Bacteraemia caused by Clostridium baratii and Kawasaki syndrome. First case report

Abstract number: r2256

Iaria  C., Stassi  G., Arena  A., Costa  G.B., La Mazza  A., Silipigni  L., Salpietro  D.C., Cascio  A.

Background: 

The clinical spectrum of clostridial bacteraemia ranges from an asymptomatic patient having an incidental positive blood culture to a full-blown, life-threatening infection. Kawasaki syndrome is an acute, self-limited systemic vasculitis of unknown aetiology that occurs in children. Its importance is due to the coronary artery aneurysms that develop in 20–25% of cases if the treatment is not given early in the course of the disease.

Case presentation: 

A 3-year-old male presented for evaluation of fever, abdominal pain, vomiting and polymorphous erythematosus rash on the extremities of 3 days duration. Three weeks before he presented with irregular fever and micropapulous exanthema over the truncus for 3 days followed after two days by perianal hyperaemia, scrotal oedema and balanopreputial hyperaemia and swelling. On admission, he was febrile (38.5°C). Physical examination showed: periungual peeling on the palms and fingers; severe hyperaemia of perianal region with peeling areas; erythematosus pharynx, strawberry tongue, dry and fissured lips, angular cheilitis; unilateral enlarged jugulodigastric nodes. Laboratory examinations revealed a white blood cell count of 5000/mL with 54% neutrophils and 38% lymphocytes. Platelet count 222.000/mL, C-reactive protein concentration of 50 mg/l and an erythrocyte sedimentation rate of 27 mm/h, serum IgA 297 mg/dl. Within the normal range anti-streptolysin O, IgM, IgG, blood urea, glycaemia, creatinine, plasma bilirubin, transaminases, gamma-glutamyltransferase, CD4+T-cells, CD8+ T-cells, CD19, NK cells, CD4/CD8 rate. No reactive for EBV, CMV, HSV-1, HSV-2, VZV, Adenovirus, Parvovirus B19, Coxsackie, Echovirus and Chlamydia pneumoniae. Results of urine analysis showed sterile pyuria. Two blood cultures were processed by the hospital microbiology laboratory using a standard blood culturing system (BACTEC 9120; Becton Dickinson). The anaerobic bottles gave a positive result at day 3 after inoculation. The biochemical profiles produced by the RapID ANA II System (Remel, Inc., Lenexa, KS) showed that the organism was Clostridium baratii with a probability of 99%.

Conclusions: 

Our report highlights the importance of C. baratii as a potential human pathogen and documents the association with symptoms never before reported in clostridial infections.