Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
Department of Biochemical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.
J Nephrol. 2024 Jan;37(1):181-186. doi: 10.1007/s40620-023-01641-9. Epub 2023 Jun 14.
Clostridium septicum (C. septicum) is a zoonotic bacillus found in 2.8% of healthy human stools. In humans, it can cause serious infections such as bacteremia, myonecrosis, and encephalitis by spreading through the bloodstream. Reports of Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome complicated by C. septicum superinfection are rare, likely because colonic microangiopathic lesions by Shiga toxin-producing Escherichia Coli facilitate bacterial dissemination. Only 13 cases of Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome with C. septicum superinfection have been reported to date, according to our litterature review, with a 50% mortality rate. The lack of clinico-laboratory clues suggesting this condition makes the diagnosis challenging. For these reasons C. septicum superinfection usually goes undiagnosed in patients with Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome, and results in unfavorable outcomes. In this paper, we describe the case of a 5-year-old girl admitted for Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome who developed C. septicum coinfection leading to a fatal outcome. We carried out a review of the available literature on C. septicum infection complicating Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome and we compared the clinical features of the observed cases with those of an historical cohort of uncomplicated Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome. The mechanisms of superinfection are still unclear and clinical features are indistinguishable from those of uncomplicated Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome. However, rapid deterioration of clinical conditions and evidence of neurological involvement, associated with abnormal radiological findings, require immediate management. Although therapeutic approaches have not been directly compared, neurosurgical treatment of amenable lesions may improve the clinical outcome of patients with C. septicum-hemolytic-uremic syndrome.
败毒梭菌（C. septicum）是一种存在于 2.8%健康人粪便中的动物源性杆菌。在人类中，它可以通过血液传播引起严重感染，如菌血症、肌坏死和脑炎。由产志贺毒素大肠埃希菌引起的溶血性尿毒综合征并发败毒梭菌感染的报告很少见，这可能是因为产志贺毒素大肠埃希菌引起的结肠微血管病变有利于细菌传播。根据我们的文献回顾，到目前为止，只有 13 例产志贺毒素大肠埃希菌引起的溶血性尿毒综合征并发败毒梭菌感染的病例报告，死亡率为 50%。由于缺乏提示这种情况的临床和实验室线索，因此诊断具有挑战性。由于这些原因，产志贺毒素大肠埃希菌引起的溶血性尿毒综合征患者通常会漏诊败毒梭菌感染，导致不良结局。在本文中，我们描述了一例 5 岁女孩因产志贺毒素大肠埃希菌引起的溶血性尿毒综合征入院，并发败毒梭菌合并感染导致致命结局的病例。我们对产志贺毒素大肠埃希菌引起的溶血性尿毒综合征并发败毒梭菌感染的文献进行了回顾，并比较了观察病例与产志贺毒素大肠埃希菌引起的溶血性尿毒综合征无合并感染的历史队列的临床特征。继发感染的机制尚不清楚，临床特征与产志贺毒素大肠埃希菌引起的溶血性尿毒综合征无合并感染的临床特征无法区分。然而，临床状况的迅速恶化和神经受累的证据，同时伴有异常的影像学发现，需要立即进行治疗。尽管治疗方法尚未直接比较，但针对可治疗病变的神经外科治疗可能会改善败毒梭菌-溶血性尿毒综合征患者的临床结局。
