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Article Excerpt
To the Editor: Bacterial species of the genus Clostridium are anaerobic or aerotolerant, gram-positive, endospore-forming bacilli found in the soil and gut of humans and other animals. These species cause botulism, tetanus, gas gangrene, antibiotic-associated diarrhea, pseudomembranous colitis, foodborne diarrhea, and necrotic enteritis in humans and infections in other animals. Clostridium tertium, a non-exotoxin-producing, aerotolerant species, is an uncommon human pathogen. First isolated by Henry from war wounds in 1917 (1), C. tertium was recognized as a human pathogen when cases of bacteremia were reported in 1963 (2). The organism has been implicated in bacteremia (3,4), meningitis (5), septic arthritis (6), enterocolitis (7), spontaneous bacterial peritonitis (8), post-traumatic brain abscess (9), and pneumonia (4). Miller and colleagues, in a recent review of 32 cases, highlighted the role of neutropenia, intestinal mucosal injury, and exposure to [beta]-lactam antibiotics predisposing to C. tertium bacteremia (3). C. tertium as the sole pathogen causing necrotizing fasciitis and gangrene has not been reported. We report the first two cases of necrotizing fasciitis and gangrene caused by C. tertium.
A 58-year-old man was seen at the Postgraduate Institute of Medical Education and...
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