Fulminant endogenous panophthalmitis caused by Clostridium septicum infection / Panoftalmite endógena fulminante por infecção por Clostridium septicum

ABSTRACT We report an unusual case of fulminant endogenous Clostridium septicum panophthalmitis. A 74-year-old male patient presented with sudden amaurosis in the right eye, which in a few hours, evolved into an orbital cellulitis, endophthalmitis, anterior segment ischemia, and secondary perforation of the eye. A complete diagnostic study, which included cranial and orbital contrast-enhanced computed tomography scan, contrast-enhanced magnetic resonance imaging, blood cultures, and complete blood work, were performed. No causal agent was identified. Clostridium septicum infection caused fulminant gaseous panophthalmitis. Despite broad-spectrum antibiotic treatment, evisceration of the eyeball was necessary. The extension study showed a colon adenocarcinoma as the origin of the infection. Clostridium septicum panophthalmitis is a rare but aggressive orbital infection. This infection warrants the identification of a neoplastic process in the gastrointestinal tract in many cases not previously described.

RESUMO Este é o relato de um caso incomum de panoftalmite endógena fulminante por Clostridium septicum. Um paciente do sexo masculino, 74 anos, apresentou amaurose súbita no olho direito, que em poucas horas evoluiu para celulite orbitária, endoftalmite, isquemia do segmento anterior e perfuração secundária do olho. Foi realizado um estudo diagnóstico completo, que incluiu uma tomografia computadorizada com contraste cranial e orbital, um exame de ressonância magnética, hemocultura e hemograma completo. Nenhum agente causal foi identificado. A infecção por Clostridium septicum causou uma panoftalmite gasosa fulminante. Apesar do tratamento com antibióticos de amplo espectro, foi necessário eviscerar o globo ocular. O estudo de seguimento mostrou um adenocarcinoma de cólon como a origem da infecção. A panoftalmite por Clostridium septicum é um tipo raro, mas muito agressivo de infecção orbitária. Essa infecção deve sugerir a busca por um processo neoplásico no trato gastrointestinal, em muitos casos não diagnosticado anteriormente.

Perforación colónica y sepsis fulminante asociada a Clostridium septicum como presentación de un cáncer de colon / Colonic perforation and sepsis associated with Clostridium septicum as clinical presentation of colon cancer

Resumen La asociación entre algunas infecciones bacterianas y cáncer de colon está bien documentada. La más descrita es la infección por Streptococcus bovis. Otra bacteria relacionada a neoplasias intestinales es Clostridium septicum. Presentamos el caso clínico de un varón de 62 años que consultó por dolor abdominal, diarrea y fiebre. Se realizó una tomografía computada de abdomen y pelvis que evidenció un engrosamiento de las paredes del ciego con una aparente solución de continuidad en su borde libre. En una laparotomía exploradora se confirmó la presencia de peritonitis y perforación cecal, siendo sometido a una hemicolectomía derecha e ileostomía terminal. El estudio histopatológico reveló la presencia de un adenocarcinoma de tipo células en anillo de sello asociado a isquemia. Los hemocultivos fueron positivos a C. septicum. El paciente falleció por una sepsis fulminante.

Abstract The association between some bacterial infections and colon cancer is well documented. The most described is Streptococcus bovis infection. Another bacteria related to intestinal neoplasms is Clostridium septicum. We present the case of a 62-year-old man who consulted for abdominal pain associated with diarrhea and fever. A computed tomography scan of the abdomen and pelvis was performed, which revealed thickening of the cecum walls with an apparent break in continuity at its free edge. An exploratory laparotomy was performed which confirmed the presence of peritonitis and cecal perforation. A right hemicolectomy and terminal ileostomy were performed. The histopathological study revealed the presence of signet ring cell type adenocarcinoma associated with ischemia. The blood cultures results demonstrated the presence of C. septicum. The patient died due to fulminant sepsis.

Fascitis necrosante clostridial asociada a neoplasia colónica perforada: importancia de un diagnóstico precoz / Necrotizing fasciitis following colon neoplasm perforation: the clue of an early detection

Introducción: La gangrena espontánea por Clostridium septicum es una entidad poco frecuente con una alta mortalidad que se asocia a pacientes neoplásicos y/o inmunodeprimidos. Caso clínico: Presentamos un caso de gangrena clostridial en un paciente con neoplasia de colon ascendente perforada a retroperitoneo. Discusión-conclusiones: Aunque es poco común deberemos pensar en una infección clostridial en pacientes sépticos y sospecha de neoplasia colónica. En ausencia de diagnóstico y tratamiento precoz, el pronóstico es fatal.

Introduction: Spontaneous gangrene due to Clostridium septicum is a low frequency pathology with a high mortality rate. It is related to neoplasic and/or immunodeficient patients. Case report: We present the case of a patient who presented clostridial gangrene associated with a perforated colon neoplasm. Discussion-conclusions: Although it is not very common it must supposed a clostridial infection in septic patients with colon neoplasm suspect. If diagnosis and treatment are delayed the prognostic of the patient is fatal.

[Production of Braxy vaccine by fermenter and enriched culture media]

Braxy vaccine, a culture of a suitable strain or strains of Clostridium septicum in a fluid medium, its filtrate or derivatives, will be inactivated so that it produces its immunogenic activity without toxicity. Production of C. septicum vaccine [Braxy vaccine] using enriched culture media in fermenter. Conventional and enriched culture media were used for growing C. septicum [CN913] vaccinal strain in both 10 liter glass bottle and fermenter, in a triplicate manner. All twelve experiments were inspected to ensure compliance with the requirements of the vaccine international standards for minimum lethal dose [MLD], sterility, freedom of abnormal toxicity, safety and potency tests. Results showed that the culture of C. septicum in fermenter using enriched culture media is the best. Based on international standards, 2.5IU/mL was determined for C. septicum alpha toxin potency test, but in this study 4IU/mL was obtained. Using enriched culture media in fermenter is suitable for braxy vaccine production

Mionecrose aguda por Clostridium septicum em equinos / Acute myonecrosis by Clostridium septicum in horses

Descrevem-se dois casos de miosite necrosante causada por Clostridium septicum em equinos. Os dois equinos apresentavam aumento de volume no membro pélvico direito e que se estendia para a região abdominal ventral. Ao corte, essa área era formada por edema sanguinolento e bolhas de gás. Os músculos esqueléticos da região caudal da coxa apresentavam áreas vermelho-escuras, crepitantes, com edema sanguinolento e, ao corte, as áreas mais profundas da musculatura tinham aspecto seco. As principais alterações histopatológicas observadas foram tumefação, vacuolização, necrose hialina e necrose flocular de fibras musculares esqueléticas. Entre as fibras, havia hemorragia, edema e grande quantidade de bacilos com tamanho de 3-6μm. Na coloração de Gram, os bacilos se apresentavam roxos (gram-positivos); quando impregnados pela prata (Warthin-Starry), se mostraram enegrecidos. Nos dois casos, C. septicum foi isolado, em ambiente anaeróbio, do líquido de edema das lesões musculares.

Two cases of acute necrotizing myositis caused by Clostridium septicum in horses are described. Both horses presented swelling of the right pelvic limb extending to the ventral abdominal region. The cut surface of the affected area revealed blood-stained edema and gas bubbles. The skeletal muscles of the caudal region of the thigh of the affect limbs had dark red discolored areas of blood-stained edema and crepitation; the deep musculature was dry. The main histopathological findings were swelling, vacuolation and hyaline and floccular necrosis of skeletal myofibers; in between myofibers there were hemorrhage, edema and large amounts of bacilli. In both cases, C. septicum was isolated from the edema fluid of muscular lesions.

In vitro evaluation of Clostridium septicum alpha toxoid / Avaliação in vitro de toxoide alfa de Clostridium septicum

Aiming to investigate in vitro alternatives, a test for neutralizing antibody detection using cell culture was developed. This test was more sensitive than previous animal models, allowing for detection of substantially lower alpha toxin and anti-alpha toxin titers. Titers observed during in vivo and in vitro seroneutralization had a correlation of 99.12 percent, indicating that cell culture is a viable alternative in the evaluation of vaccine potency, screening of vaccinal seeds, and Clostridium septicum alpha toxin titration.

Padronizou-se um teste para detecção de anticorpos neutralizantes in vitro, em cultura de células. O modelo in vitro mostrou-se mais sensível que os testes com animais, permitindo a detecção de títulos de toxina e antitoxina alfa mais baixos. Os títulos observados na soroneutralização in vivo e in vitro, apresentaram correlação de 99,12 por cento, demonstrando ser a cultura de células uma alternativa viável na avaliação da potência de vacinas, triagem de sementes vacinais e titulação de toxina alfa de Clostridium septicum.

A Case of Aortic Aneurysm Rupture Infected by Clostridium septicum in a Patient with Colon Cancer / 감염과화학요법

Infected aortic aneurysm a life-threatening disease entity. Clostridium septicum is a very rare pathogen of infected aneurysms that carries a high mortality rate and demonstrates a strong association with an derlying colonic or hematologic neoplasm. Herein, we report a case of ruptured aortic aneurysm infected by C. septicum in a patient with colon cancer. This is the first reported case of infected aneurysm caused by C. septicum in Korea. Early diagnosis, appropriate antibiotic therapy, and prompt surgical interventions are required considering the rapid downhill progression of C. septicum-induced infected aneurysm.

A Case of Aortic Aneurysm Rupture Infected by Clostridium septicum in a Patient with Colon Cancer / 감염과화학요법

Infected aortic aneurysm a life-threatening disease entity. Clostridium septicum is a very rare pathogen of infected aneurysms that carries a high mortality rate and demonstrates a strong association with an derlying colonic or hematologic neoplasm. Herein, we report a case of ruptured aortic aneurysm infected by C. septicum in a patient with colon cancer. This is the first reported case of infected aneurysm caused by C. septicum in Korea. Early diagnosis, appropriate antibiotic therapy, and prompt surgical interventions are required considering the rapid downhill progression of C. septicum-induced infected aneurysm.

PCR multiplex para identificação de isolados de Clostridium chauvoei e Clostridium septicum / Multiplex PCR for identification of Clostridium chauvoei and Clostridium septicum

Padronizou-se uma técnica de reação em cadeia da polimerase múltipla (PCR multiplex) para detecção de Clostridium chauvoei e Clostridium septicum em culturas puras. Foram utilizados pares de iniciadores para segmentos específicos dos genes que codificam a flagelina de C. chauvoei e a toxina alfa de C. septicum. Para avaliaçã o da PCR multiplex, foram testados 16 isolados clínicos de C. chauvoei e 15 isolados de C. septicum provenientes de ruminantes, quatro sementes vacinais de cada um desses agentes. Amostras de referência de ambos os microrganismos foram usadas como controle. Para avaliar a especificidade, DNAs genômicos dos seguintes microrganismos foram usados: C. sordellii, C. novyi tipo A, C. novyi tipo B, C. perfringens tipo A, C. haemolyticum, C. botulinum tipo D, Pseudomonas aeruginosa, Staphylococcus aureus, Enterobacter aerogenes, Escherichia coli e Salmonella typhimurium. Todos os isolados e sementes vacinais de C. chauvoei e C. septicum foram detectados pela técnica. Não foram observadas reações cruzadas com as outras espécies de clostrídios, outras espécies bacterianas ou entre C. Chauvoei e C. septicum. As menores concentrações de DNA de C. chauvoei e C. septicum detectadas foram 45pg/µl e 30pg/µl, respectivamente. A PCR multiplex pode ser utilizada para a identificação específica de C. chauvoei e C. septicum em culturas puras.

Multiplex PCR was optimized to detect Clostridium chauvoei and Clostridium septicum in pure cultures. In each reaction, a pair of primers for a specific segment of the flagellin gene of C. chauvoei and a pair of primers for a specific segment of alpha toxin gene of C. septicum were employed. Reference strains of both microorganisms were used as control. The multiplex PCR was evaluated by testing 16 clinical isolates of C. chauvoei from ruminants, 15 clinical isolates of C. septicum from ruminants and, four vaccine strains of each one of these agents. Reference strains of both microorganisms were used as control. To evaluate the specificity, genomic DNA of the following microorganisms was used: C. sordellii, C. novyi type A, C. novyi type B, C. perfringens type A, C. haemolyticum, C. botulinum type D, Pseudomonas aeruginosa, Staphylococcus aureus, Enterobacter aerogenes, Escherichia coli, and Salmonella typhimurium. All the isolates and vaccine strains of C. chauvoei and C. septicum were positive by PCR assay and cross reactions were not observed with the other species of clostridia, the other bacterial species or amongst both investigated agents. The smallest concentrations of DNA detected from C. chauvoei and C. septicum were 45pg/µl and 30pg/µl, respectively. The multiplex PCR was useful for the specific identification of C. chauvoei and C. septicum in pure cultures.

The study on the cloning and expression of alpha toxin gene of clostridium septicum and the immunity of the toxoid / 生物工程学报

In order to amplify alpha toxin gene of Clostridium septicum HeB01 strain, one pair of primers was designed according to the GenBank sequence, and a 1323bp alpha toxin gene fragment was obstained by PCR. Sequence analysis indicated that the homology of the nucleotid sequence of HeB01 strain to those other reference strains was more than 99.5% . The expression plasmid pQE30-alpha was constructed by inserting alpha toxin gene into the prokaryotic expression vector pQE30. The plasmid expressed when the recombinant strain M15(pQE30-alpha) was induced by IPTG. The specific 48 kD protein was detected SDS-PAGE and the immunogenicity of the expressed alpha toxin was confirmed by Western blot and ELISA. The expressed alpha toxin was transformed into alpha toxoid vaccine by adding 0.3% formaldehyde into alpha toxin. The protective immune response was proved after the mice was immunized with alpha toxoid vaccine. The results showed that the recombinanted strain M15 (pQE30-alpha) could be as a candidate of alpha toxoid vaccine to provide protective immune response against clostridium septicum infection.

A Case of Clostridium Septicum Sepsis Associated with Malignancy / 감염

Clostridium septicum is a toxin producing anaerobic, motile, spore-forming, spindle shaped Gram positive rod that may cause devastating systemic illness in patients with neutropenia and underlying hematologic or gastrointestinal malignancy. Clostridium septicum sepsis usually have fulminating clinical courses, and unless the appropriate antibiotics are administered soon after admission, the outcome is fatal. We experienced a case of sepsis due to Clostridium septicum, in a 65-year-old woman with peripheral T-cell lymphoma and diabetes mellitus. She was admitted due to abdominal pain, fever, chilling, nausea, vomiting and watery diarrhea, followed by rapidly progressive course. This patient was not improved by intensive care and continuous antibiotic therapy, expired at the 4th hospital day. Clostridium septicum grew from premortem blood cultures.