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Chatterton B, Devanabanda B, Dutta A, Patel J, Mittal PK. Fetal Gas Gangrene: A Rare and Critical Case. Cureus 2024; 16:e61833. [PMID: 38975460 PMCID: PMC11227342 DOI: 10.7759/cureus.61833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Gas gangrene is a lethal necrotic infection resulting in gas production within tissue. It is typically associated with trauma and is especially lethal during pregnancy, resulting in severe maternal infection and fetal death. We report the case of a 31-year-old G3P2 female who presented to the emergency department with abdominal bloating, vaginal cramping, and brown vaginal discharge. Physical examination showed that the patient was hypertensive, tachycardic, and tachypneic, and laboratory examination showed a downtrending beta-human chorionic gonadotropin and leukocytosis, with elevated inflammatory markers. Ultrasound showed copious gas located within the lower abdomen and the fetus was not visualized. Computed tomography (CT) of the abdomen and pelvis showed a gravid uterus with a single fetus and extensive air locules in the fetus, amniotic cavity, and placenta. The findings were consistent with gas gangrene of a mature fetus in the third trimester. Fetal gas gangrene is a potentially lethal condition during pregnancy, and early diagnosis is imperative in management. CT was utilized in this case to outline the increased gas production within the amniotic cavity and fetal organs and proved crucial in determining the next steps of management.
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Affiliation(s)
- Bradley Chatterton
- Internal Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | | | - Arka Dutta
- Diagnostic Radiology, RWJBarnabas Health, Livingston, USA
| | - Jay Patel
- Diagnostic Radiology, RWJBarnabas Health, Livingston, USA
| | - Pardeep K Mittal
- Radiology, Augusta University Medical College of Georgia, Augusta, USA
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2
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Serafio-Gómez JL, Bustillos-Ponce M, Almeida-Muñoz DE, Parra-Hernández JA, Pompa-Díaz JC. Unbridled Threat of Gas Gangrene in a Patient With Uncontrolled Diabetes Mellitus: A Compelling Case Report of Clostridium perfringens Infection. Cureus 2023; 15:e50614. [PMID: 38111817 PMCID: PMC10726074 DOI: 10.7759/cureus.50614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 12/20/2023] Open
Abstract
Clostridium perfringens, a Gram-positive anaerobic bacterium, is well-known for its association with gas gangrene, a severe and rapidly progressing infection characterized by tissue gas production and necrosis. In this case report, we present the instance of a 64-year-old male with poorly controlled diabetes mellitus who developed a C. perfringens-related infection following a traumatic foot wound. The report emphasizes the critical significance of early diagnosis and aggressive treatment in C. perfringens infections, particularly in patients with underlying risk factors. Detailed accounts of clinical findings, laboratory results, computed tomography, and surgical interventions are provided. A multidisciplinary approach proved essential for successful management. The inherent scholarly value of this case is substantiated by its meticulous documentation of the clinical trajectory, diagnostic modalities, and treatment modalities employed. The intricate collaboration across diverse medical disciplines, the uncommon manifestation of the infection following a traumatic foot wound, and the favorable outcome achieved through prompt and multidisciplinary intervention collectively contribute to the exceptional nature and didactic significance of this case. The dissemination of such clinical experiences assumes paramount importance in advancing medical scholarship, cultivating awareness, and engendering a profound comprehension of the complexities associated with C. perfringens infections, thereby enriching the wider scientific and medical community.
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Affiliation(s)
- José Luis Serafio-Gómez
- General Surgery, Chihuahua City General Hospital "Dr. Salvador Zubirán Anchondo", Chihuahua, MEX
| | - Melanie Bustillos-Ponce
- General Surgery, Chihuahua City General Hospital "Dr. Salvador Zubirán Anchondo", Chihuahua, MEX
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3
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Vishnoi V, Hoedt EC, Gould T, Carroll G, Carroll R, Lott N, Pockney P, Smith SR, Keely S. A pilot study: intraoperative 16S rRNA sequencing versus culture in predicting colorectal incisional surgical site infection. ANZ J Surg 2023; 93:2464-2472. [PMID: 37025037 DOI: 10.1111/ans.18455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Surgical Site Infection (SSI) of the abdominal incision is a dreaded complication following colorectal surgery. Identifying the intraoperative surgical site microbes may provide clarity in the pathogenesis of SSIs. Genomic sequencing has revolutionized the ability to identify microbes from clinical samples. Utilization of 16S rRNA amplicon sequencing to characterize the intraoperative surgical site may provide the critical information required to predict and prevent infection in colorectal surgery. METHODS This is a pilot, prospective observational study of 50 patients undergoing elective colorectal resection. At completion of surgery, prior to skin closure, swabs were taken from the subcutaneous tissue of the abdominal incision to investigate the microbial profile. Dual swabs were taken to compare standard culture technique and 16S rRNA sequencing to establish if a microbial profile was associated with postoperative SSI. RESULTS 8/50 patients developed an SSI, which was more likely in those undergoing open surgery (5/15 33.3% versus 3/35, 8.6%; P = 0.029). 16S rRNA amplicon sequencing was more sensitive in microbial detection compared to traditional culture. Both culture and 16S rRNA demonstrated contamination of the surgical site, predominantly with anaerobes. Culture was not statistically predictive of infection. 16S rRNA amplicon sequencing was not statistically predictive of infection, however, it demonstrated patients with an SSI had an increased biodiversity (not significant) and a greater relative abundance (not significant) of pathogens such as Bacteroidacaea and Enterobacteriaceae within the intraoperative site. CONCLUSIONS 16S rRNA amplicon sequencing has demonstrated a potential difference in the intraoperative microbial profile of those that develop an infection. These findings require validation through powered experiments to determine the overall clinical significance.
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Affiliation(s)
- Veral Vishnoi
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Immune Health Program, Newcastle, New South Wales, Australia
- Department of Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Emily C Hoedt
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Immune Health Program, Newcastle, New South Wales, Australia
- NHMRC Centre for Research Excellence in Digestive Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tiffany Gould
- Department of Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Georgia Carroll
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Immune Health Program, Newcastle, New South Wales, Australia
- Department of Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- NHMRC Centre for Research Excellence in Digestive Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Rosemary Carroll
- Department of Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Natalie Lott
- Department of Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Peter Pockney
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Immune Health Program, Newcastle, New South Wales, Australia
- Department of Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- NHMRC Centre for Research Excellence in Digestive Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Stephen R Smith
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Immune Health Program, Newcastle, New South Wales, Australia
- Department of Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- NHMRC Centre for Research Excellence in Digestive Health, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Surgical Services, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Simon Keely
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Immune Health Program, Newcastle, New South Wales, Australia
- NHMRC Centre for Research Excellence in Digestive Health, University of Newcastle, Newcastle, New South Wales, Australia
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4
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Li HY, Wang ZX, Wang JC, Zhang XD. Clostridium perfringens gas gangrene caused by closed abdominal injury: A case report and review of the literature. World J Clin Cases 2023; 11:852-858. [PMID: 36818624 PMCID: PMC9928709 DOI: 10.12998/wjcc.v11.i4.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/28/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Abdominal Clostridium perfringens (C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-abdominal gas gangrene caused by C. perfringens infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal injury.
CASE SUMMARY A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation, we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were obtained. Two consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to Guillain-Barre syndrome 75 d after the first surgery. This paper presents this case of intra-abdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current literature.
CONCLUSION When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage, appropriate antibiotic therapy, and intensive supportive care comprise the most effective treatment strategy. If the abdominal cavity is heavily contaminated, an open abdominal approach may be a beneficial treatment.
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Affiliation(s)
- He-Yun Li
- Department of Intensive Care Unit, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
| | - Zhi-Xiang Wang
- Department of General Surgery, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
| | - Jian-Chun Wang
- Department of Healthcare-associate Infection Management, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
| | - Xiao-Di Zhang
- Department of General Surgery, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
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SACHER M, LADENHAUF V, FREUND MC, KAFKA-RITSCH R, KRONBERGER IE, OBERHUBER R, KRENDL F, ESSWEIN K, BOGENSBERGER C, SCHNEEBERGER S, PROFANTER C, ÖFNER D, RESCH T. Intestinal perforation mimicking postoperative gas gangrene: a differential diagnosis of a rare but feared surgical complication. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Wang X, Jiao S, Sun Z, Wang Z, Wang X, Liu T. Case Report: Clostridial Gas Gangrene of Pelvic Wall After Laparoscopic Rectal Cancer Surgery Induced Fatal Sepsis. Front Surg 2022; 9:822605. [PMID: 35372485 PMCID: PMC8971600 DOI: 10.3389/fsurg.2022.822605] [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: 11/26/2021] [Accepted: 02/11/2022] [Indexed: 12/02/2022] Open
Abstract
Clostridial gas gangrene is an unusual but fast-spreading necrotic infection of soft tissue relevant to high mortality rates. We report a case of postoperative gas gangrene of the pelvic wall, scrotum, and perineal site, with very acute onset and rapid progression of symptoms after laparoscopic radical resection for rectal cancer. Although potentially treatable with appropriate antibiotic cover and urgent thorough surgical debridement, this case still developed irreversibly into fulminant and fatal sepsis. The possible etiologic factors, better measures of diagnosis, and treatment are discussed, and the relevant literature is reviewed.
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Morel G, Mulier G, Ghrenassia E, Abdel Nabey M, Tandjaoui Y, Kouatchet A, Platon L, Pène F, Moreau AS, Seguin A, Contou D, Sonneville R, Rousset D, Picard M, Dumas G, Mokart D, Megarbane B, Voiriot G, Oddou I, Azoulay E, Biard L, Zafrani L. Non-C. difficile Clostridioides Bacteremia in Intensive Care Patients, France. Emerg Infect Dis 2021; 27:1840-1849. [PMID: 34153220 PMCID: PMC8237868 DOI: 10.3201/eid2707.203471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Article Summary: This multicenter study focusing on critically ill patients showed a strong relationship between hemolysis and mortality. Usually responsible for soft tissue infections, Clostridioides species can also cause bacteremia, life-threatening infections often requiring intensive care unit (ICU) admission. We conducted a multicenter retrospective study to investigate Clostridioides bacteremia in ICUs to describe the clinical and biologic characteristics and outcomes in critically ill patients. We identified 135 patients with Clostridioides bacteremia, which occurred almost exclusively (96%) in patients with underlying conditions. Septic shock and digestive symptoms were the hallmarks of Clostridioides bacteremia in the ICU. We identified 16 different species of Clostridioides, among which C. perfringens accounted for 31% of cases. Despite the high sensitivity of Clostridioides to common antimicrobial drugs, mortality rates were high: 52% for ICU patients and 71% overall at 3 months. In multivariate analysis, the most important factor associated with increased risk for death was the presence of hemolysis. Clostridioides bacteremia often leads to multiple organ failures, which have high mortality rates.
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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.
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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.
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Bath M, McKelvie M, Canna K. Rare postoperative complication: Clostridium perfringens septic shock following elective abdominal surgery. BMJ Case Rep 2017; 2017:bcr-2017-221980. [PMID: 28993363 DOI: 10.1136/bcr-2017-221980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Postoperative infections are one of the most common complications in general surgery, and while rates have reduced with the routine administration of perioperative antibiotics, around 5% of patients undergoing a surgical procedure will develop an infective complication.1 The Gram-positive, obligate anaerobe, Clostridium perfringens, is a well-known pathogen that forms part of both the environmental and gastrointestinal flora.2 While more commonly associated with food poisoning, anaerobic cellulitis and traumatic gas gangrene, rare cases of spontaneous non-traumatic gas gangrene of abdominal viscera have also been recorded.3 Although potentially treatable with appropriate antibiotic cover, cases of C. perfringens can rapidly progress into fulminant and fatal sepsis.4 Moreover, the timing of symptom onset postoperatively can vary significantly, reports ranging from hours to days.5 6 We report a case of C. perfringens-induced septic shock following elective bowel resection.
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Affiliation(s)
- Michael Bath
- Department of General Surgery, Bedford Hospital NHS Trust, Bedford, UK
| | - Mark McKelvie
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Khalid Canna
- Department of General Surgery, Bedford Hospital NHS Trust, Bedford, UK
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Hirai J, Sakanashi D, Huh JY, Suematsu H, Hagihara M, Kato H, Yamagishi Y, Fujita J, Mikamo H. The first human clinical case of chronic osteomyelitis caused by Clostridium hydrogeniformans. Anaerobe 2017; 45:138-141. [PMID: 28232120 DOI: 10.1016/j.anaerobe.2017.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 12/19/2022]
Abstract
We present the first case report of osteomyelitis due to Clostridium hydrogeniformans in a previously healthy 18-year-old male. He was admitted to our hospital because of an open contaminated fracture of the right arm after being blown into a drain in a motorbike accident. He underwent surgical debridement and treatment course of cefazolin. Although he responded well to these initial treatments, subcutaneous abscess and ulnar osteomyelitis developed 1 month after discharge. Second debridement was performed and specimens were collected from both the abscess and bone tissues. Only anaerobic culture showed a gas-producing Gam-positive rod. Conventional methods and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry could not accurately identify this organism. However, 16S rRNA gene sequence analysis determined the isolate as C. hydrogeniformans with 99.79% homology. The patient recovered after 90 days of antibiotic treatment, and had no evidence of recurrence. Anaerobic bacteria are more common as causative pathogens in osteomyelitis related to traumatic wounds and Clostridium spp. are particularly associated with open fractures, which is consistent with our case. Although the epidemiology and clinical characteristics of C. hydrogeniformans infection is poorly understood because of the limitations of currently available conventional methods of identification, clinicians need to consider this organism as a causative pathogen in a patient with osteomyelitis in traumatic wounds, especially contaminated by sewer water.
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MESH Headings
- Adolescent
- Bacteriological Techniques
- Clostridium/classification
- Clostridium/genetics
- Clostridium/isolation & purification
- Clostridium Infections/diagnosis
- Clostridium Infections/pathology
- Cluster Analysis
- DNA, Bacterial/chemistry
- DNA, Bacterial/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- Fractures, Bone/complications
- Humans
- Male
- Osteomyelitis/diagnosis
- Osteomyelitis/pathology
- Phylogeny
- RNA, Ribosomal, 16S/genetics
- Sequence Analysis, DNA
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
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Affiliation(s)
- Jun Hirai
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, 207, Aza-Uehara, Nakagami, Okinawa 903-0215, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan.
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan
| | - Ji Young Huh
- Department of Family Medicine, Adventist Medical Center, Okinawa, Japan, 868 Kochi, Nishihara city, Okinawa 903-0201, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan
| | - Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan
| | - Yuka Yamagishi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, 207, Aza-Uehara, Nakagami, Okinawa 903-0215, Japan
| | - Hiroshige Mikamo
- Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan
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