THE ED PLYMOUTH
  • Home
    • About us
    • TUEC >
      • Timeline
      • Current drawings
  • Education
    • Derrifoam Blog >
      • Get involved
      • FOAM
    • Education Faculty >
      • Core Education guide
    • Core education >
      • non-accs
      • accs
    • Higher specialist education
  • Clinical
    • EM Induction
    • Guidelines

Trust me, It'll grow on you

2/6/2015

1 Comment

 
A middle aged male patient presents to Emergency Department following a brief severe retrosternal pain which has now resolved. He's currently undergoing chemotherapy and radiotherapy for esophageal cancer.  When you see him, he's pain free, afebrile and reasonably well appearing with an unremarkable clinical exam
All kinds of scary differentials raise their head: Radiation oesophagitis,  mediastinitis, oesophageal rupture, radiation pericarditis , pleural effusion, PE, aortic dissection, ACS, severe reflux / gastritis to name but a few...

In the end, his chest Xray is normal, his bloods show (borderline) neutropenia  with no evidence of sepsis, and he goes home, advised to keep an eye on his temperatures.

A few days later his blood cultures grow Clostridium Ramosum.

What is it?   Is it a contaminant?  Does it matter?

Clostridium spp. are ubiquitous in the human gut but rarely pathogenic and are NOT skin commensals. There are in fact 200 species of which 30 are associated with disease.  We are more familiar with Clostrium tetani, perfringens, difficile and botulinum.
Clostridium ramosum is the most common commensal clostridial species in humans. 

A review of 12 case reports has identified three main patient demographics : immunocompromised patients with bacteremia, children with acute or chronic otitis media and patients with bowel perforation and abscess formation.

This particular patient probably radiation oesophagitis with translocation of bacteria from his esophagus.

Would you treat this patient with antibiotics ?

Fortunately resistance to antibiotics is rare and in this particular case the patient was commenced on penicillin by his GP and did well.  Due to confirmed bacteremia and neutropenia the decision to treat was correct. 

1 Comment
maag sering kambuh ? sembuhkan dengan 5 tanaman herbal ini link
20/3/2019 07:51:04

This article is very useful, thank you for sharing. And allow me to share articles too, it's about health and treatment. God willing

Reply



Leave a Reply.

    Categories

    All
    ACCS
    Cardiology
    ENT
    Minors
    Non Tech
    Non-tech
    Orthopaedics
    Paediatric
    Radiology
    Safety
    Simulation
    Toxicology

    The Derrifoam Blog

    Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....

    Subscribe to our mailing list

    * indicates required

    Archives

    October 2022
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    July 2020
    June 2020
    May 2020
    April 2020
    January 2020
    December 2019
    July 2019
    May 2019
    February 2019
    December 2018
    November 2018
    September 2018
    July 2018
    May 2018
    April 2018
    December 2017
    November 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    November 2016
    September 2016
    August 2016
    July 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    November 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    January 2015
    November 2014
    October 2014
    September 2014
    August 2014

Picture
  • Home
    • About us
    • TUEC >
      • Timeline
      • Current drawings
  • Education
    • Derrifoam Blog >
      • Get involved
      • FOAM
    • Education Faculty >
      • Core Education guide
    • Core education >
      • non-accs
      • accs
    • Higher specialist education
  • Clinical
    • EM Induction
    • Guidelines