MEDizzy - A 19-year-old man presents to the emergency department with

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Infectious Diseases

A 19-year-old man presents to the emergency department with 4 days of watery diarrhea, nausea, vomiting, and low-grade fever. He recalls no unusual meals, sick contacts, or travel. He is hydrated with IV fluid, given antiemetics, and discharged home after feeling much better.Three days later two out of three blood cultures are positive for Clostridium perfringens. He is called at home and says that he feels fine and is back to work. What should your next instruction to the patient be?

ExplanationClostridia are gram-positive spore-forming obligate anaerobes that reside normally in the gastrointestinal (GI) tract. Several clostridial species can cause severe disease. C. perfringens, which is the second most common clostridial species to normally colonize the GI tract, is associated with food poisoning, gas gangrene, and myonecrosis. C. septicum is seen often in conjunction with GI tumors. C. sordellii is associated with septic abortions. All can cause a fulminant overwhelming bacteremia, but this condition is rare. The fact that this patient is well several days after his acute complaints rules out this fulminant course. A more common scenario is transient, self-limited bacteremia due to transient gut translocation during an episode of gastroenteritis. There is no need to treat when this occurs, and no further workup is necessary. Clostridium spp. sepsis rarely causes endocarditis because overwhelming disseminated intravascular coagulation and death occur so rapidly. Screening for GI tumor is warranted when C. septicum is cultured from the blood or a deep wound infection.