Content area
Full Text
ABSTRACT
Haemodialysis patients have acquired immunity disturbances, co-morbidities and a vascular access, factors predisposing them to infection and bacteraemia. Clostridium perfringens is an anaerobic bacterium potentially causing severe infections, including rarely septic arthritis. We report the first case of Clostridium perfringens septic arthritis in a haemodialysis patient and suggest a haematogenous spread. After rapid joint lavage combined with appropriate anti-microbial therapy, the patient recovered.
Key words: septic arthritis, Clostridium perfringens, haemodialysis
INTRODUCTION
Haemodialysis (HD) patients have acquired immunity disturbances, co-morbidities and a vascular access, these factors predisposing them to infection and bacteraemia (1-3). The type of vascular access is the most important predictor of infection, with native arteriovenous (AV) fistulas being safer than AV grafts [relative risk (RR) of bloodstream infection of 1.47 when compared to AV fistulas], and cuffed central venous catheters (RR 8.49) (4). Most bacteraemia in HD patients are caused by Gram-positive pathogens, predominantly Staphylococcus aureus and Staphylococcus epidermidis, and are frequently associated with metastatic complications (mainly endocarditis and osteoarticular infections) (3).
Clostridium perfringens is an anaerobic bacterium, potentially causing severe infections, such as gas gangrenes and food borne toxin-mediated infection, and rarely septic arthritis (5). We report the first case of Clostridium perfringens septic arthritis in a haemodialysis patient.
CASE REPORT
A 36-year-old Caucasian man presented to our HD unit in November 2009 with hyperglycaemia (479 mg/dl), fatigue and persistent right hip and calf pain since 2 days. He had been examined in the emergency unit the day before, and conventional radiography of the hip showed no fracture or increased peri-articular soft-tissue density. Trochanteric tendinitis was diagnosed and the patient was sent home with analgesics. His medical history included type1-diabetes mellitus with advanced retinopathy leading to blindness and diabetic nephropathy, chronic hepatitis C and alcohol and past drug (cocaine and heroin) use. HIV testing was negative in July 2009. He was on HD for the last 3 years via a right internal jugular tunnelled catheter and was receiving acenocoumarol (anti-vitamin K, a derivative of coumarin) since 2007 for a superior vena cava thrombosis. He had a low socioeconomic status and had been repeatedly hospitalised for severe hypoglycaemia. His regular medications included aspirin, insulin, losartan, omeprazole, sevelamer, amlodipine and calcium carbonate.
At the HD unit, the patient complained of chills....