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Published on: September 14, 2013
Clostridium perfringens Empyema: Anaerobic Invasion in an Uncommon Location
Harjinder Singh1, Jessica Kaushal2, Alejandro Garcia2
1Internal Medicine, Henry Ford Health System, Jackson, USA.
Abstract:
Clostridium perfringens bacteremia arises due to skin inoculation from the external environment or translocation from the gastrointestinal tract. In the event of bacteremia, it tends to colonize in anaerobic environments due to its obligatory anaerobic nature. Its inoculation in the lung, albeit rare, can occur if an anaerobic nidus is created. In the presented case, the patient developed C. perfringens bacteremia andempyema in the area of lung necrosis caused by acute pulmonary embolism. He did not have any history of chest trauma, and the source of bacteremia was deemed to be via gut translocation. The patient was noted to have multiple gastric ulcers on endoscopy and jejunal wall thickening, which likely led to the bacterial translocation into the bloodstream. He underwent video-assisted thoracoscopic surgery-assisted decortication and intravenous antibiotics, eventually leading to clinical improvement. To identify the source of Clostridium in the absence of penetrating trauma, a thorough gastrointestinal evaluation, including a colonoscopy, is warranted to identify the pathology leading to the gastrointestinal translocation.
Insights
Clostridium perfringens bacteremia can occur from gut translocation, leading to rare lung infections like empyema. A thorough gastrointestinal evaluation is crucial for identifying the translocation source.
Area of Science:
- Medical microbiology
- Infectious diseases
- Pulmonology
Background:
- Clostridium perfringens bacteremia typically originates from skin or gastrointestinal sources.
- The bacterium's anaerobic nature favors colonization in suitable environments.
- Lung inoculation by C. perfringens is uncommon, requiring an anaerobic nidus.
Observation:
- A patient presented with C. perfringens bacteremia and empyema in necrotic lung tissue secondary to pulmonary embolism.
- No history of chest trauma was reported; gut translocation was identified as the likely source.
- Endoscopic findings revealed gastric ulcers and jejunal wall thickening, suggesting a gastrointestinal translocation pathway.
Findings:
- The case highlights a rare instance of C. perfringens lung empyema originating from gut translocation.
- Successful treatment involved video-assisted thoracoscopic surgery and intravenous antibiotics.
- Identifying the gastrointestinal pathology is key to preventing recurrence.
Implications:
- This case underscores the importance of considering gastrointestinal translocation in C. perfringens bacteremia without obvious external sources.
- Comprehensive gastrointestinal evaluation, including colonoscopy, is recommended for diagnosing the underlying cause.
- Early identification and management of gastrointestinal pathology can prevent severe infectious complications like empyema.
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