Fatal Clostridium septicum gas gangrene complicating ECMO: case report and review of literature
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Clostridium septicum gas gangrene is a severe and deadly infection caused by an anaerobic, spore-forming, Gram-positive bacillus. As previously described, two entities are observed: traumatic and spontaneous (or non-traumatic) forms. In this report, we aim to describe the case of a fulminant and ultimately fatal C. septicum myonecrosis occurring in a patient who was first admitted for refractory cardiac arrest and placed on veino-arterial extracorporeal membrane oxygenation (ECMO). Building upon prior studies that have documented cases of spontaneous gas gangrene caused by C. septicum, we provide an updated compilation, focusing on microbiological characteristics of C. septicum, along with the diagnostic and therapeutic challenges associated with spontaneous gas gangrene. Additionally, the specific clinical situation of our case illustrates the seriousness of this infectious complication that combined both spontaneous and traumatic gas gangrene risk factors. We thus, discuss the antibiotic coverage prior to the initiation of ECMO procedure.
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Comments to Author
Please ONLY put comments for the Author(s) in here The authors have responded postively to my comments and have improved the manuscript.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
This review is from a microbiologist who is not clinically qualified, therefore only the microbiology aspects of the manuscript are reviewed. My comments are as follows. The manuscript describes the clinical presentation of a patient who contracted Clostridium septicum infection as a complication of a cardiac arrest followed by veino-arterial extracorporeal membrane oxygenation. The manuscript describes, as far as I am aware, a very unusual clinical case and will be of interest to many clinicians as well as microbiologists. There are some unusual aspects of the manuscript which the authors should address. Notably, there is no methods section to describe the techniques used to culture, identify and characterise the C. septicum isolated from the patient. Such a methods section is invariably included …
Comments to Author
This review is from a microbiologist who is not clinically qualified, therefore only the microbiology aspects of the manuscript are reviewed. My comments are as follows. The manuscript describes the clinical presentation of a patient who contracted Clostridium septicum infection as a complication of a cardiac arrest followed by veino-arterial extracorporeal membrane oxygenation. The manuscript describes, as far as I am aware, a very unusual clinical case and will be of interest to many clinicians as well as microbiologists. There are some unusual aspects of the manuscript which the authors should address. Notably, there is no methods section to describe the techniques used to culture, identify and characterise the C. septicum isolated from the patient. Such a methods section is invariably included in a microbiology manuscript. At the very least I would like to know the methods used to identify the organism as C. septicum. It is becoming increasingly common to subject newly identified organisms to genome sequencing, as this is relatively inexpensive. Such analysis can inform us of many aspects of a pathogen, notably which virulence factors are present in the genome, such as toxins to which the authors refer in the manuscript. Was genome sequencing considered? The authors refer to the limited knowledge of antibiotic susceptibility of C. septicum (lines 149 -155) but do not refer to any results of antibiotic testing on the isolate recovered from the patient. Were such tests carried out and if so, please report them in the manuscript. The section describing C. septicum gas gangrene is very long and is not related to the results presented in the manuscript. Can the authors consider either shortening this section, or including reference to the clinical presentation described, so that links can be made between the literature and the observed case? The Discussion section is very clear and does relate the findings to accepted clinical practice.
Please rate the quality of the presentation and structure of the manuscript
Good
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
line 141: please describe your method for detection of C. septicum. line 122 and 123: In contrast to other Clostridium species (add like as C. perfringens).
Please rate the quality of the presentation and structure of the manuscript
Very good
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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