within the PFC, yet these cells are indispensable for coordinating PFC ensemble function, oscillatory activity, and subcortical output. Based on this, PV-INs represent an exciting target for the rational design of breakthrough treatments for alcohol use disorders. Here, we assessed experience-dependent physiological adaptations via ethanol place conditioning. By manipulating the timing of administration relative to conditioning sessions, equivalent ethanol exposure can form either rewarding or aversive memories in different individuals. Here, we found that female mice and male mice on a C57BL/6J background display conditioned place preference (CPP) or aversion (CPA) to an intoxicating dose of ethanol (2 g/kg, intraperitoneal [i.p.]) without overt differences between sexes. Ethanol reward learning was associated with decreased PV-IN excitability in deep layer prelimbic PFC, whereas PV-INs from CPA mice were not different from controls. Furthermore, PV-INs from mice in the CPP group, but not the CPA group, displayed potentiated excitatory synaptic strength that emerged during 1 week of abstinence. Taken together, these findings illustrate that synaptic and intrinsic adaptations associated with ethanol can depend on an individual's experience. These studies provide further context and support for PFC PV-INs as intriguing targets for modulating alcohol associations.

Role of theta toxin, a sulfhydryl-activated cytolysin, in the pathogenesis of clostridial gas gangrene.

Clostridial infections cause a wide variety of dramatic infections and intoxications. In each case the major virulence factors are extracellular toxins. Clostridium perfringens produces potent exotoxins, which are its major virulence factors. theta Toxin, a thiol-activated cytolysin, causes the clear zone of hemolysis around colonies on blood-agar plates, suppresses myocardial contractility ex vivo, and induces shock within 1 to 2 hours in vivo. Low concentrations of theta toxin induce priming and degranulation of polymorphonuclear leukocytes (PMNs) and functional up-regulation of PMN-dependent adherence molecules such as the integrin CD11/CD18, whereas higher concentrations are cytotoxic. Similarly, theta toxin causes concentration- and time-dependent induction of endothelial cell synthesis of platelet-activating factor, a potent proinflammatory lipid autocoid that mediates endothelial cell-dependent adherence of PMNs. These data suggest that theta toxin in high concentrations is a potent cytolysin and promotes direct vascular injury at the site of infection. At lower concentrations theta toxin activates PMNs and endothelial cells, and in so doing promotes vascular injury distally by activating adherence mechanisms. The rapid tissue necrosis associated with C. perfringens infection may be related to progressive vascular compromise orchestrated by dysregulated host-cell responses induced by theta toxin.

High tension electrical burns

In this study, 85 patients with high-tension electrical burns who were seen in an 11 year period were reviewed. Only victims with documented passage of high-tension electrical current (more than 1000 volts) through the body were included. A total of 210 operations were performed for exploration, debridement and closures of the injuries; 44 cases underwent a total of 65 amputations. Acute renal failure developed in two cases (2.3%) and both died. No cases of clostridial infection occurred. Four patients (4.7%) died in this series. We came to the conclusion that the primary treatment of these burns must include aggressive fluid resuscitation and early aggressive debridement.

Causes of lamb morbidity and mortality in the Ethiopian highlands.

A study was conducted to investigate causes of lamb morbidity and mortality on farms and on-station at Debre Berhan during 1989 and 1990. It showed pneumonia (bacterial and/or verminous), starvation-mismothering exposure (SME) complex, gastrointestinal parasites, enteritis, abomasal impaction and physical injuries to be important health constraints on productivity. Neonatal mortalities were 51.5% and 46.3% on farms and on-station respectively and occurred owing to management problems such as SME, abomasal impaction and physical injuries. On the farms the lamb birth weight was 2.56 +/- 0.25 kg and was significantly (p < 0.05) affected by the dam's age, lambing weight, litter size, sex of lamb and year of lambing, but not by the season of lambing. Birth weight significantly (p < 0.05) influenced lamb mortality. Lambs with a low birth weight tended to die from SME. Morbidities and mortalities due to infectious causes increased in older lambs, suggesting that infections were acquired with age when resistance was lowered owing to inadequate nutrition and poor management. Heavy loss of lambs could be overcome by such health management interventions as foster mothering, warming lambs during the cold season and vaccination with polyvalent vaccines against pasteurellosis, clostridial infection and Dictyocaulus filaria.

Clostridial infections encountered in an aeromedical retrieval service

ABSTRACTThis paper describes four patients with clostridial wound infections recently treated by the Life Saver Rescue Service. A review of the current literature on tetanus and gas gangrene is presented.