Clostridium tertiumin Necrotizing Fasciitis and Gangrene

Clostridium tertium in Necrotizing Fasciitis and GangreneTo the Editor: Bacterial species of the genus Clostridium are anaerobic or aerotolerant, gram-positive, endospore-forming bacilli found in the soil and gut of humans and other animals.These species cause botulism, tetanus, gas gangrene, antibiotic-associated diarrhea, pseudomembranous colitis, foodborne diarrhea, and necrotic enteritis in humans and infections in other animals.Clostridium tertium, a non-exotoxinproducing, aerotolerant species, is an uncommon human pathogen.First isolated by Henry from war wounds in 1917 (1), C. tertium was recognized as a human pathogen when cases of bacteremia were reported in 1963 (2).The organism has been implicated in bacteremia (3,4), meningitis (5), septic arthritis (6), enterocolitis (7), spontaneous bacterial peritonitis (8), posttraumatic brain abscess (9), and pneumonia (4).Miller and colleagues, in a recent review of 32 cases, highlighted the role of neutropenia, intestinal mucosal injury, and exposure to β-lactam antibiotics predisposing to C. tertium bacteremia (3).C. tertium as the sole pathogen causing necrotizing fasciitis and gangrene has not been reported.We report the first two cases of necrotizing fasciitis and gangrene caused by C. tertium.A 58-year-old man was seen at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, on August 17, 2001, with two nonhealing, punched-out ulcers near the right lateral malleolus.The ulcers were approximately 2 cm x 2.5 cm in size, with necrotic margins, purulent exudate, and a foul odor.On the second day, temperature of 39.4°C and gangrene of the right leg developed.The patient also had alcoholic liver disease and non-Hodgkin lymphoma,