Clostridium septicum infection complicating Hemolytic-Uremic Syndrome: a case report and review of the literature

Clostridium septicum (C. septicum) is a zoonotic bacillus found in 2.8% of healthy human stools. In humans, it can cause serious infections such as bacteremia, myonecrosis, and encephalitis by spreading through the bloodstream. Reports of Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome complicated by C. septicum superinfection are rare, likely because colonic microangiopathic lesions by Shiga toxin-producing Escherichia Coli facilitate bacterial dissemination. Only 13 cases of Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome with C. septicum superinfection have been reported to date, according to our litterature review, with a 50% mortality rate. The lack of clinico-laboratory clues suggesting this condition makes the diagnosis challenging. For these reasons C. septicum superinfection usually goes undiagnosed in patients with Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome, and results in unfavorable outcomes. In this paper, we describe the case of a 5-year-old girl admitted for Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome who developed C. septicum coinfection leading to a fatal outcome. We carried out a review of the available literature on C. septicum infection complicating Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome and we compared the clinical features of the observed cases with those of an historical cohort of uncomplicated Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome. The mechanisms of superinfection are still unclear and clinical features are indistinguishable from those of uncomplicated Shiga toxin-producing Escherichia Coli-related hemolytic-uremic syndrome. However, rapid deterioration of clinical conditions and evidence of neurological involvement, associated with abnormal radiological findings, require immediate management. Although therapeutic approaches have not been directly compared, neurosurgical treatment of amenable lesions may improve the clinical outcome of patients with C. septicum-hemolytic-uremic syndrome.

MO910: Anti-COVID-19 Vaccination and Haemodialysis: Safety During the Haemodialysis Session

BACKGROUND AND AIMS

A complex interplay lies between COVID-19 infection and kidney disease. Patients with COVID-19 are at an increased risk of acute kidney injury (AKI), while CKD patients represent a population at a high risk of mortality from COVID-19 [1]. For 3 years, our hospital has been running an intradyalitic vaccination project (HBV, Haemophylus, Pneumococcus, Influenza) for haemodialysis patients. No data regarding the anti-COVID-19 vaccination administered during the dialysis session are available yet. This is a safety study aimed at defining the feasibility of this vaccination protocol.

METHOD

A total of 186 haemodialysis patients from 3 centres were vaccinated with the Spikevax-Moderna vaccine (Fig. 1). According to Italian law, patients with a COVID-19 infection in the previous 12 months received only one dose. The administration was performed between 1 and 2 h after the start of the dialysis session. Data regarding mild adverse events were collected. In 117 patients, a titration of the anti-RBD S1 antibodies of the virus spike antigen was performed 1 month after the completion of the vaccination [2]. Therefore, a new titration was obtained after 3 months in 50 patients.

RESULTS

Of the 117 patients, 65 (55.5%) were male, with a mean age of 69.2 ± 13.1 years. Of these, 25 patients (21.3%) showed mild adverse events without compromising dialysis administration. No serious adverse events took place. Seroconversion was noticed in 111 patients (94.9%) after 1 month, with a mean anti-RBD S1 antibody titer of 751.1 ± 610.5 BAU/mL. When a new titration was performed after 3 months, the titer decreased to 203.1 ± 134.3 BAU/mL (t-test; P = 0.005).

CONCLUSION

Intradialytic vaccination is a procedure with an excellent safety profile that may be implemented in dialysis settings. Further studies should be permormed to confirm these results.

[The psychodynamic basis of diver training]

The techniques employed in teaching diving and especially diving safety, were studied. Since it was felt that most accidents are not merely fortuitous but also derive from unconscious urges towards risk-taking, an attempt was made to understand the psychodynamics of the question. The study also investigated the effectiveness of the teaching method as a means not only of transmitting intrinsically useful skills and knowledge, but also as a psychotherapeutic technique aiding the diver to control any self-destructive aggressive urges.

[Psychodynamic aspects of sports diving]

Individual and group discussions with divers and instructors were used to discover the psychodynamic bases of the diver's psychology. The clearly narcisistic compensation mechanisms, based essentially on so-called "cross-identification" appear to explain the apparently contradictory personality traits revealed by both psychodiagnostic techniques and phenomenological analysis. The recognition of cross identification as the basis of the narcisism-masochism collusion appears to be a useful addition to the field of accident prevention.