ABSTRACT
La bacteriemia por Clostridium sordellii es infrecuente y usualmente se origina a partir de infecciones de etiología generalmente ginecológica y puerperal, con una mortalidad de aproximadamente el 70%. Existen pocas herramientas para el diagnóstico rápido y oportuno, siendo así la experiencia de tratamiento para este germen muy limitada en otros escenarios, lo que probablemente sea la causa de su alta mortalidad. Presentamos una paciente con antecedente de masa abdominal expansiva de larga data, con diagnóstico por histopatología e inmunohistoquimica compatibles con tumor del estroma gastrointestinal (GIST por sus siglas en inglés) y estudios de extensión que confirman compromiso metastásico hepático, en quien se documenta bacteriemia por Clostridium sordellii.
Clostridium sordellii bacteriemia is infrequent and usually comes from infections of gynecological and puerperal etiology, with mortality near 70%. There are few tools for rapid and timely diagnosis. Thus, treatment experience for this pathogen is very limited in other scenarios, which is probably the cause of high mortality rates. We describe a patient with a history of expansive abdominal mass, diagnosed with metastasic Gastrointestinal Stromal Tumor (GIST), with Clostridium sordellii bacteremia.
Subject(s)
Humans , Female , Aged , Bacteremia , Clostridium sordellii , Gastrointestinal Stromal Tumors , Gram-Positive Rods , Sepsis , NeoplasmsABSTRACT
Background & objectives: Clostridium sordellii and its toxins are associated with diseases in animals as well as human. C. sordellii produces two protein toxins (lethal toxin and haemorrhagic toxin). Lethal toxin has gained more importance due its high toxicity. The present study was carried out to develop a sandwich ELISA for detection of lethal toxin of C. sordellii. Methods: The catalytic domain (1.6kb) of lethal toxin of C. sordellii was PCR amplified, cloned into pQE30 UA vector and transformed into Escherichia coli SG 13009. Expression conditions were optimized and the recombinant protein was purified under native condition using Ni-NTA affinity chromatography, confirmed by SDS-PAGE and Western blot. Antibody was generated against the purified recombinant protein using Freund’s complete and incomplete adjuvants (FCA and FIA) in BALB/c mice and rabbit. A sandwich ELISA was optimized for the detection of lethal toxin. Results: The maximum recombinant protein expression was achieved at 0.5 mM IPTG (isopropylthiogalactoside) induction 4.0 h of post-induction. The polyclonal antibody raised in mice and rabbit showed a titre up to 1:512000. The produced antibody was highly sensitive with the detection limit of 0.3 ng/ml of lethal toxin at 1:4000 dilutions of mice (capturing) and rabbit (revealing) antibody. Interpretation & conclusions: An ELISA based detection system was developed for the detection of lethal toxin of C. sordellii. The developed detection system was found to be specific as there was no cross-reactivity with any other clostridial toxins. It will be useful for the detection of lethal toxin of C. sordellii in clinical and environmental samples.
ABSTRACT
A bacterial strain of Clostridium sordellii and another one of Peptostreptococcus tetradius (isolated in a previous study, from the cecum of fattening rabbits) were evaluated as supplements, administered by means of food aspersion on a commercial feed for weaned fattening white New Zealand rabbits. The study was carried out in a rabbit fattening farm with 60% morbidity and 50% mortality due to unspecific diarrheas. Three experimental groups were formed: the first group was fed normal commercial feed, the second commercial feed inoculated with C. sordellii and the third, inoculated with P. tetradius. Daily weight gain, feed consumption and feed efficacy were evaluated during five weeks, and three tests of apparent digestibility were made. In addition, the mortality and the morbidity caused by unspecific diarrheas during the same period were quantified. After the rabbits were euthanized, total and cellulolytic bacteria concentration, pH and ammonium concentration were measured from samples taken from the cecal appendix, thirteenth cecal loop and colon. The results did not show significant difference (P > 0.05) between the treatments for any of the production variables measured. Statistical differences (P < 0.05) were found in pH and ammonium concentration in the cecal appendix between the group with C. sordellii and the other two groups, while in the thirteenth cecal loop differences were found (P < 0.05) in ammonium concentration between the group with P. tetradius and the other two groups. In regard to total bacteria, differences (P < 0.05) were found at the cecal appendix level between the control group and the one that received P. tetradius, and at the colon level between the group that received P. tetradius and the one that received C. sordelli. C. sordellii supplementation was associated with lower diarrheal morbidity (35%), as compared with that observed in the control group (80%), and that of the group receiving the P. tetradius supplement (80%) (P < 0.05).
Se evaluó una cepa bacteriana de Clostridium sordellii y otra de Peptostreptococcus tetradius (aisladas en un trabajo previo, a partir del ciego de conejos en engorda) como complementos, suministrados mediante aspersión en alimento comercial para conejos Nueva Zelanda, blancos, recién destetados y en etapa de engorda. El trabajo se llevó a cabo en un centro de engorda cunícola en el cual se presentaba morbilidad de 60% y mortalidad de 50% a causa de diarreas inespecíficas. Se crearon tres grupos experimentales: al primero se le proporcionó alimento comercial sin inocular, al segundo se le proporcionó alimento comercial adicionado con C. sordellii y al tercero, adicionado con P. tetradius. Se evaluó ganancia diaria de peso, consumo de alimento y eficiencia alimenticia durante cinco semanas, además se realizaron tres ensayos de digestibilidad aparente. Asimismo, se cuantificó la mortalidad y la morbilidad causada por diarreas inespecíficas durante el periodo señalado. Después del sacrificio de los conejos, se midió la concentración de bacterias totales y celulolíticas, pH y amonio en muestras del apéndice cecal, treceava asa cecal y colon. Los resultados no mostraron diferencia significativa (P > 0.05) entre los tratamientos para ninguna de las variables productivas medidas. Se encontraron diferencias estadísticas (P < 0.05) en el pH y la concentración de amonio a nivel del apéndice cecal entre el grupo al que se le suministró C. sordelliiy los dos grupos restantes, mientras que a nivel de la treceava asa cecal se encontraron diferencias (P < 0.05) en la concentración de amonio entre el grupo que recibió P. tetradius y los otros dos grupos. En lo referente a bacterias totales se encontraron diferencias (P < 0.05) a nivel de apéndice cecal entre el grupo testigo y el que recibió P. tetradius, y a nivel de colón distal entre el grupo que recibió C. sordellii y P. tetradius. La administración de C. sordelli estuvo asociada a una morbilidad diarreica más baja (35%) que la observada en el caso del grupo testigo (80%) y del grupo que recibió complemento de P. tetradius (80%) (P < 0.05).
ABSTRACT
Clostridium sordellii is a gram-positive spore forming anaerobic bacillus, rarely encountered in human infection. It produces several exotoxins which contribute to myonecrosis, pulmonary infection, obstetric infection and bacteremia. C. sordellii bacteremia is very rare and has been reported in few patients with malignancy or immunosuppression. To date, there has been no report in Korea. Mortality is high when deep site infection exists regardless of underlying pathology and immune status. In contrast, superficial skin and subcutaneous tissue infection has a favorable prognosis. We present a case of C. sordellii bacteremia in a patient with osteosarcoma. The patient was admitted for the treatment of the infection at the ulcerative osteosarcoma lesions of the leg, and C. sordellii bacteremia was demonstrated. He was successfully treated with intravenous ampicillin/sulbactam for two weeks.
Subject(s)
Humans , Bacillus , Bacteremia , Clostridium sordellii , Clostridium , Exotoxins , Immunosuppression Therapy , Korea , Leg , Mortality , Osteosarcoma , Pathology , Prognosis , Skin , Spores , Subcutaneous Tissue , UlcerABSTRACT
Clostridium sordellii is a gram-positive spore forming anaerobic bacillus, rarely encountered in human infection. It produces several exotoxins which contribute to myonecrosis, pulmonary infection, obstetric infection and bacteremia. C. sordellii bacteremia is very rare and has been reported in few patients with malignancy or immunosuppression. To date, there has been no report in Korea. Mortality is high when deep site infection exists regardless of underlying pathology and immune status. In contrast, superficial skin and subcutaneous tissue infection has a favorable prognosis. We present a case of C. sordellii bacteremia in a patient with osteosarcoma. The patient was admitted for the treatment of the infection at the ulcerative osteosarcoma lesions of the leg, and C. sordellii bacteremia was demonstrated. He was successfully treated with intravenous ampicillin/sulbactam for two weeks.