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PubMed2002

[Aerobilia: a rare consequence of anaerobic acute cholecystitis: a case report].

Acute acalculous cholecystitis is rare in non critically ill or postoperative patients. We report a case of acute acalculous cholecystitis with secondary bile infection with Clostridium perfringens. Ultrasound and tomodensitometry revealed diffuse aerobilia. The germ in this case report is atypical and contrasts with the very discrete clinical findings. Aerobilia, secondary to the development of bacteria in the biliary tract falsely suggested a bilio-digestive fistula. Treatment included a simple cholecystectomy associated with 7 days of antibiotherapy.

Acute Disease↗
PubMed1992

[Specific immunity in patients with inflammatory diseases of the abdominal cavity].

In most patients with pyoinflammatory diseases of the abdominal cavity caused by Cl. perfringens microbial associations accumulation of agglutinins occurred during the disease. In purulent abdominal processes caused by Cl. perfringens microbial associations a connection exists between the increased antibody level and wound suppuration. The rise of the antibody level was most marked, whatever the character of the bacterial associations, in patients with generalized peritonitis, abdominal abscess, and in young patients (10-40 years of age) and least in those with phlegmonous cholecystitis and in elderly patients (61-70 years of age). Patients with destructive forms of appendicitis and individuals aged 41-60 took an intermediate position according to these values. Antibody production was weaker in patients with 5 species in the microbial association than in monoinfection. A agglutinin titer in the blood of patients beginning with 1:80 and higher should be considered diagnostic.

Abdomen↗
PubMed1977

The in vitro and in vivo activity of taurolin against anaerobic pathogenic organisms.

An antibacterial agent, taurolin, formed by the combination of 2 molecules of taurine with 3 molecules of formaldehyde has been tested against anaerobes in vitro and in vivo. In vitro, taurolin is highly active against Bacteroides species and anaerobic Streptococci as measured by the minimum inhibitory concentration. In vivo, small dosages of taurolin given intraperitoneally increase the mortality in mice with Bacteroides peritonitis. However, by increasing the dosage of taurolin, survival is prolonged and mortality reduced. Intravenously administered taurolin protects rabbits from the effects of Bacteroides fragilis infection whether the organisms are given intravenously or intraperitoneally.

Animals↗
PubMed1980

[Interest in gnotoxenic systems for the study of host-microbial flora of the digestive tract].

It is necessary to use experimental models in all studies of interactions between a host, its digestive tract microbial flora and the environment because these interactions are complex. The gnotoxenic animal, reared in an isolator as the axenic animal and harbouring a known microbial flora, constitutes either an analytic or mimetic experimental model. The gnotoxenic animal may be considered as an analytic model when used to determine which biotic or abiotic environmental factor of the host-animal plays a role in the intestinal ecosystem. The potential metabolic or immunologic role of a given bacterial strain in the intestinal ecosystem may be determined when the axenic animal is associated with this strain. The variation of the expression of the potential role of this strain in relation to the environment can be ascertained by diversifying the diet of the host or by introducing other bacterial strains into the intestinal ecosystem. The role of an association of strains in host physiology and host protection against potentially pathogenic target strains can also be studied using this analytic model. An analytic model is created by associating either isolated strains of the holoxenic or heated or diluted suspensions of holoxenic digestive tract flora. Axenic mice associated with these simplified flora are called meroxenic. The gnotoxenic animal is considered to be a mimetic model when it harbours a microbial flora isolated from an animal of a different species. The advantage of the mimetic model is that it provides an easy-to-use biological tool, i.e. gnotoxenic mice, to first determine the potential role of these microbial strains. The validity of the mimetic model is then tested by comparing gnotoxenic mice and gnotoxenic piglets or chickens. When all the gnotoxenic animals are given the same diet, this comparison permits an estimation of the animal-host role in the expression of the potential activities of microbial strains. The mimetic model, composed of gnotoxenic animals harbouring microbial strains of human origin, is the only experimental model which can be used to study the role of microorganisms in the intestinal ecosystem of man.

Animals↗
PubMed2004

Diagnosis of Clostridium perfringens intestinal infections in sheep and goats.

Clostridium perfringens produces disease in sheep, goats and other animal species, most of which are generically called enterotoxemias. This micro-organism can be a normal inhabitant of the intestine of most animal species including humans, but when the intestinal environment is altered by sudden changes in diet or other factors, C. perfringens proliferates in large numbers and produces several potent toxins that are absorbed into the general circulation or act locally with usually devastating effects on the host. History, clinical signs and gross post-mortem findings are useful tools for establishing a presumptive diagnosis of enterotoxaemia by C. perfringens in sheep and goats, although no definitive diagnosis of these diseases can be made without laboratory confirmation. Because all types of C. perfringens can be normal inhabitants of the intestine of most animals, culture of this micro-organism from intestinal contents of animals has no diagnostic value unless a colony count is performed and large numbers (usually more than 10(4)-10(7)CFU/g) of C. perfringens are found. The most accepted criterion in establishing a definitive diagnosis of enterotoxaemia by C. perfringens is the detection of its toxins in intestinal contents. However, some of the major toxins of C. perfringens (i.e. epsilon toxin) can also be found, albeit in small amounts, in the small intestine of clinically normal sheep, and this poses a diagnostic challenge. In such cases the histopathology of the brain must be used as an alternative diagnostic tool, since the lesions produced by epsilon toxin in the brains of sheep and goats are unique and pathognomonic for C. perfringens type D enterotoxaemia. Ancillary tests, such as measurement of urine glucose or observation of Gram stained smears of intestinal mucosa can be used and, although they have a presumptive diagnostic value when positive, they cannot be used to rule out a diagnosis of enterotoxaemia if they are negative. In conclusion, the diagnosis of C. perfringens infections in animals is complex and it is appropriate to rely on a combination of diagnostic techniques rather than one singe test.

Journal Article↗
PubMed2002

Liver abscess after non-operative management of blunt liver injury.

BACKGROUND: The non-operative management of blunt liver trauma can be applied in almost 80% of patients with this type of injury, with the advantages of the need for fewer blood transfusions, less intra-abdominal sepsis, and a better survival rate, than with the operative approach. However, liver abscess, as a known complication of the non-operative management of blunt liver trauma, is discussed infrequently. Therefore, we herein review our experience and describe this complication in detail. MATERIALS AND METHODS: From 1995 to 2001, 674 patients were admitted to our hospital due to blunt hepatic trauma. Among these patients, 279 underwent laparotomy and the remaining 395 patients were treated non-operatively. Twenty-two patients were identified as having liver abscess, with 16 of them belonging to the operative group, and six to the non-operative group. A retrospective review of these six patients and their characteristics, as well as pathogenesis, diagnosis, and the management of the liver abscesses, was conducted. RESULTS: These six patients were all male, with a median age of 19.5 years (range 3-24). The median injury severity score was 16.5 (range 9-25); three patients sustained grade-3 hepatic injury, and the other three were grade 4. The main diagnostic tool was abdominal computed tomography, and the abscesses took a median of 6 days (range 1-12) to form and be diagnosed. The abscesses were usually caused by infection from mixed organisms, and an abscess resulting from Clostridium infection developed within 1 day after injury. These abscesses were treated with antibiotics and drainage, and the median length of hospital stay was 26 days (range 8-44), without mortality or long-term morbidity. CONCLUSION: Liver abscess as a complication of the non-operative management of blunt hepatic trauma is a rare entity, with an incidence of 1.5% (6/395). It is usually seen in severe liver injury (grade 3 and above), but all our patients were all treated successfully, with no mortality. However, prolonged hospitalization may be required in this patient group.

Abdominal Injuries↗
PubMed2001

Acute necrotizing bacterial tonsillitis with Clostridium perfringens.

Bacterial infection with Clostridium perfringens in children less than 2 years of age is frequently associated with meningitis, necrotizing gastrointestinal infection, and postoperative infections. However, a review of the literature reveals no reports of these bacteria infecting the tonsils. A 9-month old black female was found unresponsive at the baby-sitter's and was rushed to the hospital. Shortly after admission to the emergency department death was pronounced. An autopsy performed on this otherwise healthy infant revealed shock and acute necrotizing bacterial tonsillitis. The initial report of this infant's death was questionable sudden infant death syndrome and questionable smothering. Postmortem cerebrospinal fluid, blood, and lung cultures grew pure colonies of C. perfringens. The necrotizing tonsil revealed no significant gross lesions. Microscopically, large numbers of gram-positive rods were easily recognized and were compatible with C. perfringens. Because the oropharynx is a common portal of entry for infectious agents, it is essential to sample tissues of Waldeyer's ring and especially the tonsils to find infectious diseases that may become systemic.

Acute Disease↗
PubMed1968

Clostridium perfringens type A infection of ligated intestinal loops in lambs.

Clostridium perfringens type A suspended in fresh medium was injected into ligated intestinal loops of lambs. Within 7 hr after inoculation, the fluid volume of the loops increased up to seven times. No significant accumulation of fluid occurred in loops receiving grown culture, culture supernatant fluid, or medium alone. alpha-Antitoxin injected along with C. perfringens in fresh medium into intestinal loops did not prevent the accumulation of fluid. It is concluded that alpha-toxin plays no major role in C. perfringens type A enteritis.

Animals↗
PubMed1975

Isolation of Clostridium in human infections: evaluation of 114 cases.

One hundred fifty-two strains of Clostridium were isolated from 144 patients over a 14-month-peroid. These included 23 recognized species and 23 strains that were unclassified. Soft tissues or abscesses yielded 84 strains of Clostridium. Intraabdominal sites predominated, but clostridia were recovered from empyema, carcinoma, frostbite with gas gangrene, muscle abscess, aortic graft, and brain abscess. Blood cultures yielded 65 strains of Clostridium from 49 patients, representing 0.3% of 16,314 blood cultures (or 2.6% of 2,168 positive cultures). Clostridium perfringens was most common in blood, accounting for 37 isolates (57%). Clostridial bacteremia was often unrelated to the clinical setting and was found in alcoholics with aspiration or Streptococcus pneumoniae pneumonia, pulmonary tuberculosis, empyema, meningococcemia, and infantile gastroenteritis. In 20 of the 49 patients (41%), aerobic or other anaerobic bacteria were cultured concurrently from the blood. Thus, clostridial bacteremia should be interpreted with caution since there may be little correlation with the patient's clinical condition.

Abscess↗
PubMed1962

Occurrence of Clostridium difficile in infections of man.

Smith, Louis DS. (Montana State College, Bozeman) and Elizabeth O. King. Occurrence of Clostridium difficile in infections of man. J. Bacteriol. 84:65-67. 1962-Eight strains of Clostridium difficile were isolated from cases of infection in man in seven different bacteriological laboratories. One of these was isolated from a case of gas gangrene, one from an abscess following a fractured femur, one from a blood culture from an infant, two from pleural fluid, two from peritoneal fluid, and one from an abscess in the vaginal vault. There was no evidence, in these cases, that C. difficile is pathogenic for man. All strains were typical morphologically and culturally and were lethal when inoculated intramuscularly into guinea pigs.

Animals↗
PubMed2001

Extra-intestinal infections caused by Clostridium difficile.

The objective of this paper was to investigate the incidence of extra-intestinal infections caused by Clostridium difficile. During a 10-year period, the microbiology laboratory of our institution isolated 2034 isolates of C. difficile. Of the 2034 isolates, 21 (1.08%) were obtained from extra-intestinal sources. This represents an incidence of extra-intestinal isolation of four cases per 100 000 admissions. We were able to review the records of 17 patients for our study. The isolates in 12 patients were obtained from structures or fluids anatomically close to the colon and included the following infections: peritonitis in five cases (three primary and two secondary), intra-abdominal abscesses in three patients and abdominal wound infections in four cases. The infections in the other five patients were not in the anatomic vicinity of the colon. They included one case with a brain abscess, two episodes of bacteremia and two cases of foot infections (one chronic osteomyelitis). In all but one case, C. difficile isolation was obtained as part of a polymicrobial flora. The isolates were frequently non-toxigenic and the extra-intestinal infections occurred without concomitant diarrhea or prior anti-microbial therapy. Out of the 17 patients, eight died and nine survived. Death could not be directly attributed to C. difficile in any of the cases. The isolation of C. difficile outside the intestinal tract is very uncommon. Its clinical significance should be interpreted with caution.

Abdominal Abscess↗
PubMed1989

Teicoplanin in the treatment of infections by staphylococci, Clostridium difficile and other gram-positive bacteria.

Eighty-three episodes of Gram-positive infection in 82 patients were treated with teicoplanin in an open study. Infectious episodes included endocarditis (6 cases), bacteraemia (7), osteomyelitis (8), pseudomembranous colitis (13), cellulitis (11), urinary tract infection (5), pneumonia (1), wound and post-surgical infections (9) and erysipelas (23). Four patients affected by an overwhelming Gram-positive infection as well as eight cases of Gram-positive-Gram-negative mixed infections received teicoplanin in combination with other antibiotics. The average duration of treatment was 16 days (range 5-70). In pseudomembranous colitis teicoplanin was given by mouth for ten days. Staphylococcus aureus (11 methicillin-sensitive and 13 methicillin-resistant strains) and Clostridium difficile (13 isolates) were the most frequent pathogens. Overall 89% (74/83) of the infections were cured, 3.6% (3/83) improved and 3.6% (3/83) failed. Relapse and superinfection were observed in 2.4% (2/83) and 1.2% (1/83) episodes respectively. All pseudomembranous colitis cases were clinically cured and C. difficile was eradicated in all but one patient. The MIC range, MIC50 and MIC90 (mg/l) of teicoplanin for C. difficile were less than 0.125-0.250, less than 0.125 and 0.250 respectively. Pharmacokinetic studies in patients given a single iv daily maintenance dose of 400 mg showed that the steady-state trough teicoplanin concentrations in serum were reached on day 8. Assays of skin-subcutaneous tissue biopsies showed that teicoplanin penetrated well into these structures. Side effects were observed in six of the 82 treated patients (7.3%) and teicoplanin had to be discontinued in four cases. The results of the study show that teicoplanin is a safe and useful new agent for the treatment of infections caused by Gram-positive organisms, including methicillin-resistant staphylococci and C. difficile.

Adolescent↗
PubMed1976

Anaerobic infections in surgery: clinical review.

Anaerobic bacteria are being recognized with increasing frequency as important micro-organisms in surgical infections. Clostridium, Bacteriodes, Fusobacterium, and Peptostreptococcus are the clinically prominent pathological anaerobes. All are commensals and, consequently, most anaerobic infections are endogenous in origin. In the colon, anaerobes are 1,000 times more prevalent than aerobes. This has important implications regarding the management of gastrointestinal tract operations and the treatment of infections originating from the bowel. Typical anaerobic infections include gas gangrene, brain abscess, oral infections, putrid lung abscesses, intra-abdominal abscesses, and wound infections following gynecologic and bowel surgery, perirectal abscesses, postabortal infections, and septic thrombophlebitis. Infections with anaerobic organisms must be suspected when there is feculent odor and/or gas production following gynecologic or bowel surgery, when there are organisms on gram staining but no growth on aerobic cultures, or when septicemia is associated with repeatedly negative blood cultures. Debridement and drainage constitute the main stay of treatment. All anaerobes are sensitive to chloramphenicol and clindamycin and all but Bacteroides fragils are sensitive to penicillin. Identification of anaerobes requires proper specimen sampling, immediate culturing on prereduced media, and careful gram staining of clinical material. The frequency of anaerobic organisms in surgical infections generally is not recognized by many surgeons; their importance needs to be stressed in the future.

Abscess↗