ISSN: 2474-3674 Alataby et al. Int J Crit Care Emerg Med 2020, 6:095 DOI: 10.23937/2474-3674/1510095 Volume 6 | Issue 1 International Journal of Open Access Critical Care and Emergency Medicine CaSe reporT Clostridium Sporogenes Causing Bacteremia Originated from the Skin and Soft Tissue Infection in an Immunocompetent Patient - Case Report and Literature Review Harith A Alataby, MD1*, Vaishali Krishnamoorthy, MD1, Laura Ndzelen, MD1, Foma Munoh Kenne, MD1, Kate Valenti, MLT4, Jessie Savermuttu, MD2 and Jay Nfonoyim, MD1,3 1Department of Medicine, Richmond University Medical Center, New York, USA 2Department of Infectious Disease, Richmond University Medical Center, New York, USA 3 Check for Department of Critical Care, Richmond University Medical Center, New York, USA updates 4Department of Microbiology, Richmond University Medical Center, New York, USA *Corresponding author: Harith Adnan Alataby, Department of Medicine, Richmond University Medical Center, Staten Island, New York, USA, Tel: 3463179648 Abstract include septic arthritis, pyogenic liver abscess, empyema, gas gangrene, and septicemia. To our knowledge, only se- Introduction: Clostridium sporogenes is a major cause of venteen cases of C. sporogenes bacteremia, including the food spoilage. In this report, we present a case of bactere- one described in this case report, have ever been reported. mia in an immunocompetent patient, caused by C. sporoge- Severe of them with Clostridium bacteremia had leukope- nes and most likely originated from the skin and soft tissue nia. Fourteen out of these seventeen patients were diagno- infections. sed with malignancies. There were only three non-cancer Case Presentation: 75-year-old man with PMHx of Par- patients with C. sporogenes bacteremia. A 45-year-old renal kinson’s disease presented to ED after he was found lying transplant recipient who developed acute empyema with on the floor inside his house, covered in urine and feces hydropneumothorax treated aggressively with drainage for unknown duration of time. He was extremely lethargic and antibiotics, a 66-year-old immunocompetent patient and dehydrated. He had BP90/60 mmHg, PR100, RR 22, with cellulitis and osteomyelitis of the lower limb, the pa- tient refused limb amputation and ended up with death and temperature 100.5 °F, and SPO2 98% on room air. Skin examination revealed the presence of multiple pressure the patient described in this case report who developed C. ulcers located on his face, chest, and left leg were cove- sporogenes bacteremia most likely due to infected pressu- red with necrotic tissue and were unstageable. No abscess re ulcers. First-line treatment is penicillin. Due to reported or gas gangrene was noted. In medical-ICU, he was trea- increased resistance of Clostridial species to Penicillin G ted for severe AKI (obstructive uropathy, rhabdomyolysis and metronidazole, clindamycin, and cefoxitin combination and dehydration), hypernatremia, hyperkalemia, lactic aci- antibiotic therapy may be required in certain patients who dosis, leukocytosis and Bacteremia. Three sets of blood are infected with resistant strains of C. sporogenes. cultures were obtained; each of them collected two days Conclusion: Due to the high mortality rate associated with apart. All three were positive for Clostridium sporogenes. Clostridium bacteremia, early initiation antimicrobial the- The patient was treated with intravenous penicillin and rapy and surgical intervention are very important to control vancomycin for seven days but was still having febrile the source of infection, improve survival, and prevent com- episodes. Clindamycin was then added. His condition si- plications. gnificantly improved and completed a 14-days. After this, the patient underwent surgical debridement of the necrotic Keywords pressure ulcers. Clostridium Sporogenes, C. sporogenes, Clostridial infections, Discussion: Less than twenty-five cases of infections cau- Anaerobic, Gram-positive bacillus, Bacteremia, Bloodstre- sed by C. sporogenes have so far been reported and am infection Citation: Alataby HA, Krishnamoorthy V, Ndzelen L, Kenne FM, Valenti K, et al. (2020)Clostridium Sporogenes Causing Bacteremia Originated from the Skin and Soft Tissue Infection in an Immunocompetent Patient - Case Report and Literature Review. Int J Crit Care Emerg Med 6:095. doi.org/10.23937/2474-3674/1510095 Accepted: July 07, 2020: Published: July 09, 2020 Copyright: © 2020 Alataby HA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Alataby et al. Int J Crit Care Emerg Med 2020, 6:095 • Page 1 of 4 • DOI: 10.23937/2474-3674/1510095 ISSN: 2474-3674 Introduction treated with intravenous penicillin and vancomycin for seven days but was still having febrile episodes. The genus Clostridium comprises of over 200 de- Then Clindamycin was added to the antibiotic regi- scribed species that are associated with a variety of men. The patient showed significant improvement in toxin-mediated as well as invasive infections, such as his condition and completed a 14-day course of each bacteremia, gas gangrene, foodborne botulism, and an- antibiotic. The skin debridement was postponed be- tibiotic-associated colitis.Clostridium sporogenes is one cause of the unstable patient condition and the good of the members of the genus Clostridium that is consi- response that had reached by medical management. dered to be a significant cause of food spoilage. Howe- After stabilization of the patient's condition, the pa- ver, it is rarely recognized as a clinical pathogen. Less tient underwent surgical debridement of the necrotic than 25 cases of infection secondary to this organism pressure ulcers. Biopsy and culture of the skin tissue have been reported so far. In this report, we present were performed and did not reveal the presence of a case of bacteremia in an immunocompetent patient, any pathogens. which was caused by C. sporogenes and most likely ori- ginated from the skin and soft tissue infections. Discussion Case Presentation Members of the genus Clostridium are characterized as anaerobic, gram-positive, spore-forming rods that A 75-year-old man with a past medical history of are found ubiquitously in soils and marine sediments, Parkinson's disease was brought to the emergency also as natural inhabitants of the gastrointestinal tract department of our hospital by ambulance after he in humans and most other animals. These bacteria are was found lying on the floor in prone position inside well-recognized for their ability to cause serious and ra- his house. The patient most probably fell on the floor pidly fatal diseases. The development of these diseases several days ago before he was found in this position. may be due to a variety of toxigenic or invasive proces- According to the next of kin, the patient had multiple ses [1]. falls in the past few months that were attributed by her to the patient’s Parkinson disease. The patient did Despite the presence of Clostridium species as a part of the natural intestinal microflora and in the outside not seek medical attention for any of these episodes. environment, infection with these organisms is not On arrival in the emergency department, the patient common. This may largely be because of the anaero- was found to be extremely lethargic and dehydrated. bic conditions that are required for the growth of these He had Blood Pressure 90/60 mmHg, Pulse Rate 100, bacteria. Moreover, not all Clostridium species produce Respiration rate 22, Temperature 100.5 °F, and SPO2 toxins to the same degree [2]. 98% on room air. On physical examination: Skin reve- Clostridium sporogenes is one of the several de- aled the presence of multiple pressure ulcers located scribed species that are included in the genus Clo- on his face, chest, and left leg that had developed from stridium. This anaerobic, gram-positive rod was first staying immobilized on the ground for several days. The described in detail by Metchnikoff in the year 1908. ulcers were covered with necrotic tissue and were un- The organism was isolated from the diarrheal mate- stageable. No abscess or gas gangrene was noted to be rial of patients who had chronic colitis as well as from present. the feces of normal individuals [3]. Clostridium spo- Initial Laboratory test result: WBC 16000/μL, Hb 14.1 rogenes is a major cause of food spoilage, and due g/dl, PLT 129000/μL, Na 153 mEq/L, K 5.9 mEq/L, Blood to its strong genetic and physiological similarity to Urea Nitrogen 244 mg/dL, Creatinine 9.6 mg/dL, Gluco- Clostridium botulinum Group I, it is frequently used se 138, Creatine Kinase 599 U/L. as a surrogate for this organism in illustrating the ef- fectiveness of food preservation processes. Strains Initial Head/chest/abdomen/pelvis CT scans were of both C. sporogenes and Group I C. botulinum exist unremarkable for relevant findings. in the environment as highly heat-resistant spores. The patient was admitted to the medical intensive This highly resistant dormant state allows these or- care unit (MICU) for eight days and was then transfer- ganisms to survive in hostile conditions, such as the red to the general medical floor, where he remained absence of nutrients, desiccation, oxygen, high pres- admitted for almost a month. In medical-ICU, he was sure, heat treatment, and toxic chemicals. The resi- treated for severe AKI (obstructive uropathy, rhab- stance properties of these Clostridial species are the domyolysis and dehydration), hypernatremia, hyper- primary reason why these organisms present serious kalemia, lactic acidosis, leukocytosis and Bacteremia. food spoilage and food safety problem. However, Initially, in MICU, the patient was found to have a the formation of botulinum neurotoxin may be used high white blood cell count and fever. Three sets of to differentiate Group I Clostridium botulinum from blood cultures were obtained; each of them collected Clostridium sporogenes. C. botulinum is an extre- two days apart.