JMID/ 2019; 9 (3):129-132

Journal of Microbiology and Infectious Diseases doi: 10.5799/jmid.614251

CASE REPORT

Brain abscess with Clostridium cadaveris and Clostridium sporogenes

1 1 1 1
Rakesh Parakadavathu , Mohammed Abu Khathab , Muna Al-Maslamani , Arun P. Nair , Manoj K
1 2 3 3 4 4
Varghese , Anand Deshmukh , Aisha Larem , Hassan Haider , Talal Alrabayah , Adnan Khan , Faraj
1
Howady
1
Department of Microbiology, Hamad Medical Corporation, Qatar
2
Department of Microbiology, Hamad Medical Corporation, Qatar
3
Department of ENT, Hamad Medical Corporation, Qatar
4
Department of Neurosurgery, Hamad Medical Corporation, Qatar

ABSTRACT
Brain abscess is a collection of pus in the parenchyma of brain. Most common infecting organisms are streptococci,
staphylococci and anaerobes, depending upon the source from which it originates. Clostridium cadaveris and
Clostridium sporogenes are common organisms found in the gastrointestinal tract of humans, rarely producing
disease. Few cases of bacteremia and abscesses are reported with these organisms. We hereby report the first case
of brain abscess with C cadaveris and C. sporogenes in a young male with good outcome by surgical and medical
management. J Microbiol Infect Dis 2019; 9(3):129-132.
Keywords: Clostridium cadaveris, Clostridium sporogenes, Brain abscess

INTRODUCTION the last nine months. He reported no smoking,

alcohol use or intravenous drug abuse.
Clostridium species are ubiquitous, some of
them commensals of the intestinal flora and can On examination he was alert and co-operative,
lead illness like self-limiting food poisoning to life not in any distress with stable vital signs. Right
threatening gas gangrene or tetanus. C ear examination showed patent ear canal,
cadaveris and C. sporogenesis infections are yellowish discharge over tympanic membrane
extremely rare, the former being the and attic retraction pocket with cholesteatoma;
predominant bacteria during putrification of dead nervous system examination was within normal
bodies. Here we describe a case of brain limits.
abscess from which C cadaveris and C. Blood counts, routine chemistry and chest X-ray
sporogenesis were isolated with good treatment were normal. Emergency non-contrast CT scan
outcome. of the head showed hypodense lesions in right
CASE superior cerebellum at the posterior and anterior
aspect with mild peri-lesional edema, significant
21 year old male was admitted to our hospital mass effect and obstructive hydrocephalus;
with history of diffuse headache, low grade fever features suggestive of cerebellar abscess which
for two weeks and right ear discharge with pain was confirmed by MRI (Figure 1)
for one week. Four days before admission, he
developed nausea and vomited multiple times. Patient was planned for immediate aspiration of
the abscess. He was empirically given
There was history of right lower molar tooth intravenous ceftriaxone 2 g IV q 12 h,
extraction done 35 days back in a private clinic. vancomycin 1g IV q 12 h and metronidazole 750
Patient is not known to have diabetes, systemic mg IV q8h. He underwent drainage of right
hypertension or valvular heart disease. He was cerebellar abscess through suboccipital
Nepalese by origin and was residing in Qatar for paramedian burr hole, navigation guided
aspiration with external ventricular drain

Correspondence: Dr. Rakesh Parakadavathu, Department of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
E-mail: tparakadavathu@hamad.qa
Received: 16 January 2019 Accepted: 27 June 2019
Copyright © JMID / Journal of Microbiology and Infectious Diseases 2019, All rights reserved
130 Parakadavathu R, et al., Brain abscess with Clostridium

insertion, right cortical mastoidectomy and grew Pseudomonas aeruginosa that was
cholesteatoma removal from mastoid and middle sensitive to all antibiotics and hence final
ear. Eight ml of frank pus was aspirated. Gram regimen was changed to cefepime and
stain of the aspirate was obtained (Figure 2). metronidazole. Repeat MRI scan after 2 weeks
There was profuse growth of Clostridium showed resolution of smaller abscesses and
cadaveris, Clostridium sporogenes and reduction in size of the biggest one. He showed
Peptostreptococcus species as identified by good clinical improvement and continued to be
MALDI-TOF machine. asymptomatic with no signs of relapse at 2
months follow up.
Vancomycin was stopped and ceftriaxone and
metronidazole was continued. His ear discharge

Figure 1. MRI of head showing right ear cholesteatoma with right multi focal cerebellar hemisphere abscesses about
3x2, 2x1, and 1 cm diameter in cross section, with marginal enhancement and central diffusion restriction, associated
with significant right cerebellar hemispheric swelling, mid line shift, encroachment on the fourth ventricle and mild
ventriculomegaly with venous thrombosis involving right sigmoid and distal right transverse dural sinuses.

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131 Parakadavathu R, et al., Brain abscess with Clostridium

Figure 2. Pus aspirate showing profuse polymorphonuclear leukocytes, gram positive bacilli with terminal spores,
gram positive cocci and scanty gram negative bacilli. HEx100

Infections of ear, nose and throat remain the Majority of the reported cases were associated
most frequent etiology for brain abscess [1]. The with bacteremia secondary to bowel perforation
causative organism is variable, depends on the and other sources being pleura and joint. C
patient age, predisposing condition and immune cadaveris generally remain sensitive to most of
status. Commonly isolated organisms include the antibiotics [3]. Only one case of central
staphylococcus, streptococcus, bacteroides and nervous system infection- meningitis- with C
peptostreptococcus [2]. cadaveris is reported [4].
The genus Clostridium consist of more than 200 C. sporogenes was first described by
species, some of them are commensals of the Metchnikoff in 1908, who isolated it from the
gut microflora and can produce variety of gastrointestinal tracts of normal individuals and
infections in humans and animals. The patients with chronic colitis [5]. It is capable of
organisms are ubiquitous in environment. The producing a hemorrhagic toxin which contributes
commonly disease producing species include C. to the virulence [6]. C. sporogenes rarely
tetani, C. botulinum, C. perfringens, C. novyi, C. produce disease in humans and majority of
septicum, C. histolyticum, C. perfringens and C. reported cases are bacteremia in cancer
difficile. Clostridial infections can result in food patients on chemotherapy. One case of post-
poisoning, necrotizing enterocolitis, skin and soft operative septic arthritis [7] and two cases of
tissue infections and gas gangrene. empyma thorax [8,9] are also reported.
C cadaveris is commonly found in the Peptostreptococcus is one of the well described
gastrointestinal tract of humans and is the bacteria associated with brain abscess [10]. This
predominant bacteria during decomposition of is the first reported case of brain abscess with C
dead bodies. Very rarely it produces infection cadaveris and C. sporogenes. Both strains didn’t
and only nine case reports are published so far. show resistance to antibiotics except

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132 Parakadavathu R, et al., Brain abscess with Clostridium

C.sporogens which showed intermediate 5. Princewill TJT. Differences in Colony Morphology

sensitivity towards clindamycin. and Carbohydrate Fermentation of Clostridium
sporogenes. Microbiology. 1978; 108(2):315-319.
Conclusions
6. Hara-kudo Y, Ogura A, Noguchi Y, Kumagai S.
Our case is the first reported case of brain Characteristics of toxicity and haemorrhagic toxin
produced by Clostridium sporogenes in various
abscess from which C cadaveris and C.
animals and cultured cells. J Med Microbiol 1997;
sporogenes were isolated. Polymicrobial 1;46(4):270–5.
infection were reported in majority of the cases
7. Inkster T, Cordina C, Siegmeth A. Septic arthritis
of brain abscess and in one series it showed
following anterior cruciate ligament reconstruction
correlation with the bacteria in middle ear or secondary to Clostridium sporogenes; a rare
paranasal sinus in only 38%, nullifying the clinical pathogen. J Clin Pathol 2011; 1;64(9):820-
results of ENT samples for choosing antibiotic 821.
regimens [1]. We believe that the Psuedomonas 8. Corbett CE, Wall BM, Cohen M. Case report:
which grown form the ear discharge was not empyema with hydropneumothorax and
contributing to the brain abscesses but was bacteremia caused by Clostridium sporogenes.
responsible for the mastoiditis and the origin of Am J Med Sci 1996; 312(5):242–5.
the bacteria causing brain abscess is from the 9. Malmborg AS, Rylander M, Selander H. Primary
oral flora related to tooth extraction done thoracic empyema caused by Clostridium
previously. Anaerobes continues to be one of sporogenes. Scand J Infect Dis 1970;n2(2):155-
156.
the common causes of brain abscesses and the
treating physicians should be well aware of this 10. Aras Y, Sabanci PA, Izgi N, et al. Surgery for
in order to include medications to cover it in the pyogenic brain abscess over 30 years: Evaluation
of the roles of aspiration and craniotomy. Turk
empirical regimen. Isolating the precise
Neurosurg 2016; 26(1):39-47.
organism is of clinical importance as antibiotics
can be tailored and narrowed.
ACKNOWLEDGMENTS
The authors would like to thank all the staff of
Hamad Medical Corporation, Qatar, involved in
the patient care.
Conflict of Interest: There is no conflict of
interest involved in this case. Financial
Disclosure: There is no financial support in this
case report
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