Clostridium sordellii infection

Clostridium sordellii [klaw–strĭ–dee–um sore–dell–ee–i] (also called C. sordellii) is a rare bacterium that causes pneumonia, endocarditis, arthritis, peritonitis, and myonecrosis. C. sordellii bacteremia and sepsis occur rarely. Most cases of sepsis from C. sordellii occur in patients with underlying conditions. Severe toxic shock syndrome among previously healthy persons has been described in a small number of C. sordellii cases, most often associated with gynecologic infections in women and infection of the umbilical stump in newborns.

Riskfactors

Women are at highest risk of infection from C. sordellii following the end of pregnancy, whether that pregnancy ended in a live birth, induced abortion (medical or surgical), or spontaneous abortion (miscarriage). Fatal infections with C. sordellii and C. perfringens have occurred after medical abortion. In some cases, women can carry the bacteria, but not be infected (known as colonization). The rate of vaginal colonization (when bacteria are present, but not causing an infection) with Clostridium species in the period after abortion has been reported to be as high as 29%, whereas these bacteria have been isolated in the vaginal secretions of 5%-10% of non-pregnant women. Researchers continue to study what percentage of women carries vaginal or rectal C. sordellii and C. perfringens before and after abortion, as well as during pregnancy.

Symptoms

Symptoms of a C. sordellii infection include nausea, vomiting, diarrhea, and sometimes abdominal pain without fever. These symptoms often can occur in women after live birth or following a spontaneous, medical, or surgical abortion, so it is important to see a healthcare provider for further tests if someone is symptomatic.

Transmission

It is not known how C. sordellii is spread between persons or from the environment to persons. Other similar Clostridium species are spread from person to person and sometimes contaminated surfaces are involved in this transmission.

Diagnosis

Early diagnosis of Clostridium sordellii infection is problematic because the symptoms are broad and present in many other diseases—sometimes they do not even appear in infected hosts . Diagnostic tests for C. sordellii are not aggressively pursued, even after childbirth or gynecological procedures, because the local infection does not appear until hours after the disease has progressed . Earlier diagnosis among injection drug users is more common than in other cases of infection, however, because of the apparent swelling, pain and redness at the site of injection . These patients have surgical intervention at the dermis of the skin in order to obtain specimens for culture and Gram stain . CT and MRI scans may also be conducted to investigate swelling of infected areas. The early diagnosis of injection drug users strongly correlates with a lower mortality rate of those infected with C. sordellii. Health care providers should suspect a C. sordellii infection in patients who present with early disease symptoms, but are afebrile .Generally, vigorous diagnostic tests are pursued when patients have hypotension and tachycardia . When hypotension develops, physicians may order complete blood cell counts which disclose leukemoid reaction and hematocrit levels . C. sordellii infections are systematic; therefore, liver function value tests are necessary to know the levels of bilirubin, alanine aminotransferase, and alkaline phosphatase . Diagnostic tests for the heart, kidney, lung, and other organ functions may also be performed to check the extent of the spread of C. sordellii throughout the body.

Treatment

There is limited information regarding successful treatment of Clostridium sordellii infections because many cases are fatal. C. sordellii can be treated with antibiotics, but many hospital laboratories do not perform antimicrobial susceptibility tests on anaerobes . Previous studies suggest that, similar to most Clostridia species, C. sordellii is susceptible to beta-lactam, clindamycin, tetracycline, and chloramphenicol drugs, while resistant to aminoglycosides and sulfonamides . Intravenous fluids are used to treat patients with symptoms of tachycardia and hypotension. Removal of necrotic tissue is important to reduce buildup of toxins and diagnosis of disease . Other treatments for C. sordellii include plasma injections, vasopressors, steroids, morphine, atropine and supplemental oxygen.

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