A rare case of pleural empyema caused by Clostridium baratii

2^nd International Conference on Respiratory and Pulmonary Medicine

October 17-18, 2016 Chicago, USA

Arslan Talat

Northeast Ohio Medical University, USA

Posters & Accepted Abstracts: J Pulm Respir Med

Abstract :

Introduction: Clostridium baratii is an anaerobic, motile, Gram-positive bacterium. It is a rare cause of infant botulinum. We present a rare case of pleural empyema caused by C. baratii. Case Presentation: A 74-year-old female presented to ER with chief complaint of right-sided chest pain and shortness of breath. She was discharged from the hospital 10 days ago due to small bowel obstruction caused by internal hernia resulting in laparotomy. On examination, she was afebrile and hypoxic with O2 saturation of 89%. She had diminished breath sounds in the right lung field. CT chest showed moderate right pleural effusion with compressive atelectasis and right lower lobe infiltrate. She was given vancomycin, levofloxacin and cefepime for possible healthcare associated pneumonia. Ultrasound guided right sided thoracentesis revealed exudative effusion. A 14F pigtail catheter was placed under CT guidance and tissue plasminogen activator (tPA) was infused via catheter to help drain the fluid. Total of 3.5L pleural fluid was drained over 5 days with the tPA infusion. Repeat cultures of pleural fluid came back positive for Clostridium baratii which was sensitive to Penicillin. The catheter was removed and she received a PICC line. She was discharged home with home healthcare on Ampicillin-Sulbactam to complete total of 3 weeks� treatment. During the course of treatment her symptoms resolved. Discussion: Clostridial pleuropulmonary infections are rare; most of these infections are attributed to Clostridium perfringens. Clostridium baratii, usually associated with infant botulisms has not been reported to cause pulmonary infections. Trauma, chest surgery or other invasive procedures and underlying lung disease are often found to precede clostridial empyema. In our patient, spread of C. baratii most likely occurred after a recent abdominal surgery which may have resulted from transdiaphragmatic lymphatic translocation. Intra-pleural infusion of tPA is a controversial treatment for empyema. If combined with DNase may result in better drainage. This treatment was effective in our patient and resulted in resolution of the empyema. Conclusions: Although mostly associated with infant botulisms, Clostridium baratii may be associated with other infections in immunocompetent patients particularly pulmonary infections. Infusion of tPA via catheter is an effective option before considering surgery in cases with pleural empyema.

Biography :

Email: arslantalat@gmail.com