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.
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.....