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Clostridium septicum Case Series: A 5-Year Experience at a Cancer Center

AbstractThe clostridia species are opportunistic pathogens responsible for some of the deadliest diseases including gas gangrene, tetanus, and botulism. Clostridium septicum is a rare subgroup found to cause atraumatic myonecrosis. It is a Gram-positive, anaerobic, spore-forming bacilli found in the gastrointestinal tract. Although rare, in the setting of malignancy or immunosuppression, it is associated with direct, spontaneous infections of the bowel and peritoneal cavity. The anaerobic glycolysis of the tumor produces an acidic, hypoxic environment favoring germination of clostridial spores. Tumor-induced mucosal ulceration allows for translocation of sporulated bacteria from the bowel into the bloodstream, leading to fulminant sepsis. Over 80% of C. septicum cases are associated with underlying malignancy, and it is associated with greater than 60% mortality rate. The majority of deaths occur within the first 24 hours if diagnosis and appropriate treatment measures are not promptly started. Therefore, in patients whom a C. septicum infection is diagnosed without a clear underlying etiology, there should be a strong suspicion for an associated malignancy. We report a case series of C. septicum bacteremia in patients with underlying malignancy, a 5-year experience at a cancer institute, as a reminder of the importance of early diagnosis.