title: The first human clinical case of chronic osteomyelitis caused by Clostridium hydrogeniformans.
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.
authors.affiliation: 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. Electronic address: j.eichi419@gmail.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Hirai
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sakanashi
authors.affiliation: Department of Family Medicine, Adventist Medical Center, Okinawa, Japan, 868 Kochi, Nishihara city, Okinawa 903-0201, Japan.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Huh
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Suematsu
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan.
authors.forename: Mao
authors.initials: M
authors.lastname: Hagihara
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University Hospital, 1-1, Yazako-karimata, Nagakute, Aichi 480-1195, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Kato
authors.affiliation: 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.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yamagishi
authors.affiliation: 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.
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujita
authors.affiliation: 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.
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Mikamo
mesh_terms: D000293:Adolescent; D001431:Bacteriological Techniques; D003013:Clostridium / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000473:pathology*; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis* / Q000473:pathology*; D010802:Phylogeny; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
chemical_list: D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S
keywords: 16S ribosomal RNA; Anaerobic osteomyelitis; Clostridium hydrogeniformans