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Chapter 53 : Clostridium*

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Abstract:

Severe infections caused by species have been described in the medical literature for centuries—largely because of their fulminant nature, distinctive clinical presentations, and complex management issues. The pathogenesis of these infections is attributable to the production of potent extracellular toxins, many of which are also diagnostically important. This review highlights the microbiological, epidemiological, and clinical characteristics of these infections, with emphasis on both classical and state-of-the-art identification methods and typing systems. The rapid and severe course of these infections mandates clear communication between the clinical microbiology laboratory and the health care provider in order to institute early interventions and appropriate antimicrobial treatment. Current antimicrobial susceptibilities among the clostridia are also presented, as are the evaluation, interpretation, and reporting of clinical microbiology laboratory results. Application of this integrated body of knowledge can reduce the incidence, lessen the severity, and improve outcomes of these devastating clostridial infections.

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
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Image of FIGURE 1
FIGURE 1

(top row, left) Gram stain of . Note the thin, Gram stain-variable bacilli with distinct spores. Reprinted with permission from . doi:10.1128/9781555817381.ch53.f1

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
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Image of FIGURE 2
FIGURE 2

(top row, right) Lecithinase reaction on egg yolk agar. Note the opacity of the agar surrounding colonies due to precipitation of complex fats. Reprinted with permission from . doi:10.1128/9781555817381.ch53.f2

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
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Image of FIGURE 3
FIGURE 3

(middle row, left) on CCFA. Note the yellow, ground-glass appearance of colonies. Reprinted with permission from . doi:10.1128/9781555817381.ch53.f3

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
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Image of FIGURE 4
FIGURE 4

(middle row, right) on blood agar showing a double zone of beta-hemolysis. Reprinted with permission from . doi:10.1128/9781555817381.ch53.f4

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
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Image of FIGURE 5
FIGURE 5

(bottom row, left) on blood agar after 12 h of incubation. Note the spreading colonies. Courtesy of E. J. Baron. doi:10.1128/9781555817381.ch53.f5

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
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Image of FIGURE 6
FIGURE 6

(bottom row, right) Gram stain of . Note the long, filamentous bacilli with rare spores. Courtesy of E. J. Baron. doi:10.1128/9781555817381.ch53.f6

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
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Tables

Generic image for table
TABLE 1

Characteristics of species of clinical significance

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
Generic image for table
TABLE 1

Characteristics of species of clinical significance

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
Generic image for table
TABLE 2

Commonly used tests for the diagnosis of disease

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
Generic image for table
TABLE 3

Rapid identification of some lecithinase-positive and/or swarming spp. of clinical significance

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53
Generic image for table
TABLE 4

Activities of various drugs against spp. (Wadsworth agar dilution procedure)

Citation: Stevens D, Bryant A, Carroll K. 2015. Clostridium*, p 940-966. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch53

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