C septicumComplicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention.
Clostridium septicumis an anaerobic bacterium that causes rapidly progressive myonecrosis, bacteremia, and central nervous system infection. It has been reported as a complication ofEscherichia colihemolytic uremic syndrome (HUS) in 8 children worldwide; 5 children died, and the 3 reported survivors had surgically treated disease. We present 3 cases ofC septicumcomplicating HUS in children, including the first 2 reported cases of survival without surgical intervention. All patients presented with classic cases of HUS with initial clinical improvement followed by deterioration. Patient 1 had rising fever, tachycardia, and severe abdominal pain 24 hours after admission. She developed large multifocal intraparenchymal cerebral hemorrhages and died 12 hours later. Autopsy revealedC septicumintestinal necrosis, myonecrosis, and encephalitis. Patient 2 had new fever, increasing leukocytosis, and severe abdominal pain on hospital day 4. She was diagnosed withC septicumbacteremia and treated with metronidazole, meropenem, and clindamycin. Patient 3 had new fever and increasing leukocytosis on hospital day 3; blood cultures grewC septicum, and she was treated with penicillin. Patients 2 and 3 improved rapidly and did not require surgery.C septicumis a potential co-infection withE coliIt thrives in the anaerobic environment ofE coli-damaged intestinal mucosa and translocates to cause systemic infection. Fever, tachycardia, a rising white blood cell count, and abdominal pain out of proportion to examination are key findings for which physicians should be vigilant. Timely evaluation by anaerobic blood culture and early initiation of antibiotics are necessary to prevent fatalities.
Departments of Pediatrics, and rachel.engen@seattlechildrens.org.
Rachel M
RM
Engen
Departments of Pediatrics, and.
Elizabeth Y
EY
Killien
Pathology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington; and.|Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, California.
Jessica L
JL
Davis
Departments of Pediatrics, and.
Jordan M
JM
Symons
Departments of Pediatrics, and.
Silvia M
SM
Hartmann
D015746:Abdominal Pain / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003015:Clostridium Infections / Q000150:complications* / Q000188:drug therapy; D052557:Clostridium septicum; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000150:complications*; D006801:Humans; D000069544:Infectious Encephalitis / Q000382:microbiology; D007422:Intestines / Q000473:pathology; D007964:Leukocytosis / Q000188:drug therapy / Q000382:microbiology; D009336:Necrosis / Q000382:microbiology
D000900:Anti-Bacterial Agents