{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:17:42Z","timestamp":1787836662246,"version":"build-2784847793"},"reference-count":22,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,3,1]]},"abstract":"<jats:p>Clostridium septicum is an anaerobic bacterium that causes rapidly progressive myonecrosis, bacteremia, and central nervous system infection. It has been reported as a complication of Escherichia coli hemolytic uremic syndrome (HUS) in 8 children worldwide; 5 children died, and the 3 reported survivors had surgically treated disease. We present 3 cases of C septicum complicating HUS in children, including the first 2 reported cases of survival without surgical intervention. All patients presented with classic cases of HUS with initial clinical improvement followed by deterioration. Patient 1 had rising fever, tachycardia, and severe abdominal pain 24 hours after admission. She developed large multifocal intraparenchymal cerebral hemorrhages and died 12 hours later. Autopsy revealed C septicum intestinal necrosis, myonecrosis, and encephalitis. Patient 2 had new fever, increasing leukocytosis, and severe abdominal pain on hospital day 4. She was diagnosed with C septicum bacteremia and treated with metronidazole, meropenem, and clindamycin. Patient 3 had new fever and increasing leukocytosis on hospital day 3; blood cultures grew C septicum, and she was treated with penicillin. Patients 2 and 3 improved rapidly and did not require surgery. C septicum is a potential co-infection with E coli. It thrives in the anaerobic environment of E coli\u2013damaged intestinal mucosa and translocates to cause systemic infection. Fever, tachycardia, a rising white blood cell count, and abdominal pain out of proportion to examination are key findings for which physicians should be vigilant. Timely evaluation by anaerobic blood culture and early initiation of antibiotics are necessary to prevent fatalities.<\/jats:p>","DOI":"10.1542\/peds.2016-1362","type":"journal-article","created":{"date-parts":[[2017,2,9]],"date-time":"2017-02-09T10:05:11Z","timestamp":1486634711000},"source":"Crossref","is-referenced-by-count":13,"title":["<i>C septicum<\/i> Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention"],"prefix":"10.1542","volume":"139","author":[{"given":"Rachel M.","family":"Engen","sequence":"first","affiliation":[{"name":"Departments of Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Y.","family":"Killien","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Davis","sequence":"additional","affiliation":[{"name":"Pathology, Seattle Children\u2019s Hospital and University of Washington School of Medicine, Seattle, Washington; and"},{"name":"Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan M.","family":"Symons","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia M.","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2017,3,1]]},"reference":[{"issue":"7","key":"2021120907463325600_B1","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s00467-008-0774-5","article-title":"Clostridium septicum myonecrosis complicating diarrhea-associated hemolytic uremic syndrome.","volume":"23","author":"Hunley","year":"2008","journal-title":"Pediatr Nephrol"},{"key":"2021120907463325600_B2","doi-asserted-by":"crossref","first-page":"bcr2012006424","DOI":"10.1136\/bcr-2012-006424","article-title":"A microbiological hazard of rural living: Clostridium septicum brain abscess in a child with E coli 0157 associated haemolytic uraemic syndrome.","volume":"2012","author":"Williams","year":"2012","journal-title":"BMJ Case Rep"},{"issue":"4","key":"2021120907463325600_B3","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/j.jpedsurg.2013.01.033","article-title":"Clostridium septicum gas gangrene in a previously healthy 8-year-old female with survival.","volume":"48","author":"Pinzon-Guzman","year":"2013","journal-title":"J Pediatr Surg"},{"issue":"5","key":"2021120907463325600_B4","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1111\/j.1365-2958.2005.04774.x","article-title":"The \u03b1-toxin of Clostridium septicum is essential for virulence.","volume":"57","author":"Kennedy","year":"2005","journal-title":"Mol Microbiol"},{"issue":"4","key":"2021120907463325600_B5","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2005-1074","article-title":"Clostridium septicum infections in children: a case report and review of the literature.","volume":"117","author":"Smith-Slatas","year":"2006","journal-title":"Pediatrics"},{"issue":"1","key":"2021120907463325600_B6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jss.2008.02.027","article-title":"Phenotyping Clostridium septicum infection: a surgeon\u2019s infectious disease.","volume":"148","author":"Hermsen","year":"2008","journal-title":"J Surg Res"},{"issue":"9464","key":"2021120907463325600_B7","first-page":"1073","article-title":"Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome.","volume":"365","author":"Tarr","year":"2005","journal-title":"Lancet"},{"issue":"1","key":"2021120907463325600_B8","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/j.1750-3639.2011.00555.x","article-title":"A 2-year-old boy with hemolytic uremic syndrome and pneumocephalus.","volume":"22","author":"Martin","year":"2012","journal-title":"Brain Pathol"},{"issue":"2","key":"2021120907463325600_B9","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3201\/eid0402.980224","article-title":"Clostridium septicum infection and hemolytic uremic syndrome.","volume":"4","author":"Barnham","year":"1998","journal-title":"Emerg Infect Dis"},{"issue":"12","key":"2021120907463325600_B10","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1177\/000992289303201211","article-title":"Clostridium septicum sepsis and meningitis as a complication of the hemolytic-uremic syndrome.","volume":"32","author":"Broughton","year":"1993","journal-title":"Clin Pediatr (Phila)"},{"issue":"1","key":"2021120907463325600_B11","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/00006454-199501000-00019","article-title":"Brain abscesses caused by Clostridium septicum as a complication of hemolytic-uremic syndrome.","volume":"14","author":"Chiang","year":"1995","journal-title":"Pediatr Infect Dis J"},{"issue":"5","key":"2021120907463325600_B12","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1097\/00006454-198805000-00011","article-title":"Clostridium septicum sepsis and cerebritis: a rare complication of the hemolytic-uremic syndrome.","volume":"7","author":"Riccio","year":"1988","journal-title":"Pediatr Infect Dis J"},{"issue":"3","key":"2021120907463325600_B13","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/BF00588500","article-title":"Diffuse pneumocephalus due to Clostridium septicum cerebritis in haemolytic uraemic syndrome: CT demonstration.","volume":"35","author":"Randall","year":"1993","journal-title":"Neuroradiology"},{"issue":"5","key":"2021120907463325600_B14","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1097\/INF.0000000000000203","article-title":"Clostridium septicum brain abscesses in a premature neonate.","volume":"33","author":"Sadarangani","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"2021120907463325600_B15","first-page":"237674","article-title":"Clostridium sordellii as a cause of fatal septic shock in a child with hemolytic uremic syndrome.","volume-title":"Case Rep Pediatr","author":"Beyers","year":"2014"},{"issue":"33","key":"2021120907463325600_B16","doi-asserted-by":"crossref","first-page":"3856","DOI":"10.3748\/wjg.v17.i33.3856","article-title":"A case of gas gangrene in an immunosuppressed Crohn\u2019s patient.","volume":"17","author":"Kiel","year":"2011","journal-title":"World J Gastroenterol"},{"key":"2021120907463325600_B17","first-page":"297","article-title":"Clostridial myonecrosis","volume-title":"Red Book: 2015 Report of the Committee on Infectious Diseases","author":"American Academy of Pediatrics","year":"2015","edition":"30th ed."},{"issue":"10","key":"2021120907463325600_B18","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1093\/cid\/ciw099","article-title":"Shiga toxin-producing Escherichia coli infection, antibiotics, and risk of developing hemolytic uremic syndrome: a meta-analysis.","volume":"62","author":"Freedman","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"6","key":"2021120907463325600_B19","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1128\/JCM.02919-15","article-title":"Diagnosis of bloodstream infections in children.","volume":"54","author":"Dien Bard","year":"2016","journal-title":"J Clin Microbiol"},{"issue":"2","key":"2021120907463325600_B20","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0022-3476(95)70305-5","article-title":"Value of routine anaerobic blood cultures for pediatric patients.","volume":"127","author":"Zaidi","year":"1995","journal-title":"J Pediatr"},{"issue":"2","key":"2021120907463325600_B21","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1093\/cid\/ciu292","article-title":"Emerging technologies for rapid identification of bloodstream pathogens.","volume":"59","author":"Kothari","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2021120907463325600_B22","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piw033","article-title":"Impact of matrix-assisted laser desorption and ionization time-of-flight and antimicrobial stewardship intervention on treatment of bloodstream infections in hospitalized children [published online ahead of print June 23, 2016]","author":"Malcomson","journal-title":"J Pediactric Infect Dis Soc"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2016-1362\/1062757\/peds_20161362.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2016-1362\/1062757\/peds_20161362.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T02:28:14Z","timestamp":1639103294000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/139\/3\/e20161362\/53453\/C-septicum-Complicating-Hemolytic-Uremic-Syndrome"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,1]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,3,1]]},"published-print":{"date-parts":[[2017,3,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2016-1362","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,1]]},"article-number":"e20161362"}}