دانلود رایگان مقاله جداسازی کلستریدیوم indolis در بیمار مبتلا به ورم استخوان مزمن

In August 2014, a 37 years-old woman was admitted to the surgical intensive care unit of our tertiary care center, because of an open Cauchoix III fracture of left tibia and fibula with major skin damages and soft tissue defects after a motorcycle injury. On admission, the patient was intubated and ventilated. Body temperature was 36
C. Heart rate and blood pressure were normal. Ionogram, blood cell count and C-reactive protein (CRP) were all within normal ranges whereas serum creatinine phosphokinase (CPK) level was increased to 697 UI/L secondary to muscular lysis. She underwent emergency surgery involving orthopedic, vascular and plastic surgical procedures. The treatment consisted in trimming and washing followed by centromedular tibial osteosynthesis, anterior tibial artery bypass, deep peroneal nerve graft and finally soleus muscle flap for covering soft tissue defects. In early 2015, she presented a subcutaneous collection of fluid located close to orthopedic screws which had developed during the previous four months. On 15 June 2015, she was readmitted because of an acute purulent discharge that had started four days earlier. Her body temperature was normal and laboratory investigations revealed inflammation markers such as slightly elevated CRP (7.5 mg/L) and moderate neutrophil polynucleosis (7.9 G/L). The orthopedic treatment consisted in the removal of two screws and washing. Five bacteriological specimens were sampled as recommended [1].

These data along with the absence of other positive bacteriological samples and/or digestive symptoms, suggest that this posttraumatic chronic osteitis occurred after a telluric contamination. Furthermore, the prolonged contact between the open wound (with major soft tissue injury) and the ground after the accident can easily explain this mode of infection. In conclusion, the first case of osteitis caused by C. indolis has been described. The patient was immunocompetent and successfully treated by a multidisciplinary medico-surgical approach. The bacterium has previously been considered as non-pathogenic and data concerning C. saccharolyticum group species are still missing in the literature. Hopefully, the use of new tools in the bacterial routine identification, such as MALDI-TOF MS and 16S rDNA sequencing, will provide a better understanding of the clinical significance of clostridia in human infections.