1
|
Hussain H, Fadel A, Garcia E, Hernandez RJ, Saadoon ZF, Naseer L, Casmartino E, Hamad M, Schnepp T, Sarfraz R, Angly S, Jayakumar AR. Clostridial Myonecrosis: A Comprehensive Review of Toxin Pathophysiology and Management Strategies. Microorganisms 2024; 12:1464. [PMID: 39065232 PMCID: PMC11278868 DOI: 10.3390/microorganisms12071464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Clostridial myonecrosis, commonly known as gas gangrene (GG), is a rapidly progressing and potentially fatal bacterial infection that primarily affects muscle and soft tissue. In the United States, the incidence of GG is roughly 1000 cases per year, while, in developing countries, the incidence is higher. This condition is most often caused by Clostridium perfringens, a Gram-positive, spore-forming anaerobic bacterium widely distributed in the environment, although other Clostridium species have also been reported to cause GG. The CP genome contains over 200 transport-related genes, including ABC transporters, which facilitate the uptake of sugars, amino acids, nucleotides, and ions from the host environment. There are two main subtypes of GG: traumatic GG, resulting from injuries that introduce Clostridium spores into deep tissue, where anaerobic conditions allow for bacterial growth and toxin production, and spontaneous GG, which is rarer and often occurs in immunocompromised patients. Clostridium species produce various toxins (e.g., alpha, theta, beta) that induce specific downstream signaling changes in cellular pathways, causing apoptosis or severe, fatal immunological conditions. For example, the Clostridium perfringens alpha toxin (CPA) targets the host cell's plasma membrane, hydrolyzing sphingomyelin and phosphatidylcholine, which triggers necrosis and apoptosis. The clinical manifestations of clostridial myonecrosis vary. Some patients experience the sudden onset of severe pain, swelling, and muscle tenderness, with the infection progressing rapidly to widespread tissue necrosis, systemic toxicity, and, if untreated, death. Other patients present with discharge, pain, and features of cellulitis. The diagnosis of GG primarily involves clinical evaluation, imaging studies such as X-rays, computer tomography (CT) scans, and culture. The treatment of GG involves surgical exploration, broad-spectrum antibiotics, antitoxin, and hyperbaric oxygen therapy, which is considered an adjunctive treatment to inhibit anaerobic bacterial growth and enhance the antibiotic efficacy. Early recognition and prompt, comprehensive treatment are critical to improving the outcomes for patients affected by this severe and life-threatening condition.
Collapse
Affiliation(s)
- Hussain Hussain
- Department of Internal Medicine, Kendall Hospital-HCA Florida Healthcare, Miami, FL 33136, USA;
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Aya Fadel
- Department of Internal Medicine, Ocean University Medical Center—Hackensack Meridian Health, Brick, NJ 08724, USA;
| | - Efrain Garcia
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Robert J. Hernandez
- Department of Internal Medicine, Kendall Hospital-HCA Florida Healthcare, Miami, FL 33136, USA;
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Zahraa F. Saadoon
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Lamia Naseer
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Ekaterina Casmartino
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Mohammad Hamad
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Taylor Schnepp
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Rehan Sarfraz
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Sohair Angly
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Arumugam R. Jayakumar
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| |
Collapse
|
2
|
Maeda Y, Miura R, Echizenya T, Hoshi K, Kubo N, Nakai H, Matsumoto K, Ikejima S, Kudo N, Matsubara A. Clostridium paraputrificum Bacteremia in a Patient with Rectal Cancer after Receiving Antibiotic Therapy for Acute Pharyngolaryngitis. Intern Med 2024; 63:1653-1657. [PMID: 37899246 PMCID: PMC11189701 DOI: 10.2169/internalmedicine.2192-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/03/2023] [Indexed: 10/31/2023] Open
Abstract
Clostridium paraputrificum bacteremia is very rare, and its clinical importance is poorly understood. An 86-year-old man was receiving lascufloxacin therapy for acute pharyngolaryngitis before presenting to our emergency department with a recurrent fever. Two sets of blood cultures on admission revealed C. paraputrificum. A stool culture showed a reduced presence of intestinal commensal bacteria. After admission, the patient's fever resolved without antibiotics. Colonoscopy revealed a rectal tumor. Rectal tumor and microbial substitutions caused by antibiotics may have led to bacteremia. When treating C. paraputrificum bacteremia, physicians should be mindful of coexisting gastrointestinal disorders and a history of antibiotic administration.
Collapse
Affiliation(s)
- Yasunori Maeda
- Department of Otorhinolaryngology, Odate Municipal General Hospital, Japan
| | - Ryo Miura
- Department of Otorhinolaryngology, Odate Municipal General Hospital, Japan
| | - Takuma Echizenya
- Department of Clinical Laboratory, Odate Municipal General Hospital, Japan
| | - Kentaro Hoshi
- Department of Gastroenterology-Hematology-Oncology, Odate Municipal General Hospital, Japan
| | - Norihito Kubo
- Department of Surgery, Odate Municipal General Hospital, Japan
| | - Hajime Nakai
- Department of Pharmacy, Odate Municipal General Hospital, Japan
| | | | - Shin Ikejima
- Department of Endocrinology-Metabolism-Neurology, Odate Municipal General Hospital, Japan
| | - Naomi Kudo
- Department of Otorhinolaryngology-Head and Neck Surgery, Hirosaki University Graduate School of Medicine, Japan
| | - Atsushi Matsubara
- Department of Otorhinolaryngology-Head and Neck Surgery, Hirosaki University Graduate School of Medicine, Japan
| |
Collapse
|
3
|
Ben Saïd L, Diancourt L, Rabeau A, Gallet V, Delvallez G, Grare M. Binary Enterotoxin Producing Clostridium perfringens Isolated in Blood Cultures: Case Report and Review of the Literature. Microorganisms 2024; 12:1095. [PMID: 38930477 PMCID: PMC11205559 DOI: 10.3390/microorganisms12061095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/06/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Clostridium perfringens (C. perfringens) is an anaerobic, spore-forming Gram-positive rod responsible for necrotizing gangrene, bacteremia in patients with cancer or gastrointestinal tract infection. C. perfringens virulence is due in large part to toxin production. In 2014, a new enterotoxin, BEC (binary enterotoxin of Clostridium perfringens) encoded by becA and becB genes, distinct from enterotoxin (CPE) encoded by the cpe gene, has been described. BEC-producing strains can be causative agents of acute gastroenteritis in humans. We present herein the case of a 64-year-old man who presented to the emergency department of Toulouse University Hospital with pneumonia and septic shock, without digestive symptoms. Blood cultures showed C. perfringens bacteremia and despite appropriate antibiotic treatment the patient passed away 7 h after admission. The characterization of the strain by whole genome sequencing revealed the presence of typical genes of C. perfringens: plc gene (alpha-toxin, phospholipase C) and pfoA (theta-toxin, perfringolysine). Surprisingly, this strain also harbored becA and becB genes encoding the recently described BEC toxin. Interestingly, alpha-toxin typing of our isolate and other published BEC isolates showed that they belonged to different PLC subtypes, confirming the high genetic diversity of these strains. To our knowledge, it is the first clinical case reporting bacteremia due to a BEC-producing C. perfringens isolate.
Collapse
Affiliation(s)
- Linda Ben Saïd
- Department of Microbiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Laure Diancourt
- National Reference Center for Anaerobic Bacteria and Botulism, Institut Pasteur, Université Paris Cité, 75015 Paris, France (G.D.)
| | - Audrey Rabeau
- Department of Thoracic Oncology, Toulouse University Hospital, 31000 Toulouse, France
| | - Virginie Gallet
- Department of Microbiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Gauthier Delvallez
- National Reference Center for Anaerobic Bacteria and Botulism, Institut Pasteur, Université Paris Cité, 75015 Paris, France (G.D.)
| | - Marion Grare
- Department of Microbiology, Toulouse University Hospital, 31059 Toulouse, France
| |
Collapse
|
4
|
Sharma A, Elligsen M, Daneman N, Lam PW. Patient predictors of pathogenic versus commensal Gram-positive bacilli organisms isolated from blood cultures. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e245. [PMID: 38156236 PMCID: PMC10753492 DOI: 10.1017/ash.2023.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023]
Abstract
Objective Gram-positive bacilli represent a diverse species of bacteria that range from commensal flora to pathogens implicated in severe and life-threatening infection. Following the isolation of Gram-positive bacilli from blood cultures, the time to species identification may take upward of 24 hours, leaving clinicians to conjecture whether they may represent a contaminant (inadvertent inoculation of commensal flora) or pathogenic organism. In this study, we sought to identify patient variables that could help predict the isolation of contaminant versus pathogenic Gram-positive bacilli from blood cultures. Design Retrospective cohort study. Settings One quaternary academic medical center affiliated with the University of Toronto. Patients Adult inpatients were admitted to hospital over a 5-year period (May 2014 to December 2019). Methods A total of 260 unique Gram-positive bacilli blood culture results from adult inpatients were reviewed and analyzed in both a univariable and multivariable model. Results Malignancy (aOR 2.78, 95% CI 1.33-5.91, p = 0.007), point increments in the Quick Sepsis Related Organ Failure Assessment score for sepsis (aOR 2.25, 95% CI 1.50-3.47, p < 0.001), peptic ulcer disease (aOR 5.63, 95% CI 1.43-21.0, p = 0.01), and the receipt of immunosuppression prior to a blood culture draw (aOR 3.80, 95% CI 1.86-8.01, p < 0.001) were associated with an increased likelihood of speciating pathogenic Gram-positive bacilli from blood cultures such as Clostridium species and Listeria monocytogenes. Conclusion Such predictors can help supplement a clinician's assessment on determining when empirical therapy is indicated when faced with Gram-positive bacilli from blood cultures and may direct future stewardship interventions for responsible antimicrobial prescribing.
Collapse
Affiliation(s)
- Arjun Sharma
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marion Elligsen
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Philip W. Lam
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
5
|
Tohmatsu Y, Yamada M, Otsuka S, Ohgi K, Ashida R, Kurai H, Yasui H, Sugino T, Uesaka K, Sugiura T. Liver abscess caused by Clostridium perfringens after left hepatic trisectionectomy for perihilar cholangiocarcinoma: a case report. Surg Case Rep 2023; 9:111. [PMID: 37335427 DOI: 10.1186/s40792-023-01687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Clostridium perfringens sepsis has been reported to have a rapid onset and severe clinical outcome. We herein report a case of C. perfringens sepsis associated with massive intravascular hemolysis after left hepatic trisectionectomy for perihilar cholangiocarcinoma. CASE PRESENTATION A 72-year-old woman underwent left hepatic trisectionectomy for perihilar cholangiocarcinoma. Her postoperative course was uneventful except for bile leakage. She was discharged on postoperative day (POD) 35. On POD 54, she was readmitted because of abdominal pain with a high fever. Although her vital signs were stable on arrival at the hospital, a laboratory examination showed a severe inflammatory reaction and hemolysis, and she had developed disseminated intravascular coagulation. Abdominal contrast-enhanced computed tomography showed a 70-mm irregular shape and low-density containing air in liver segment 6, which suggested a liver abscess. The abscess was immediately drained of pus containing air. The pus showed multiple Gram-positive bacilli, and two blood cultures showed Gram-positive bacilli and hemolysis. Empirical antibiotic therapy with vancomycin and meropenem was started because C. perfringens was detected from the preoperative bile culture. Four hours after arrival, tachypnea and decreased oxygen saturation were observed. Her general condition deteriorated rapidly with significant hypoglycemia, progressive acidosis, anemia, and thrombocytopenia. Despite rapid drainage and empiric therapy, she died six hours after her arrival. At autopsy, the abscess consisted of coagulation necrosis of liver cells with inflammatory cell infiltration, and clusters of Gram-positive large bacilli were observed in the necrotic debris. C. perfringens was detected in the drainage fluid and blood culture. She was diagnosed with a liver abscess and severe sepsis caused by C. perfringens and treated promptly, but the disease progressed rapidly and led to her death. CONCLUSIONS Sepsis caused by C. perfringens can progress rapidly and lead to death in a few hours, so prompt treatment is needed. When patients who have undergone highly invasive hepatobiliary-pancreatic surgery show hemolysis and hepatic abscesses with gas, C. perfringens should be considered the most likely bacterium.
Collapse
Affiliation(s)
- Yuuko Tohmatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Mihoko Yamada
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.
| | - Shimpei Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Hanako Kurai
- Division of Infectious Diseases, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruna Yasui
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| |
Collapse
|
6
|
Yamairi K, Niki M, Imoto W, Kuwabara G, Shibata W, Oshima K, Yamada K, Kaneko Y, Kakeya H. Two cases of Clostridium ramosum bacteremia with intestinal perforation: The antimicrobial susceptibility of clinical strains. Anaerobe 2023; 80:102695. [PMID: 36640992 DOI: 10.1016/j.anaerobe.2023.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
Clostridium ramosum is one of the obligate anaerobes that constitute the intestinal flora, and one of the rare Clostridia. With Clostridium ramosum, very few data have been reported to investigate antimicrobial susceptibility for clinical isolates that have caused bacteremia. Here, we report two cases of Clostridium ramosum bacteremia. The first case was a 54-year-old Japanese man with taking 20mg hydrocortisone for hypopituitarism. He presented to the emergency department for an unknown cause cardiopulmonary arrest. At the hospital day 36, he had fever and a drop in blood pressure. Abdomen computed tomography (CT) revealed free air around the ascending colon, we diagnosed with intestinal perforation, and peritonitis. Blood culture revealed Clostridium ramosum. We administered conservative management by 6-week of antibiotic treatment. The second case was a 78-year-old Japanese man with no significant medical history. He was referred to our hospital with fever and abdominal pain. Abdomen CT revealed perforated appendicitis, and blood cultures revealed Clostridium ramosum. We performed emergency surgery, and administered one-week course of antibiotic treatment. This report demonstrates two cases of Clostridium ramosum bacteremia with intestinal perforation, and the antimicrobial susceptibility of each clinical strain. For the future, it is necessary to accumulate data on the susceptibility of clinical isolates in order to find an appropriate treatment.
Collapse
Affiliation(s)
- Kazushi Yamairi
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Makoto Niki
- Department of Bacteriology, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Waki Imoto
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Gaku Kuwabara
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Wataru Shibata
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Kazuhiro Oshima
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Koichi Yamada
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Yukihiro Kaneko
- Department of Bacteriology, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Osaka, Japan.
| |
Collapse
|
7
|
Acute fulminant intravascular hemolysis induced by Clostridium perfringens in a symptomatic multiple myeloma patient under immuno-chemotherapy. Ann Hematol 2022; 101:2813-2815. [DOI: 10.1007/s00277-022-05010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
|
8
|
An Autopsy Case of Rapidly Aggravated Clostridium perfringens Septicemia with Colorectal Cancer. Case Rep Infect Dis 2022; 2022:1071582. [PMID: 36213874 PMCID: PMC9546719 DOI: 10.1155/2022/1071582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
This report presents a case of a 60-year-old man who was diagnosed with ascending colon cancer with metastases of the lymph nodes and multiple liver metastases. Three days before the introduction of the first chemotherapy, he visited our hospital due to high fever. The blood test revealed an increase in the inflammatory response, hepatobiliary enzyme level, lactate dehydrogenase (LDH) level, and renal function deterioration. Contrast-enhanced computed tomography (CT) showed a rapid progression of primary lesion and liver metastatic lesions. Treatment with 5-fluorouracil, leucovorin, and oxaliplatin and cetuximab (FOLFOX/Cmab) was initiated, and the patient was admitted to our hospital after the first day of chemotherapy. At midnight, he had chills, red urine, and rapid hypoxemia. The second blood test showed progression of anemia; increased total bilirubin, aspartate aminotransferase, and LDH levels; and decreased platelet and fibrinogen levels. The serum was red wine in color, indicating marked hemolysis. The respiratory condition rapidly deteriorated, and tracheal intubation was performed and transferred into the intensive care unit. However, blood oxygenation did not increase, and the patient died the next morning, 19 h after admission, despite intensive care. Postmortem CT showed intraperitoneal free air and gas retention in the liver tumor and portal vein system. Pathological autopsy revealed perforation in ascending colon cancer, many Gram-positive rods in the perforation site, dissemination of bacteria throughout the body, and diffuse pulmonary edema. Subsequently, blood cultures reported Clostridium perfringens (CP), which is a product of alpha-toxin. CP infection can cause rapid aggravation and sudden death. The physicians should be aware of this highly fatal infection, leading to immediate diagnosis and treatment.
Collapse
|
9
|
Itoh N, Akazawa N, Yanaidani T, Kuwahara T. Clinical and microbiological features of intratumor abscess with bloodstream infection caused by Plesiomonas shigelloides, Citrobacter freundii, Streptococcus mitis/oralis, Clostridium perfringens, and Candida albicans in a patient with cholangiocarcinoma: A case report. J Infect Chemother 2022; 28:1677-1681. [PMID: 36067910 DOI: 10.1016/j.jiac.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/19/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
Abstract
Plesiomonas shigelloides is a gram-negative facultative anaerobic bacillus, usually found in soil and freshwater, which causes self-limited diarrhea, although reports of bacteremia are rare. Here, we report the first case of an intratumoral abscess with mixed bacteremia caused by P. shigelloides, Citrobacter freundii, Streptococcus mitis/oralis, Clostridium perfringens, and Candida albicans in a patient with recurrent postoperative cholangiocarcinoma. A 77-year-old man with hilar cholangiocarcinoma and hypertension was admitted to our hospital with fever and abdominal pain. He had visited Vietnam for 3 years, 20 years ago. Abdominal computed tomography showed air within the recurrent tumor at the left liver lobectomy resection margin site, which was diagnosed as an intratumor abscess perforating the intestinal tract. P. shigelloides, C. freundii, S. mitis/oralis, C. perfringens, and C. albicans were isolated in blood culture. P. shigelloides was identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and 16S ribosomal RNA (16S rRNA) sequencing. Piperacillin-tazobactam was administered for almost a week, ampicillin-sulbactam and levofloxacin for almost 3 weeks, and antifungal agents for almost 2 weeks, and the patient was discharged thereafter. Although bloodstream infections caused by P. shigelloides in patients with cancer are extremely rare, long-term colonization and the potential for future intra-abdominal infections were implicated.
Collapse
Affiliation(s)
- Naoya Itoh
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Nana Akazawa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Takafumi Yanaidani
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| |
Collapse
|
10
|
Li J, Yang L, Li G, Liu S, Cao W, Lin H, Chen Z, Qin X, Huang J, Zheng H. Low-molecular-weight oyster peptides ameliorate cyclophosphamide-chemotherapy side-effects in Lewis lung cancer mice by mitigating gut microbiota dysbiosis and immunosuppression. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
11
|
Dey P, Ray Chaudhuri S. Cancer-Associated Microbiota: From Mechanisms of Disease Causation to Microbiota-Centric Anti-Cancer Approaches. BIOLOGY 2022; 11:757. [PMID: 35625485 PMCID: PMC9138768 DOI: 10.3390/biology11050757] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori infection is the only well-established bacterial cause of cancer. However, due to the integral role of tissue-resident commensals in maintaining tissue-specific immunometabolic homeostasis, accumulated evidence suggests that an imbalance of tissue-resident microbiota that are otherwise considered as commensals, can also promote various types of cancers. Therefore, the present review discusses compelling evidence linking tissue-resident microbiota (especially gut bacteria) with cancer initiation and progression. Experimental evidence supporting the cancer-causing role of gut commensal through the modulation of host-specific processes (e.g., bile acid metabolism, hormonal effects) or by direct DNA damage and toxicity has been discussed. The opportunistic role of commensal through pathoadaptive mutation and overcoming colonization resistance is discussed, and how chronic inflammation triggered by microbiota could be an intermediate in cancer-causing infections has been discussed. Finally, we discuss microbiota-centric strategies, including fecal microbiota transplantation, proven to be beneficial in preventing and treating cancers. Collectively, this review provides a comprehensive understanding of the role of tissue-resident microbiota, their cancer-promoting potentials, and how beneficial bacteria can be used against cancers.
Collapse
Affiliation(s)
- Priyankar Dey
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Saumya Ray Chaudhuri
- Council of Scientific and Industrial Research (CSIR), Institute of Microbial Technology, Chandigarh 160036, India;
| |
Collapse
|
12
|
Bonda S, Lee K, Rovig J, Asad S. Clostridium Bacteremia and its Implications: A Case Report. IDCases 2022; 29:e01516. [PMID: 35663607 PMCID: PMC9157464 DOI: 10.1016/j.idcr.2022.e01516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022] Open
Abstract
Background The Clostridium species is a gram positive, anaerobic, rod-shaped microbe that is known to produce many toxins. Most infections by the Clostridium species involve C. botulinum, C. difficile, and C. perfringens. However, other types of Clostridium species are also clinically relevant, such as C. septicum and C. tertium. Case summary We discuss a case of a 79-year-old patient with a past medical history of prostate cancer and alcohol abuse who presented to the hospital after being found down. They were admitted to the ICU for septic shock, and initial blood cultures grew C. septicum, C. tertium, and E. coli. A CT of the abdomen and pelvis with IV contrast showed pneumoperitoneum and a loculated pericolic fluid collection concerning for colon perforation. Initially the patient had a benign abdominal exam, but later developed significant distention and tenderness that required an emergent exploratory laparotomy and total abdominal colectomy. The patient was found to have three separate colon perforations, and no malignancy on histopathology. Discussion C. septicum is a highly virulent pathogen, and there are several cases reporting C. septicum-associated endocarditis, aortitis, and endophthalmitis. It is also associated with colon and hematologic malignancies and neutropenia. Common risk factors for C. tertium include immunocompromised status, neutropenia, hematologic malignancy, exposure to beta-lactam antibiotics, cirrhosis, and intestinal mucosal damage. It seems to have low virulence and low mortality when treated correctly. It is important that any patient found to have Clostridium bacteremia be evaluated for a gastrointestinal source and treated promptly and appropriately. Clostridium infections are most commonly from a gastrointestinal source. Clostridium septicum is highly associated with colon malignancies. Clostridium tertium is one Clostridium species that does not produce a toxin.
Collapse
|
13
|
Antibacterial Activity of Some Medicinal Plants in Al Baha Region, Saudi Arabia, Against Carcinogenic Bacteria Related to Gastrointestinal Cancers. J Gastrointest Cancer 2022; 54:51-55. [PMID: 34988907 DOI: 10.1007/s12029-021-00793-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Gastrointestinal cancers are the most dangerous cancers all over the world. The gut microbiota dysbiosis increases the risk of GI cancers and induces the host's susceptibility to carcinogenic bacteria. Antibiotic resistance is rising in these bacteria. Thus, discovering new safe and effective antibacterial agents is a worldwide concern. This study evaluates the antibacterial activity of six wild medicinal plants from the Al Bahah region in Saudi Arabia. METHODS Arial parts of Cissus quadrangularis, Aloe castellorum, Psiadia punctulata, Aloe pseudorubroviolacea, Barbeya oleoides, Teucrium yemense were collected and dried for extraction with ethanol. The minimum inhibitory concentrations (MIC) of these ethanolic extracts against carcinogenic bacteria Bacteroides fragilis, Clostridium ssp., Cutibacterium acnes, Escherichia coli, Fusobacterium nucleatum, Helicobacter pylori, Mycoplasma spp., Neisseria gonorrhoeae, Porphyromonas gingivalis, Salmonella enterica, and Treponema pallidum were evaluated to determine its antibacterial activity. RESULTS All extracts showed antibacterial activity with MIC lower than 1 mg/ml. Psiadia punctulata showed higher antibacterial activity, while the Aloe species showed the lowest antibacterial activity. CONCLUSION The studied plants' extracts showed high effectiveness as antibacterial activity against the carcinogenic bacteria related to gastrointestinal cancers due to their high content of pharmaceutical components. These plants could be explored further for the development of new antibacterial products against these carcinogenic bacteria.
Collapse
|
14
|
Prevalence and Antimicrobial Resistance of Paeniclostridium sordellii in Hospital Settings. Antibiotics (Basel) 2021; 11:antibiotics11010038. [PMID: 35052916 PMCID: PMC8772839 DOI: 10.3390/antibiotics11010038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022] Open
Abstract
(1) Background: The purpose of this study was to determine the prevalence of clostridia strains in a hospital environment in Algeria and to evaluate their antimicrobial susceptibility to antibiotics and biocides. (2) Methods: Five hundred surface samples were collected from surfaces in the intensive care unit and surgical wards in the University Hospital of Tlemcen, Algeria. Bacterial identification was carried out using MALDI-TOF-MS, and then the minimum inhibitory concentrations (MICs) of various antimicrobial agents were determined by the E-test method. P. sordellii toxins were searched by enzymatic and PCR assays. Seven products intended for daily disinfection in the hospitals were tested against Clostridium spp. spore collections. (3) Results: Among 100 isolates, 90 P. sordellii were identified, and all strains were devoid of lethal and hemorrhagic toxin genes. Beta-lactam, linezolid, vancomycin, tigecycline, rifampicin, and chloramphenicol all proved effective against isolated strains. Among all strains tested, the spores of P. sordellii exhibited remarkable resistance to the tested biocides compared to other Clostridium species. The (chlorine-based 0.6%, 30 min), (glutaraldehyde solution 2.5%, 30 min), and (hydrogen peroxide/peracetic acid 3%, 15 min) products achieved the required reduction in spores. (4) Conclusions: Our hospital’s current cleaning and disinfection methods need to be optimized to effectively remove spores from caregivers’ hands, equipment, and surfaces.
Collapse
|
15
|
Duijster JW, Franz E, Neefjes J, Mughini-Gras L. Bacterial and Parasitic Pathogens as Risk Factors for Cancers in the Gastrointestinal Tract: A Review of Current Epidemiological Knowledge. Front Microbiol 2021; 12:790256. [PMID: 34956157 PMCID: PMC8692736 DOI: 10.3389/fmicb.2021.790256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022] Open
Abstract
The oncogenic potential of viral infections is well established and documented for many years already. However, the contribution of (commensal) bacteria and parasites to the development and progression of cancers has only recently gained momentum, resulting in a rapid growth of publications on the topic. Indeed, various bacteria and parasites have been suggested to play a role in the development of gastrointestinal cancer in particular. Therefore, an overview of the current epidemiological knowledge on the association between infections with bacteria and parasites and cancers of the gastrointestinal tract is needed. In this review, we summarized the methodological characteristics and main results of epidemiological studies investigating the association of 10 different bacteria (Bacteroides fragilis, Campylobacter spp., Clostridium spp., Enterococcus faecalis, Escherichia coli, Fusobacterium nucleatum, Porphyromonas gingivalis, non-typhoidal Salmonella, Salmonella Typhi, and Streptococcus spp.) and three parasites (Cryptosporidium spp., Schistosoma spp., and Strongyloides stercoralis) with gastrointestinal cancer. While the large body of studies based on microbiome sequencing provides valuable insights into the relative abundance of different bacterial taxa in cancer patients as compared to individuals with pre-malignant conditions or healthy controls, more research is needed to fulfill Koch's postulates, possibly making use of follow-up data, to assess the complex role of bacterial and parasitic infections in cancer epidemiology. Studies incorporating follow-up time between detection of the bacterium or parasite and cancer diagnosis remain valuable as these allow for estimation of cause-effect relationships.
Collapse
Affiliation(s)
- Janneke W. Duijster
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Department of Cell and Chemical Biology, Oncode Institute, Leiden University Medical Center, Leiden, Netherlands
| | - Eelco Franz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Jacques Neefjes
- Department of Cell and Chemical Biology, Oncode Institute, Leiden University Medical Center, Leiden, Netherlands
| | - Lapo Mughini-Gras
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
16
|
Liu F, Xue S, Zhang Y, Yang J, Hu J, Li D, Ma X, Wang J. Clostridium perfringens sepsis in three patients with acute leukemia and review of the literature. Int J Hematol 2021; 113:508-517. [PMID: 33387294 PMCID: PMC7776304 DOI: 10.1007/s12185-020-03060-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
In this study, we aimed to improve understanding of the clinical manifestations, laboratory findings, and risk factors of Clostridium perfringens sepsis in patients with acute leukemia and to analyze treatment strategies for improving prognosis. We analyzed clinical manifestations, laboratory data, diagnosis, and treatment strategies in three cases of C. perfringens sepsis in patients with acute leukemia. We also reviewed and analyzed the relevant literature, incorporating our findings into the discussion. All three patients developed septic shock with neutropenia following chemotherapy. Analysis of blood samples confirmed the presence of C. perfringens, and two patients had fulminant intravascular hemolysis and developed multiple organ dysfunction syndrome. Two patients survived and one died despite timely and full-dose antibacterial treatments, blood purification, and noninvasive positive pressure ventilation. Overall, our findings showed that C. perfringens sepsis is rare in patients with acute leukemia but progresses rapidly. A high mortality rate was observed, and patients often experienced refractory shock and intravascular hemolysis. This demonstrates the importance of early detection and diagnosis. Multimodal treatments, including fluid resuscitation, antibiotics, organ support, and blood purification, are essential for success.
Collapse
Affiliation(s)
- Fuhong Liu
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Song Xue
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Yongping Zhang
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Jingxian Yang
- Department of Laboratory, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Jiajun Hu
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Di Li
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Xiaojun Ma
- Department of Infectious Diseases, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Beijing, 100005, China.
| | - Jingbo Wang
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China.
| |
Collapse
|
17
|
The High-Fat Diet Based on Extra-Virgin Olive Oil Causes Dysbiosis Linked to Colorectal Cancer Prevention. Nutrients 2020; 12:nu12061705. [PMID: 32517306 PMCID: PMC7352482 DOI: 10.3390/nu12061705] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/24/2022] Open
Abstract
The present study aims to examine the effects of three different high-fat diet (HFD) on mice gut microbiota in order to analyse whether they create the microenvironmental conditions that either promote or prevent colorectal cancer (CRC). We evaluated colonic mucosa-associated microbiota in CD1 mice fed with HFD, based on 60% kcal from fat-containing coconut, sunflower or extra-virgin olive oil as the only source of fat. The main findings were as follows: (a) All HFD produced a decrease in the richness and diversity of the intestinal microbiota that was independent of mouse weight, (b) HFD switched Lactobacillus to Lactococcus. In general, the results showed that both sunflower- and coconut-HFD generated a pro-inflammatory intestinal microenvironment. In brief, coconut-HFD decreased Akkermansia and increased Staphylococcus, Prevotella and Bacteroides spp. abundance. Sunflower-HFD reduced Akkermansia and Bifidobacterium, while enhancing Sphingomonas and Neisseria spp. abundance. In contrast, EVOO-HFD produced an anti-inflammatory microenvironment characterised by a decreased Enterococcus, Staphylococcus, Neisseria and Pseudomonas spp. abundance. At the same time, it increased the Firmicutes/Bacteroidetes ratio and maintained the Akkermansia population. To conclude, EVOO-HFD produced changes in the gut microbiota that are associated with the prevention of CRC, while coconut and sunflower-HFD caused changes associated with an increased risk of CRC.
Collapse
|
18
|
Stabler S, Titécat M, Duployez C, Wallet F, Loïez C, Bortolotti P, Faure E, Faure K, Kipnis E, Dessein R, Le Guern R. Clinical relevance of Clostridium bacteremia: An 8-year retrospective study. Anaerobe 2020; 63:102202. [PMID: 32247000 DOI: 10.1016/j.anaerobe.2020.102202] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/14/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Abstract
Clostridium spp. are recovered from 25% of the blood culture positive with anaerobes. However, the clinical relevance of Clostridium bacteremia has been controverted in the literature, particularly for C. perfringens. We aimed to evaluate the clinical relevance of Clostridium bacteremia, either due to C. perfringens or other Clostridium species, and to identify the risk factors of mortality in these patients. A retrospective cohort study was conducted from January 2010 to April 2018. All the patients with at least one blood culture positive with any Clostridium species were included. Eighty-one patients with a least one blood culture positive with any Clostridium species were included. Seventy patients (86.4%) fulfilled the criteria for clinically relevant bacteremia. Bacteremia due to C. perfringens tended to be less clinically relevant than other Clostridium species but this was not statistically significant (76% vs 91.2%, P = 0.09). In case of clinically relevant bacteremia, the 30-day mortality rate was 31.4%. In multivariate analysis, adequate empiric antimicrobial therapy was significantly associated with survival (P = 0.03). In conclusion, bacteremia due to C. perfringens or other Clostridium species is usually clinically relevant. This finding was also supported by an improved survival at 30 days when adequate empiric antimicrobial therapy was administered.
Collapse
Affiliation(s)
- Sarah Stabler
- CHU Lille, Service de Maladies Infectieuses, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Marie Titécat
- CHU Lille, Service de Bactériologie-Hygiène, F-59000, Lille, France; Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Claire Duployez
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CHU Lille, Service de Bactériologie-Hygiène, F-59000, Lille, France
| | - Frédéric Wallet
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CHU Lille, Service de Bactériologie-Hygiène, F-59000, Lille, France
| | - Caroline Loïez
- CHU Lille, Service de Bactériologie-Hygiène, F-59000, Lille, France
| | - Perrine Bortolotti
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CHU Lille, Service de Réanimation Chirurgicale, F-59000, Lille, France
| | - Emmanuel Faure
- CHU Lille, Service de Maladies Infectieuses, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Karine Faure
- CHU Lille, Service de Maladies Infectieuses, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Eric Kipnis
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CHU Lille, Service de Réanimation Chirurgicale, F-59000, Lille, France
| | - Rodrigue Dessein
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CHU Lille, Service de Bactériologie-Hygiène, F-59000, Lille, France
| | - Rémi Le Guern
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CHU Lille, Service de Bactériologie-Hygiène, F-59000, Lille, France.
| |
Collapse
|