Infective Endocarditis Caused by C. sordellii: The First Case Report from India

Clostridium sordellii is a gram-positive anaerobic bacteria most commonly isolated from skin and soft tissue infection, penetrating injurious and intravenous drug abusers. The exotoxins produced by the bacteria are associated with toxic shock syndrome. We report here a first case of infective endocarditis due to C. sordellii from a female patient with ventricular septal defect from India.

Intravenous drug abusers presenting with pseudoaneurysm and other surgical complications in Pakistan

People who inject drugs (PWIDs) reuse injection equipment and other paraphernalia, which is a major source of transmission of human immunodeficiency (HIV) and hepatitis C virus (HCV) infections. PWIDs who use infected injections develop many surgical complications which are life- threatening. The most common complication is infected pseudoaneurysm. To assess complications requiring surgery in drug abusers, a study was conducted in the East Surgical Ward of Mayo Hospital Lahore, Pakistan from Jan 2017 to Jan 2019. A total of 48 PWIDs presented to the surgical department, out of which 39 (81%) were HIV positive, and 31 (64%) were HCV positive. Of the 52% who had pseudoaneurysm, 92% had femoral and popliteal aneurysm and 8% had brachial aneurysm. After ligation and excision of pseudoaneurysm only 8% required major amputation. Mortality rate was 0%. Ligation and excision is a safe option in pseudoaneurysm. Continuous...

Infected Pseudoaneurysm in a Tertiary Centre: A Retrospective Audit

Introduction: Infected pseudoaneurysms among intravenous drug abusers are a serious clinical condition that carries significant morbidity and mortality. The management of such cases has been controversial on deciding the need of revascularisation following simple ligation and local debridement. In this audit, we present the results of simple ligation and local debridement of our patients with infected pseudoaneurysm. Materials and methods: We conducted a retrospective review from 2013 to 2018 on 15 of our patients who are intravenous drug abusers that underwent simple ligation and local debridement for an infected pseudoaneurysm. Results: All 15 patients underwent simple ligation and local debridement. They were all male patients, and majority of the patients were between group ages of 30-40 years old at 66.7%. The oldest patient was 63 years old. All the patients self-injected the affected site for a minimum duration of 36 months. 73% of the patients had femoral pseudoaneurysm, making it the most common affected site in our audit. The remaining patients had axillary and radial pseudoaneurysm and none of our patients had brachial pseudoaneurysms. Majority of our patients were underlying Hepatitis C at 46.7%, 2 of our patients were HIV positive and only one had Hepatitis B. The remaining 5 patients’ statuses were unknown. In accessing the complications, two patients had re-bleeding after the procedure and were eventually discharged well and were uneventful. One patient required amputation as he developed a gangrenous limb within the same admission after ligation and excision of the infected pseudoaneurysm. There were two deaths due to sepsis with multiorgan failure. 10 patients were discharged well without any complications after surgery. Conclusion: Infected pseudoaneurysms can be safely managed with simple ligation and local debridement without revascularisation as they pose acceptable complication rates.