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Didier Raoult - One of the best experts on this subject based on the ideXlab platform.

  • clostridium tetani osteitis without tetanus
    Emerging Infectious Diseases, 2014
    Co-Authors: Pierreyves Levy, M Million, P Brouqui, Pierreedouard Fournier, Laurene Lotte, Didier Raoult
    Abstract:

    To the Editor: Posttraumatic osteoarticular infections caused by Clostridium spp. are rare, and their outcomes are often unfavorable because of the persistence of the bacteria in bone (1,2). In a recent series of 12 patients (2), only 1 case of posttraumatic osteoarticular infection was caused by C. tetani (fracture of the distal humerus with polymicrobial infection). However, no information was available about the production of Tetanospasmin by the infecting strain. To the best of our knowledge, the only case of C. tetani infection with a toxigenic strain but without tetanus or osteitis was a wound infection that quickly improved after administration of antitetanus vaccine, prophylactic immunoglobulins, flucloxacillin, and metronidazole (3). The absence of clinical signs of tetanus despite chronic C. tetani infection probably resulted from vaccine-induced immunity and the fact that the patient received a booster vaccination and prophylactic immunoglobulins as soon as C. tetani had been identified. Retrospective immunochromatic testing of the patient’s serum seemed to confirm this hypothesis. We report a case of osteitis caused by C. tetani in which clinical signs of tetanus did not develop despite production of Tetanospasmin by the infecting strain. In August 2011, a 26-year-old man was admitted to Nord Hospital in Marseille, France, because of an open fracture of his left tibia and fibula, contaminated with soil. The patient had been vaccinated against tetanus in 1997 and worked in scraps recycling, He rapidly underwent osteosynthesis (locking plates). Despite receiving oral amoxicillin–clavulanate (1 g 2 times/day) for 7 days, he was readmitted 12 days later for fever and suppuration of the leg wound and underwent a second surgical debridement. A bone biopsy sample revealed Enterococcus faecalis, Enterobacter cloacae, and C. tetani. Identification of C. tetani was confirmed by 16S rRNA amplification and sequencing (99.8% identity to C. tetani, GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"AE015927","term_id":"28204652","term_text":"AE015927"}}AE015927). The organism was susceptible to amoxicillin, rifampin, vancomycin, and metronidazole. Because antitetanus vaccine had not been administered at the time of his previous hospital admission, a dose of vaccine and prophylactic immunoglobulins were administered at this time. Treatment with intravenous imipenem (1 g 3 times/day) plus oral ciprofloxacin (500 mg 3 times/day) was initiated for 1 month, followed by oral amoxicillin–clavulanate (1 g 2 times/day) plus ciprofloxacin (500 mg 3 times/day) for 1 month and then oral amoxicillin (2 g 3 times/day) for 2 months. In February 2012, because bone consolidation had not occurred, the patient underwent surgical revision to remove the locking plate, clean the wound, and insert an external fixator. Cultures of specimens collected during surgery were negative. Serologic qualitative immunochromatic test result was positive for C. tetani. The patient received intravenous vancomycin and imipenem (1 g 2 times/day each) for 1 month, followed by oral amoxicillin (3 g 2 times/day), rifampin (300 mg 3 times/day), and ciprofloxacin (500 mg 3 times/day) for 3 months. In July 2012 (11 months after the accident), because of fistula persistence, the patient underwent ablation of a tibial sequestrum (Figure) and implantation of a temporary cement spacer containing gentamicin and vancomycin. The only bacterium isolated from a tibial biopsy sample was C. tetani. Figure Radiograph of left leg of patient with Clostridium tetani infection, showing delayed bone consolidation 11 months after fracture. The causative strain was referred to the Centre National de Reference des Bacteries Anaerobies et du Botulisme, Pasteur Institute, Paris, where presence of the tetX gene encoding the tetanus neurotoxin was confirmed. Oral treatment with clindamycin (2.4 g/day) for 4 months was prescribed. However, because of the unfavorable outcome despite multiple interventions and antimicrobial drug regimens, the left leg was amputated 17 months after the accident. The case reported here is remarkable because clinical tetanus did not develop despite the production of Tetanospasmin by the infecting strain and because late relapse occurred despite adapted treatment. The persistence of infection might be explained by a questionable initial antimicrobial drug regimen but also by spore formation and/or poor diffusion of antimicrobial drugs, as suggested by the presence of necrotic tissues such as the bone sequestrum. However, surgical revision, notably the ablation of this defect, should have facilitated the recovery and decreased bacterial concentration. In the literature, 3 cases of relapsing C. tetani infections have been reported, but those patients had not received antitetanus vaccine and they did show signs of tetanus (4,5); 1 of these patients with mandible necrosis experienced relapse 8 months after discontinuation of metronidazole. The pathogenesis of C. tetani has mainly been attributed to its toxin. Our report suggests that C. tetani can also cause focal infections, notably severe chronic osteitis after open fractures, especially because the anatoxin-based antitetanus vaccine does not prevent colonization and infection.

  • genome of a chronic osteitis causing clostridium tetani
    new microbes and new infections, 2014
    Co-Authors: P E Fournier, Pierreyves Levy, M Million, Olivier Croce, Caroline Blanctailleur, P Brouqui, Didier Raoult
    Abstract:

    We sequenced the genome of a Clostridium tetani strain that caused chronic tibial osteitis without any clinical sign of tetanus in a 26-year-old man previously vaccinated against this disease. The genome contained a plasmid that harboured the tetX-tetR Tetanospasmin operon, and was highly similar to that of a tetanus-causing strain.

Pierreyves Levy - One of the best experts on this subject based on the ideXlab platform.

  • clostridium tetani osteitis without tetanus
    Emerging Infectious Diseases, 2014
    Co-Authors: Pierreyves Levy, M Million, P Brouqui, Pierreedouard Fournier, Laurene Lotte, Didier Raoult
    Abstract:

    To the Editor: Posttraumatic osteoarticular infections caused by Clostridium spp. are rare, and their outcomes are often unfavorable because of the persistence of the bacteria in bone (1,2). In a recent series of 12 patients (2), only 1 case of posttraumatic osteoarticular infection was caused by C. tetani (fracture of the distal humerus with polymicrobial infection). However, no information was available about the production of Tetanospasmin by the infecting strain. To the best of our knowledge, the only case of C. tetani infection with a toxigenic strain but without tetanus or osteitis was a wound infection that quickly improved after administration of antitetanus vaccine, prophylactic immunoglobulins, flucloxacillin, and metronidazole (3). The absence of clinical signs of tetanus despite chronic C. tetani infection probably resulted from vaccine-induced immunity and the fact that the patient received a booster vaccination and prophylactic immunoglobulins as soon as C. tetani had been identified. Retrospective immunochromatic testing of the patient’s serum seemed to confirm this hypothesis. We report a case of osteitis caused by C. tetani in which clinical signs of tetanus did not develop despite production of Tetanospasmin by the infecting strain. In August 2011, a 26-year-old man was admitted to Nord Hospital in Marseille, France, because of an open fracture of his left tibia and fibula, contaminated with soil. The patient had been vaccinated against tetanus in 1997 and worked in scraps recycling, He rapidly underwent osteosynthesis (locking plates). Despite receiving oral amoxicillin–clavulanate (1 g 2 times/day) for 7 days, he was readmitted 12 days later for fever and suppuration of the leg wound and underwent a second surgical debridement. A bone biopsy sample revealed Enterococcus faecalis, Enterobacter cloacae, and C. tetani. Identification of C. tetani was confirmed by 16S rRNA amplification and sequencing (99.8% identity to C. tetani, GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"AE015927","term_id":"28204652","term_text":"AE015927"}}AE015927). The organism was susceptible to amoxicillin, rifampin, vancomycin, and metronidazole. Because antitetanus vaccine had not been administered at the time of his previous hospital admission, a dose of vaccine and prophylactic immunoglobulins were administered at this time. Treatment with intravenous imipenem (1 g 3 times/day) plus oral ciprofloxacin (500 mg 3 times/day) was initiated for 1 month, followed by oral amoxicillin–clavulanate (1 g 2 times/day) plus ciprofloxacin (500 mg 3 times/day) for 1 month and then oral amoxicillin (2 g 3 times/day) for 2 months. In February 2012, because bone consolidation had not occurred, the patient underwent surgical revision to remove the locking plate, clean the wound, and insert an external fixator. Cultures of specimens collected during surgery were negative. Serologic qualitative immunochromatic test result was positive for C. tetani. The patient received intravenous vancomycin and imipenem (1 g 2 times/day each) for 1 month, followed by oral amoxicillin (3 g 2 times/day), rifampin (300 mg 3 times/day), and ciprofloxacin (500 mg 3 times/day) for 3 months. In July 2012 (11 months after the accident), because of fistula persistence, the patient underwent ablation of a tibial sequestrum (Figure) and implantation of a temporary cement spacer containing gentamicin and vancomycin. The only bacterium isolated from a tibial biopsy sample was C. tetani. Figure Radiograph of left leg of patient with Clostridium tetani infection, showing delayed bone consolidation 11 months after fracture. The causative strain was referred to the Centre National de Reference des Bacteries Anaerobies et du Botulisme, Pasteur Institute, Paris, where presence of the tetX gene encoding the tetanus neurotoxin was confirmed. Oral treatment with clindamycin (2.4 g/day) for 4 months was prescribed. However, because of the unfavorable outcome despite multiple interventions and antimicrobial drug regimens, the left leg was amputated 17 months after the accident. The case reported here is remarkable because clinical tetanus did not develop despite the production of Tetanospasmin by the infecting strain and because late relapse occurred despite adapted treatment. The persistence of infection might be explained by a questionable initial antimicrobial drug regimen but also by spore formation and/or poor diffusion of antimicrobial drugs, as suggested by the presence of necrotic tissues such as the bone sequestrum. However, surgical revision, notably the ablation of this defect, should have facilitated the recovery and decreased bacterial concentration. In the literature, 3 cases of relapsing C. tetani infections have been reported, but those patients had not received antitetanus vaccine and they did show signs of tetanus (4,5); 1 of these patients with mandible necrosis experienced relapse 8 months after discontinuation of metronidazole. The pathogenesis of C. tetani has mainly been attributed to its toxin. Our report suggests that C. tetani can also cause focal infections, notably severe chronic osteitis after open fractures, especially because the anatoxin-based antitetanus vaccine does not prevent colonization and infection.

  • genome of a chronic osteitis causing clostridium tetani
    new microbes and new infections, 2014
    Co-Authors: P E Fournier, Pierreyves Levy, M Million, Olivier Croce, Caroline Blanctailleur, P Brouqui, Didier Raoult
    Abstract:

    We sequenced the genome of a Clostridium tetani strain that caused chronic tibial osteitis without any clinical sign of tetanus in a 26-year-old man previously vaccinated against this disease. The genome contained a plasmid that harboured the tetX-tetR Tetanospasmin operon, and was highly similar to that of a tetanus-causing strain.

P Brouqui - One of the best experts on this subject based on the ideXlab platform.

  • clostridium tetani osteitis without tetanus
    Emerging Infectious Diseases, 2014
    Co-Authors: Pierreyves Levy, M Million, P Brouqui, Pierreedouard Fournier, Laurene Lotte, Didier Raoult
    Abstract:

    To the Editor: Posttraumatic osteoarticular infections caused by Clostridium spp. are rare, and their outcomes are often unfavorable because of the persistence of the bacteria in bone (1,2). In a recent series of 12 patients (2), only 1 case of posttraumatic osteoarticular infection was caused by C. tetani (fracture of the distal humerus with polymicrobial infection). However, no information was available about the production of Tetanospasmin by the infecting strain. To the best of our knowledge, the only case of C. tetani infection with a toxigenic strain but without tetanus or osteitis was a wound infection that quickly improved after administration of antitetanus vaccine, prophylactic immunoglobulins, flucloxacillin, and metronidazole (3). The absence of clinical signs of tetanus despite chronic C. tetani infection probably resulted from vaccine-induced immunity and the fact that the patient received a booster vaccination and prophylactic immunoglobulins as soon as C. tetani had been identified. Retrospective immunochromatic testing of the patient’s serum seemed to confirm this hypothesis. We report a case of osteitis caused by C. tetani in which clinical signs of tetanus did not develop despite production of Tetanospasmin by the infecting strain. In August 2011, a 26-year-old man was admitted to Nord Hospital in Marseille, France, because of an open fracture of his left tibia and fibula, contaminated with soil. The patient had been vaccinated against tetanus in 1997 and worked in scraps recycling, He rapidly underwent osteosynthesis (locking plates). Despite receiving oral amoxicillin–clavulanate (1 g 2 times/day) for 7 days, he was readmitted 12 days later for fever and suppuration of the leg wound and underwent a second surgical debridement. A bone biopsy sample revealed Enterococcus faecalis, Enterobacter cloacae, and C. tetani. Identification of C. tetani was confirmed by 16S rRNA amplification and sequencing (99.8% identity to C. tetani, GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"AE015927","term_id":"28204652","term_text":"AE015927"}}AE015927). The organism was susceptible to amoxicillin, rifampin, vancomycin, and metronidazole. Because antitetanus vaccine had not been administered at the time of his previous hospital admission, a dose of vaccine and prophylactic immunoglobulins were administered at this time. Treatment with intravenous imipenem (1 g 3 times/day) plus oral ciprofloxacin (500 mg 3 times/day) was initiated for 1 month, followed by oral amoxicillin–clavulanate (1 g 2 times/day) plus ciprofloxacin (500 mg 3 times/day) for 1 month and then oral amoxicillin (2 g 3 times/day) for 2 months. In February 2012, because bone consolidation had not occurred, the patient underwent surgical revision to remove the locking plate, clean the wound, and insert an external fixator. Cultures of specimens collected during surgery were negative. Serologic qualitative immunochromatic test result was positive for C. tetani. The patient received intravenous vancomycin and imipenem (1 g 2 times/day each) for 1 month, followed by oral amoxicillin (3 g 2 times/day), rifampin (300 mg 3 times/day), and ciprofloxacin (500 mg 3 times/day) for 3 months. In July 2012 (11 months after the accident), because of fistula persistence, the patient underwent ablation of a tibial sequestrum (Figure) and implantation of a temporary cement spacer containing gentamicin and vancomycin. The only bacterium isolated from a tibial biopsy sample was C. tetani. Figure Radiograph of left leg of patient with Clostridium tetani infection, showing delayed bone consolidation 11 months after fracture. The causative strain was referred to the Centre National de Reference des Bacteries Anaerobies et du Botulisme, Pasteur Institute, Paris, where presence of the tetX gene encoding the tetanus neurotoxin was confirmed. Oral treatment with clindamycin (2.4 g/day) for 4 months was prescribed. However, because of the unfavorable outcome despite multiple interventions and antimicrobial drug regimens, the left leg was amputated 17 months after the accident. The case reported here is remarkable because clinical tetanus did not develop despite the production of Tetanospasmin by the infecting strain and because late relapse occurred despite adapted treatment. The persistence of infection might be explained by a questionable initial antimicrobial drug regimen but also by spore formation and/or poor diffusion of antimicrobial drugs, as suggested by the presence of necrotic tissues such as the bone sequestrum. However, surgical revision, notably the ablation of this defect, should have facilitated the recovery and decreased bacterial concentration. In the literature, 3 cases of relapsing C. tetani infections have been reported, but those patients had not received antitetanus vaccine and they did show signs of tetanus (4,5); 1 of these patients with mandible necrosis experienced relapse 8 months after discontinuation of metronidazole. The pathogenesis of C. tetani has mainly been attributed to its toxin. Our report suggests that C. tetani can also cause focal infections, notably severe chronic osteitis after open fractures, especially because the anatoxin-based antitetanus vaccine does not prevent colonization and infection.

  • genome of a chronic osteitis causing clostridium tetani
    new microbes and new infections, 2014
    Co-Authors: P E Fournier, Pierreyves Levy, M Million, Olivier Croce, Caroline Blanctailleur, P Brouqui, Didier Raoult
    Abstract:

    We sequenced the genome of a Clostridium tetani strain that caused chronic tibial osteitis without any clinical sign of tetanus in a 26-year-old man previously vaccinated against this disease. The genome contained a plasmid that harboured the tetX-tetR Tetanospasmin operon, and was highly similar to that of a tetanus-causing strain.

M Million - One of the best experts on this subject based on the ideXlab platform.

  • clostridium tetani osteitis without tetanus
    Emerging Infectious Diseases, 2014
    Co-Authors: Pierreyves Levy, M Million, P Brouqui, Pierreedouard Fournier, Laurene Lotte, Didier Raoult
    Abstract:

    To the Editor: Posttraumatic osteoarticular infections caused by Clostridium spp. are rare, and their outcomes are often unfavorable because of the persistence of the bacteria in bone (1,2). In a recent series of 12 patients (2), only 1 case of posttraumatic osteoarticular infection was caused by C. tetani (fracture of the distal humerus with polymicrobial infection). However, no information was available about the production of Tetanospasmin by the infecting strain. To the best of our knowledge, the only case of C. tetani infection with a toxigenic strain but without tetanus or osteitis was a wound infection that quickly improved after administration of antitetanus vaccine, prophylactic immunoglobulins, flucloxacillin, and metronidazole (3). The absence of clinical signs of tetanus despite chronic C. tetani infection probably resulted from vaccine-induced immunity and the fact that the patient received a booster vaccination and prophylactic immunoglobulins as soon as C. tetani had been identified. Retrospective immunochromatic testing of the patient’s serum seemed to confirm this hypothesis. We report a case of osteitis caused by C. tetani in which clinical signs of tetanus did not develop despite production of Tetanospasmin by the infecting strain. In August 2011, a 26-year-old man was admitted to Nord Hospital in Marseille, France, because of an open fracture of his left tibia and fibula, contaminated with soil. The patient had been vaccinated against tetanus in 1997 and worked in scraps recycling, He rapidly underwent osteosynthesis (locking plates). Despite receiving oral amoxicillin–clavulanate (1 g 2 times/day) for 7 days, he was readmitted 12 days later for fever and suppuration of the leg wound and underwent a second surgical debridement. A bone biopsy sample revealed Enterococcus faecalis, Enterobacter cloacae, and C. tetani. Identification of C. tetani was confirmed by 16S rRNA amplification and sequencing (99.8% identity to C. tetani, GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"AE015927","term_id":"28204652","term_text":"AE015927"}}AE015927). The organism was susceptible to amoxicillin, rifampin, vancomycin, and metronidazole. Because antitetanus vaccine had not been administered at the time of his previous hospital admission, a dose of vaccine and prophylactic immunoglobulins were administered at this time. Treatment with intravenous imipenem (1 g 3 times/day) plus oral ciprofloxacin (500 mg 3 times/day) was initiated for 1 month, followed by oral amoxicillin–clavulanate (1 g 2 times/day) plus ciprofloxacin (500 mg 3 times/day) for 1 month and then oral amoxicillin (2 g 3 times/day) for 2 months. In February 2012, because bone consolidation had not occurred, the patient underwent surgical revision to remove the locking plate, clean the wound, and insert an external fixator. Cultures of specimens collected during surgery were negative. Serologic qualitative immunochromatic test result was positive for C. tetani. The patient received intravenous vancomycin and imipenem (1 g 2 times/day each) for 1 month, followed by oral amoxicillin (3 g 2 times/day), rifampin (300 mg 3 times/day), and ciprofloxacin (500 mg 3 times/day) for 3 months. In July 2012 (11 months after the accident), because of fistula persistence, the patient underwent ablation of a tibial sequestrum (Figure) and implantation of a temporary cement spacer containing gentamicin and vancomycin. The only bacterium isolated from a tibial biopsy sample was C. tetani. Figure Radiograph of left leg of patient with Clostridium tetani infection, showing delayed bone consolidation 11 months after fracture. The causative strain was referred to the Centre National de Reference des Bacteries Anaerobies et du Botulisme, Pasteur Institute, Paris, where presence of the tetX gene encoding the tetanus neurotoxin was confirmed. Oral treatment with clindamycin (2.4 g/day) for 4 months was prescribed. However, because of the unfavorable outcome despite multiple interventions and antimicrobial drug regimens, the left leg was amputated 17 months after the accident. The case reported here is remarkable because clinical tetanus did not develop despite the production of Tetanospasmin by the infecting strain and because late relapse occurred despite adapted treatment. The persistence of infection might be explained by a questionable initial antimicrobial drug regimen but also by spore formation and/or poor diffusion of antimicrobial drugs, as suggested by the presence of necrotic tissues such as the bone sequestrum. However, surgical revision, notably the ablation of this defect, should have facilitated the recovery and decreased bacterial concentration. In the literature, 3 cases of relapsing C. tetani infections have been reported, but those patients had not received antitetanus vaccine and they did show signs of tetanus (4,5); 1 of these patients with mandible necrosis experienced relapse 8 months after discontinuation of metronidazole. The pathogenesis of C. tetani has mainly been attributed to its toxin. Our report suggests that C. tetani can also cause focal infections, notably severe chronic osteitis after open fractures, especially because the anatoxin-based antitetanus vaccine does not prevent colonization and infection.

  • genome of a chronic osteitis causing clostridium tetani
    new microbes and new infections, 2014
    Co-Authors: P E Fournier, Pierreyves Levy, M Million, Olivier Croce, Caroline Blanctailleur, P Brouqui, Didier Raoult
    Abstract:

    We sequenced the genome of a Clostridium tetani strain that caused chronic tibial osteitis without any clinical sign of tetanus in a 26-year-old man previously vaccinated against this disease. The genome contained a plasmid that harboured the tetX-tetR Tetanospasmin operon, and was highly similar to that of a tetanus-causing strain.

Kushal Gohil - One of the best experts on this subject based on the ideXlab platform.

  • Molecular Methods for Identification of Clostridium tetani by Targeting Neurotoxin.
    Methods in molecular biology (Clifton N.J.), 2017
    Co-Authors: Basavraj S. Nagoba, Mahesh S. Dharne, Kushal Gohil
    Abstract:

    Tetanus is a potentially fatal muscle spasm disease. It is an important public health problem, especially in rural/tribal areas of developing countries. Tetanus toxin, a neurotoxin (Tetanospasmin ), is the most important virulence factor that plays a key role in the pathogenicity of tetanus . Confirmation of virulence by confirming the production of Tetanospasmin by infecting species forms the most important part in the diagnosis of tetanus . Various molecular methods have been devised for confirmation of diagnosis by targeting different genes. The most common molecular methods are Tetanospasmin producing (TetX) gene-targeted methods using TetX-specific primers. Here, we describe various molecular methods targeting TetX gene such as polymerase chain reaction, pulsed-field gel electrophoresis, Southern blotting, loop-mediated isothermal amplification assay, etc. to confirm the virulence of Cl. tetani.