Clostridium sordellii

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University of Oklahoma Study Abroad Microbiology in Arezzo, Italy[1]

File:Clostridium sordellii bacteria.gif

Hematoxylin and Eosin Staining image of Clostridium difficile at 100x magnification. From: cid.oxfordjournals.org [2]

Etiology/Bacteriology

Taxonomy

| Domain = Bacteria | Phylum = Firmicutes | Class = Clostridia | Order = Clostridiales | Family = Clostridiaceae | Genus = Clostridium | species = Clostridium sordellii

NCBI: [3] Genome: [4]

Description

Clostridium sordelli is a gram positive, spore-forming, anaerobic rod (1). This bacterium was first discovered by Alfredo Sordelli in 1922 who named it Bacillus oedematis because of the distinct edematous characteristics it causes in cases of infection (1). In 1927 the organism was renamed Bacillus sordellii and two years later it became classified as Clostridium sordellii, as it is almost indistinguishable from Clostridium oedematoides (1). Previous research on this organism can be found under these former species names. Clostridium sordelli is a virulent strain of Clostridium bifermentans that causes pneumonia, endocarditis, arthritis, peritonitits, myonecrosis, bacteremia and sepsis in humans in more serious strains of the disease (1, 2). The most published manifestations of this infection are those causing severe toxic shock syndrome in association with gynecological complications in women (2). However, cases of C. sordelli infections are recorded equally among men and women (3). This microorganism is only found in 0.5% of human intestines, but more commonly isolated from soil (1). There are various treatments for this disease, some being more effective than others, ranging from antibiotic to supplemental oxygen usage (3). Two notable virulence factors, Lethal Toxin (LT) and Hemorrhagic Toxin (HT), aid in the pathogenicity of the organism (3). The method of transmission of Clostridium sordellii is unknown (1). Microbiologists and health professionals continue to work in conjunction to prevent the spread of these bacteria during gynecological procedures, non-gynecological procedures and in cases involving injury to soft tissues (2). Illicit drug users are especially susceptible to C. sordellii infections and certain drugs have shown more apt to transmit the bacterium (4).

Pathogenesis

Transmission

The mechanism of transmission for Clostridium sordellii between person to person or person to environment is not known (2). There are no known zoonotic Clostridium species, meaning they cannot transmit directly from animal to human (5). Some microbiologists hypothesize that the bacteria can travel from person to person and from contaminated surfaces to person in a similar manner to other Clostridium species, although there has yet to be a study confirming this to be true for C. sordellii. In general, Clostridium species are transmitted through contaminated wound sites and discontinuities in the gastrointestinal tract (5). An outbreak in California revealed that black tar heroin (BTH) was able to carry C. sordellii and transmit itself into injection drug users (IDU) (4). Along with IDU, C. sordelli infections have been associated with medically induced abortions, minor traumas and surgeries, spontaneous abortions and normal childbirth—the tools used in these operations are not found to carry C. sordellii on their surfaces (1). A major theme in these cases is transmission via the mucosal surfaces of the urogenital tracts in males and females, yet there are still uncommon cases of transmission through other surfaces of the body.

Clinical features

Early Symptoms

Early symptoms of Clostridium sordellii include symptoms of vomiting, nausea, diarrhea and occasional abdominal pain without fever (2). All of these indicators can occur in women after childbirth, spontaneous abortion, or medical abortion, so further testing is needed to conclude the source of the symptoms. Additional clinical features of C. sordellii infections, listed most to least prevalent include: septic shock, mild infection site pain, leukemoid reaction, afebrile, tachycardia, hemoconcentration, tissue or visceral edema, reduced serum protein, metabolic acidosis, decreased platelet count and RBCs and WBCs in urine (3). These symptoms are characteristic signs leading to more serious symptoms that manifest in C. sordellii infections.

Late Symptoms

Severe cases of Clostridium sordellii infections are extremely rare, but deadly. The progression from early to late symptoms is usually rapid, occurring within hours after the first signs of any illness (1). In women, the C. sordellii infection can develop into Clostridium sordellii Toxic Shock Sydrome (CSTS), which is associated with gynecological procedures, childbirth and abortion (5). CSTS is an acute illness that often manifests in previously healthy persons (5). The symptoms of this syndrome are edema, effusion, intense leukocytosis and hemoconcentration and eventually multi-organ failure (5). In males, C. sordellii infections occur after trauma or surgery on the soft-tissue of the body (1). Soft-tissue edema and collections of fluid in the peritoneal cavities and pleural spaces ensues (1). Severe necroses, along with interstitial hemorrhage and neutrophilic infiltrates, have appeared in histopathologic examinations of deceased patients with this disease(1). From 1927-2006, 43 patients were reported in medical databases to have contracted C. sordellii infections with a mortality rate of 100% (1). Tachycardia and hypotension were strong indicators of subsequent mortality (1).

References

Created by Caitlyn Baukal, student of Tyrrell Conway at the University of Oklahoma.