Pediatric Clostridium septicum infections: a systematic review and case-based perspective
TL;DR
Compared with a 2006 review, rates of STEC-HUS, surgical intervention, overall survival, and absence of gastrointestinal involvement have increased and rates of STEC-HUS, surgical intervention, overall survival, and absence of gastrointestinal involvement have increased.
Abstract
Pediatric Clostridium septicum infections are extremely rare but often fulminant and rapidly progressive. They may manifest as clostridial myonecrosis, sepsis, or with gastrointestinal involvement. Systematic data on presentation, management, and outcomes remain scarce. To systematically review published pediatric cases of C. septicum infection, focusing on clinical presentation, underlying conditions, management, and outcome as an update to the review by Smith-Slatas et al. (2006). In particular, to assess how frequently gastrointestinal involvement occurs in this disease and whether its presence is associated with poorer outcomes. Furthermore, to highlight the diagnostic challenges and therapeutic urgency of this condition through a fatal case. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for reports from May 2006 to May 2025. Studies describing patients under 18 years with confirmed C. septicum infection were included. Variables included infection site, underlying disease, treatment, and outcome. A previously unpublished fatal case of pediatric clostridial myonecrosis with ileocolic intussusception was added. Fisher’s exact test was used for statistical analysis. Only 18 pediatric cases published since 2006 were found; 44% had clostridial myonecrosis and 50% gastrointestinal involvement. STEC-HUS occurred in 50%. Compared with a 2006 review, rates of STEC-HUS, surgical intervention, overall survival, and absence of gastrointestinal involvement have increased. Surgical debridement was strongly associated with survival (p < 0.01), whereas gastrointestinal involvement was associated with fatal outcome (p = 0.014). The reported child deteriorated rapidly after initial intussusception diagnosis and died despite maximal intensive care. Very few cases are available because the disease is exceptionally rare; the analysis is retrospective. Surgical source control is associated with improved survival. Gastrointestinal involvement is a major risk factor for poor outcome and may include intussusception.