Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report

Background Gas-producing perianal abscess raises the possibility of clostridial infection, with Clostridium perfringens being the most common causative agent, which is highly lethal if untreated timely. As the treatment of clostridial infections often differs from that of non-clostridial infections, which they may closely resemble, the importance of accurate pathogenic organism identification cannot be overemphasized. The 16S rDNA of bacteria is highly conserved within a species and among species of the same genus but demonstrates substantial variation between different species, thus making it a suitable genomic candidate for bacterial detection and identification. Case presentation Here, we report the case of a 53-year-old patient who was admitted to the hospital for a gas-producing perianal abscess. The patient was managed with ceftizoxime and ornidazole and then received debridement and drainage at the lesion on the second day after admission. The bacterial cultures of the patient isolates from the debridement showed a coinfection of Escherichia coli and Enterococcus faecium. Although perianal redness and swelling subsided obviously after the surgery, the patient was febrile to 38.3℃ with his left upper thigh red and swollen, aggravated with tenderness and crepitus. Considering insufficient debridement and the risk of incorrect identification of pathogens, a second debridement and drainage were performed 4 days after the primary operation, and 16S rDNA sequencing of the isolates implicated Clostridium perfringens infection. Given the discrepancies in diagnostic results and the treatment outcomes, Enterococcus faecium was identified as sample contamination, and a diagnosis of coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess was confirmed. The patient was then successfully treated with meropenem and vancomycin and was discharged at 27 days of admission. Conclusions This case represents the first report of coinfection of both clostridial and non-clostridial organisms in gas-producing perianal abscess and the first case reporting the use of 16S rDNA sequencing in the diagnosis of perianal abscess. Timely pathogen identification is critical for treating gas-producing perianal abscess and an antibiotic regimen covering both aerobic and anaerobic organisms is recommended before true pathogens are identified.

Clostridial Vaccine for Veterinary Use in Iran: A Review

Clostridia are Gram-positive anaerobic, spore-forming rods, found in soil, water as well as gastro-intestinal tract of human and animals worldwide. Clostridial infections are among the most prevalent diseases in Iran. Clostridium causes botulism, tetanus, food poisoning, wound infections, enterotoxaemia, gas gangrene, necrotic enteritis, pseudomembranous colitis, blackleg and black disease. Clostridium also causes several diseases affecting the livestock and poultry industries throughout the world. Vaccination against clostridial infection is effective in immunization of domestic animals and birds. This review discusses clostridial infection and the development of vaccines against their infection in Iran. The last reported outbreaks of blackleg, black disease and enterotoxaemia occurred years ago, so these vaccines have been produced since the 1960s using traditional and conventional methods. In recent years, molecular biology methods have been developed and applied to the identification of clostridial diseases among animals. In this study, molecular cloning strategies for the major toxins of Clostridium species, for development of recombinant vaccines, were designed and evaluated. In vivo studies indicate that the recombinant vaccines will increase immunity against disease in laboratory animals. These experimental vaccines can thus be used in future pilot studies in Iran. This review article presents current knowledge regarding C. perfringens, C. novyi, C. septicum and C. chauvoei in the veterinary industry in Iran.

Learning Bioavailability Of “Diabderm” Ointment With Method Of “In Vitro”

In diabetes mellitus, a small focus of infection causes significant gangrene of the foot due to thrombosis of the peripheral and central vessels of the fingers. In 35–40% of patients with diabetes mellitus, isolated gangrene of several fingers is noted, and in 20–25% - only one finger. Gangrene of the foot can be dry or with a predominance of anaerobic-non-clostridial infection. Some patients have necrosis or gangrene of certain areas of the skin of the foot or lower leg. The main goal of diabetic gangrene treatment is to keep the areas of wet skin necrosis dry.

Intestinal microbiocenosis in patients with recurrent Clostridium difficile infection, ulcerative colitis and irritable bowel syndrome after transplantation of fecal microflora

Identified significant changes in the intestinal microbiome in patients with inflammatory bowel disease (IBD), serve as the reason for therapeutic interventions in order to correct it. Faecal microbiota transplantation (TFM) is an effective treatment for recurrent or refractory Clostridium difficile infections, including in patients with inflammatory bowel diseases receiving immunosuppressive and anticytokine therapy.The results of studying the effectiveness of TFM using a filtered aqueous suspension of donors feces in the correction of intestinal microbiocenosis in patients with recurrent Clostridial infection (RCT), ulcerative colitis (UC) and irritable bowel syndrome (IBS) are presented. 2 weeks after the introduction of the supernatant, a suspension of fecal microorganism microorganisms in patients evaluated the dynamics of the total content of microorganisms and individual representatives of the intestinal microflora. It was found that the supernatant of an aqueous suspension of donor feces containing microbial exometabolites and other biologically active compounds in the short term has the most pronounced effect on the restoration of normal intestinal microflora only in patients with clostridial infection.

A rare case of non-clostridial infection in a non-diabetic patient

A 76-year-old man presented with neck swelling associated with pain and fever. On examination, there was a submental neck swelling. His initial CT scan showed multiloculated abscess centred in the left submandibular gland. He remained febrile despite on intravenous ceftriaxone and metronidazole. A repeat CT scan revealed significant worsening with multiple pockets of fluids with gas locules in the deep neck spaces. He subsequently underwent neck exploration and drainage of neck abscess. Extensive necrotic tissue was found intraoperatively and thick pus was drained from the bilateral parapharyngeal, submental spaces and anterior mediastium. Pus culture profusely grew of Eggerthella species. Patient recovered well following further intravenous antibiotic therapy. Diabetes mellitus and odontogenic infections are the common risk factors in deep neck infections. Our patient is however non-diabetic and edentulous. Current case is presented to serve as a rare case of neck abscess with unusual cause in a non-diabetic patient.

A rare case of gas under diaphragm due to spontaneous perforation of uterus due to gas gangrene of uterus with clostridium perfringens infection presenting as intestinal perforation

Uterine perforation is an uncommon, perforation due to clostridium perfringens is very rare, but potentially serious complication of uterine gangrene is due to clostridial infection, uterine manipulation, evacuation of retained products, termination of pregnancy, during coil insertion and hysteroscopic procedures. We report a 60 year old female patient presented with abdominal pain, constipation and Fever with features of septic shock. X-ray showed free gas under both domes of diaphragm. CT showed gas under diaphragm and hollow viscus perforation. This report aims to alert surgeons to the possibility that perforation of uterus due to gangrene with clostridium perfringens infection also shows air under diaphragm apart from routine causes. Correct diagnosis and treatment is essential for the survival of the patients with gas under diaphragm due to gas gangrene of uterus.

Differential Diagnosis between Ulcerative Colitis and Clostridium Difficile-Associated Disease in a Patient with Autoimmune Polyglandular Syndrome Type 1

Aim:to demonstrate the clinical picture and the tactics of differential diagnosis between ulcerative colitis andClostridiumdifficile-associated disease in a patient with APS-1, as well as to describe the tactics of managing such patients.Key findings.A 25-year-old patient with autoimmune polyglandular syndrome type 1 (APS-1) complained of loose stools up to 10 times a day with blood admixture, rapidly growing weakness and a weight loss of 5 kg per week. When examined on the day of admission, surgical pathology was excluded. Further differential diagnostics betweenClostridiumdifficile-associated disease and ulcerative colitis was carried out, with the possibility of combining these diseases being not excluded. The examination confirmedClostridiumdifficile-associated disease, while the diagnosis of ulcerative colitis needed further verification. APS-1 is often combined with other diseases and is likely to be pathogenetically related with them; however, the mechanisms of such interrelations still remain unknown. Previous research has reported the relationship between APS-1 and clostridial infection. The combination of ulcerative colitis with APS-1 has not thus far been described.Conclusion.A specific feature of the described clinical case consists in the development of severeClostridiumdifficile-associated disease against the background of autoimmune polyglandular syndrome type 1. The management of patients with APS-1 should take into account the possibility of developing a clostridial infection, since these diseases can co-occur. When treating a patient with APS-1 in non-endocrine hospital units, consultation with an endocrinologist is necessary.