Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

360 Clostridium Infections

Clostridium Infections................................

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Clostridium spp. are anaerobic, spore-forming, Gram-positive

bacilli that are ubiquitous in nature and found in soil, dust, air and

as part of the normal flora of the intestinal tract and female repro-

ductive tract.

■Common human pathogens include C perfringens, C septicum, C

tertium, C novyi, C difficile, C tetani and C botulinum.

■Frequently recovered from infected sites, but usually as part of a

polymicrobial infection, making it difficult to determine role in caus-

ing disease

■Certain well-defined syndromes have been described (see below).

■Disease follows trauma (open fractures, crush injuries, gunshot

wounds), surgery (especially GI procedures), ingestion of contami-

nated food or occurs spontaneously from endogenous flora.

Signs & Symptoms

■Manifestations depend upon site involved

■Bacteremia: systemic symptoms and sepsis; C perfringens and C

septicum most common isolates; C septicum associated with colon

cancer and neutropenia and causes particularly severe disease with

metastatic infections in up to 25% of patients; up to 50% of blood iso-

lates considered contaminants not associated with infection requir-

ing therapy

■Intra-abdominal infections: usually part of polymicrobial infection

and role unclear

■Gallbladder: significance unclear except in emphysematous chole-

cystitis, a severe form of gallbladder disease seen most commonly in

diabetics; presents with severe RUQ pain and sepsis

■Genital tract: part of polymicrobial infection of tubo-ovarian

abscesses; cause of uterine gas gangrene, a rare complication of abor-

tion/uterine surgery

■Soft tissue infections: crepitant cellulitis presents with edema and

crepitance of the involved area, a foul-smelling discharge and sys-

temic toxicity; myonecrosis (gas gangrene) presents with systemic

toxicity, severe pain at the involved site, and as the disease progresses