OBJECTIVE: To describe the profile, management, and outcome of adult patients admitted for tetanus. METHODOLOGY: A search of the hospital and department database was conducted for patients with admitting or final diagnosis of tetanus. Patients below 19 years old, with alternative diagnosis, incomplete or unavailable records, transferred to another institution, and went home against medical advice were excluded. Data on patient demographics, source of infection, symptom severity, and management were obtained. Data was described using proportions and averages. RESULTS: Thirty-two patients were included in the study. Twenty-seven were male with a mean age of 45.63 ± 13.39. All cases had no history of tetanus vaccination. The most common focus of infection was acute injuries. More than half of patients would be diagnosed within 72 hours of symptom onset. The most common symptoms on presentation were trismus, rigidity, dysphagia, and spasms. On admission, Cole severity for 11 (34.4%) cases was mild, 17 (53.1%) moderate, and 4 (12.5%) severe. Prophylactic tracheostomy was performed in 31 patients and 19 (59.4%) were placed on assisted ventilation. All cases were treated with metronidazole. A benzodiazepine was started in all cases for spasm control. Baclofen, magnesium sulfate, and antiepileptic drugs such as carbamazepine were also used. Twenty (62.5%) patients suffered from complications, the most common of which was nosocomial pneumonia, which resulted in longer ICU and hospital stays. Eleven patients exhibited progression in Cole severity: 8.6% at stage 1, 57.1% at stage 2, and 34.3% cases were at stage 3. Mortality rate was 19% with the proportion increasing with Cole severity. CONCLUSION We describe the presentation and course of patients admitted for tetanus in our institution. Most cases were males and all cases had no vaccination history. Trismus was the most common presenting symptom. Metronidazole was the antibiotic of choice and benzodiazepines were the mainstay for spasm control. Majority of cases were mild to moderate in severity on presentation. Advanced disease stages were associated with higher fatality rates. Complications were associated with longer ICU and hospital stay. These findings suggest that prevention of progression of disease severity and complications must be the focus of tetanus protocols to shorten hospital stay and decrease mortality rate. Promoting vaccination of at-risk adults is recommended to lower the incidence of tetanus.
Tetanus ; Clostridium tetani ; Clostridium Infections

No abstract available.
Aged ; *Clostridium Infections ; *Clostridium difficile ; Diarrhea ; Enterocolitis, Pseudomembranous ; Humans

Gas gangrene, a subset of necrotizing myositis, is a bacterial infection that produces gas in tissues in gangrene. It is usually caused by Clostridium species, most commonly Clostridium perfringens. Streptococcus anginosus is a rare cause of gas gangrene, with very few cases reported. We report a rare case of traumatic gas gangrene caused by S. anginosus in a 57-year-old female with diabetes after being stabbed with scissors.
Bacterial Infections ; Clostridium ; Clostridium perfringens ; Diabetes Mellitus ; Female ; Gangrene ; Gas Gangrene* ; Humans ; Middle Aged ; Myositis ; Streptococcus anginosus* ; Streptococcus*

Cytomegalovirus (CMV) colitis is a rare event that has been described mainly in immunocompromised patients who are on immunosuppressive medication or they have HIV infection. CMV colitis manifesting in an immunocompetent host is exceedingly rare, but this has occasionally been described in pregnant patients and patients with chronic renal failure. Pseudomembranous colitis (PMC) is known to develop with long-term antibiotic administration and it is caused by the abnormal overgrowth of toxin-producing Clostridium difficile that colonize the large bowel. Appropriate diagnostic testing and early treatment may avert morbidity and mortality. A case of the simultaneous occurrence of cytomegalovirus and Clostridium difficile colitis in an immunocompetent adult has not yet been reported in the Koran medical literature. We report here on a case of the simultaneous occurrence of cytomegalovirus and Clostridium diffiicle colitis in an immunocompetent Korean adult.
Adult ; Clostridium ; Clostridium difficile ; Colitis ; Colon ; Cytomegalovirus ; Diagnostic Tests, Routine ; Enterocolitis, Pseudomembranous ; HIV Infections ; Humans ; Immunocompromised Host ; Kidney Failure, Chronic

BACKGROUND/AIMS: Clostridium difficile infection (CDI) has been reported to be a cause of flare-ups in patients with ulcerative colitis (UC). We evaluated the prevalence and clinical outcomes of CDI in patients with UC hospitalized for flare-ups. METHODS: This was a prospective, multicenter study including 7 academic teaching hospitals in Korea. All consecutive patients with UC admitted for disease flare-up were enrolled. We detected the presence of CDI by using enzyme immunoassay, real-time polymerase chain reaction (RT-PCR) for toxin genes, and sigmoidoscopy. RESULTS: Eighty-one consecutive patients with UC were enrolled from January 2014 to December 2015. Among 81 patients, 8 (9.9%) were diagnosed with CDI. Most of the cases were identified by RT-PCR. Enzyme immunoassay was positive in 3 of 8 patients, and only 1 had typical endoscopic findings of pseudomembranous colitis. There were no differences in demographic data, length of hospital stay, or colectomy rate between patients with and without CDI. CONCLUSIONS: CDI was not a rare cause of flare-up in patients with UC in Korea. However, CDI did not appear to affect the course of UC flare-up in Korean patients. RT-PCR was sensitive in detecting CDI and can be considered a diagnostic tool in patients with UC flare-up.
Clostridium difficile* ; Clostridium Infections ; Clostridium* ; Colectomy ; Colitis, Ulcerative* ; Enterocolitis, Pseudomembranous ; Hospitals, Teaching ; Humans ; Immunoenzyme Techniques ; Korea* ; Length of Stay ; Polymerase Chain Reaction ; Prevalence ; Prospective Studies* ; Real-Time Polymerase Chain Reaction ; Sigmoidoscopy ; Ulcer*

Pleuropulmonary diseases caused by Clostridial species infections are rare, but have a mortality rate of up to 30%. Furthermore, older people are at greater risk of developing invasive clostridium infections, and the majority of reported cases of clostridium empyema have been attributed to iatrogenic trauma or aspiration. The authors report a case of spontaneous empyema caused by Clostridium perfringens. A 72-year-old woman was admitted to Kangwon National University Hospital for empyema. The patient had no history of trauma, a dental procedure, or aspiration, and was treated using empirical antibiotics and by drainage of pleural fluid. Bacteria species that cause empyema are usually not detected, but on the 4th day of admission, C. perfringens was isolated from the pleural space. The patient was continuously treated with antibiotics for C. perfringens and drainage, and was discharged 25 days after admission with almost a fully recovered status. Increased awareness of Clostrium species infection in the elderly is needed to ensure appropriate treatment.
Aged ; Anti-Bacterial Agents ; Bacteria ; Clostridium ; Clostridium Infections ; Clostridium perfringens* ; Drainage ; Empyema* ; Female ; Gangwon-do ; Humans ; Mortality

Anti-Bacterial Agents ; Clostridium Infections ; diagnosis ; microbiology ; Clostridium difficile ; genetics ; Drug Resistance, Bacterial ; genetics ; Humans

Bacteremia ; microbiology ; Clostridium Infections ; complications ; Clostridium perfringens ; pathogenicity ; Female ; Hemolysis ; physiology ; Humans ; Sepsis ; microbiology

Intestinal microbiome closely relates with human health and disease, which plays a critical role in the immune response, homeostasis, drug metabolism and tumorigenesis. Imbalances in the composition and function of these intestinal microbes associate with diseases. Fecal microbiota transplantation (FMT) is an established successful treatment modality for recurrent Clostridium difficile infection (CDI). The safety profile and potential therapeutic advantages of FMT for diseases associated with dysbiosis and immune dysfunction have led to many publications, mainly case series. The literature on the use of FMT for hematologic diseases is very limited, however, immune thrombocytopenic purpura（ITP）, CDI and aGVHD after HSCT were reported to be improved by FMT. The aim of this review is to briefly summarize the research current state, procedures and clinical application of FMT.
Clostridium Infections ; Clostridium difficile ; Dysbiosis ; Fecal Microbiota Transplantation ; Hematologic Diseases ; Humans ; Treatment Outcome

Objective: To establish and optimize PCR methods for the gene encoding of Clostridium perfringens β₂ toxin (cpb₂) and atypical-cpb₂ (aty-cpb₂), analyze the epidemiological characteristics and genetic polymorphism of the cpb₂ of Clostridium perfringens in 9 Chinese areas from 2016 to 2021. Methods: The cpb₂ of 188 Clostridium perfringens strains were examined by PCR; the cpb₂ sequences were acquired by whole-genome sequencing to analyze the genetic polymorphism. Using Mega 11 and the Makeblastdb tool, a phylogenetic tree, and cpb₂-library based on 110 strains carrying the cpb₂ were produced. Using the Blastn technique, a comparison was made to discover sequence similarity between consensus-cpb₂ (con-cpb₂) and aty-cpb₂. Results: The specificity of PCR assay for the cpb₂ and aty-cpb₂ was verified. The PCR results for cpb₂ amplification were highly consistent with the whole-genome sequencing approach (Kappa=0.946, P<0.001). A total of 107 strains from nine regions in China carried cpb₂, 94 types A strains carried aty-cpb₂, 6 types A strains carried con-cpb₂, and 7 types F strains carried aty-cpb₂. The nucleotide sequence similarity between the two coding genes was 68.97%-70.97%, and the similarity between the same coding genes was 98.00%-100.00%. Conclusions: In this study, a specific PCR method for cpb₂ toxin was developed, and the previous PCR method for detecting aty-cpb₂ was improved. aty-cpb₂ is the primary gene encoding of β₂ toxin. There is a significant nucleotide sequence variance between the various cpb₂ genotypes.
Humans ; Clostridium perfringens/genetics* ; Clostridium Infections ; Bacterial Toxins/genetics* ; Phylogeny ; Polymerase Chain Reaction ; Polymorphism, Genetic