Skip to main content

Advertisement

SpringerLink
Log in

Clostridial Infections in Children: Spectrum and Management

  • Pediatric Infectious Diseases (I Brook, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Clostridia can cause unique histotoxic syndromes produced by specific toxins (e.g., gas gangrene and food poisoning) as well as non-syndromic infections (e.g., abscess, local infections, and blood born infection). Clostridia can also be recovered from various body sites as part of polymicrobial aerobic–anaerobic infection. These include intra-abdominal (peritonitis and abscess), biliary tract, female genital tract, abscess (rectal area and oropharyngeal), pleuropulmonary, central nervous system, and skin and soft-tissue infections. Clostridia were recovered from children with bacteremia of gastrointestinal origin, necrotizing enterocolitis, and sickle cell disease. They have also been isolated in acute and chronic otitis media, chronic sinusitis and mastoiditis, peritonsillar abscesses, and neonatal conjunctivitis. Early and aggressive surgical debridement, decompression, and drainage of affected tissues are critical to successful outcome of histotoxic infections. Effective antimicrobials include penicillin, clindamycin, chloramphenicol, third-generation cephalosporins, carbapenems, and vancomycin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dunkle LM, Brotherton TJ, Feigen RD. Anaerobic infections in children: a prospective study. Pediatrics. 1976;57:311–20.

    CAS  PubMed  Google Scholar 

  2. Trimourthi MC, Keen BM, Dajani AS. Anaerobic infections in children: a prospective study. J Clin Microbiol. 1976;3:318–23.

    Google Scholar 

  3. Brook I. Clostridial infection in children. J Med Microbiol. 1995;42:78–82. A survey of the isolation of Clostridium spp. from 1543 specimens sent to anaerobic microbiology laboratories revealed 113 isolates from 107 specimens (7.0% of all specimens) from 96 children. The isolates comprised 43 (38%) unidentified Clostridium spp., 37 (33%) C. perfringens, 13 (12%) C. ramosum, five (4%) C. innocuum, six (5%) C. botulinum, three (3%) C. difficile, two (2%) C. butyricum, and one isolate each of C. bifermentans, C. clostridiiforme, C. limosum and C. paraputrificum.

    Article  CAS  PubMed  Google Scholar 

  4. Finegold SM, George WL (eds) Anaerobic Infections in Humans. New York, Academic Press, 1977. An extensive and thorough textbook that reviews all case reports and studies of anaerobic infections until 1977.

  5. Hatheway CL. Toxogenic clostridia. Clin Microbiol Rev. 1990;3:66–98.

    PubMed Central  CAS  PubMed  Google Scholar 

  6. Rosebury T. Microorganisms indigenous to man. New York: McGraw-Hill Book Company; 1966.

    Google Scholar 

  7. Brook I. Anaerobic infections diagnosis and management a textbook. New York: Informa Healthcare USA; 2007. A textbook devoted to the diagnosis and treatment of all anaerobic infections in newborns and children.

  8. Brook I. Bacterial studies of peritoneal cavity and postoperative surgical wound drainage following perforated appendix in children. Ann Surg. 1980;192:208–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Brook I. A 12 year study of aerobic and anaerobic bacteria in intra-abdominal and postsurgical abdominal wound infections. Surg Gynecol Obstet. 1989;169:387–92.

    CAS  PubMed  Google Scholar 

  10. Brook I, Frazier E. Microbiology of liver and spleen abscesses. J Med Microbiol. 1998;47:1075–80.

    Article  CAS  PubMed  Google Scholar 

  11. Brook I, Frazier E. Aerobic and anaerobic microbiology of retroperitoneal abscesses. Clin Infect Dis. 1998;26:938–41.

    Article  CAS  PubMed  Google Scholar 

  12. Cashore WJ, Peter G, Lauermann M, Stonestreet BS, Oh W. Clostridium colonization and clostridial toxin in neonatal necrotizing enterocolitis. J Pediatr. 1981;98:308–11.

    Article  CAS  PubMed  Google Scholar 

  13. Sturm R, Staneck JL, Stauffer LR, Neblett 3rd WW. Neonatal necrotizing enterocolitis associated with penicillin resistant Clostridium butyricum. Pediatrics. 1980;66:928–31.

    CAS  PubMed  Google Scholar 

  14. Cooperstock MS, Steffen E, Yolken R, Onderdonk A. Clostridium difficile in normal infants and sudden infant death syndrome: an association with infant formula feeding. Pediatrics. 1982;70:91–5.

    CAS  PubMed  Google Scholar 

  15. Brook I, Controni G, Rodriguez W, Martin WJ. Anaerobic bacteremia in children. Am J Dis Child. 1980;134:1052–6.

    Article  CAS  PubMed  Google Scholar 

  16. Brook I, Gluck RS. Clostridium paraputrificum sepsis in sickle cell disease: a report of a case. South Med J. 1980;73:1644–5.

    Article  CAS  PubMed  Google Scholar 

  17. Brook I, Schwartz RH, Controni G. Clostridium ramosum isolation in acute otitis media. Clin Pediatr. 1979;18:699–70.

    Article  CAS  Google Scholar 

  18. Brook I. Microbiology of chronic otitis media with perforation in children. Am J Dis Child. 1980;130:564–66. The middle ear aspirate and a swab specimen of the external auditory canal were cultured aerobically and anaerobically from 68 children with chronic otitis media (COM). Seventy-eight isolates were recovered from the middle ears, 99 from the external ear canals, and 95 from both sites. Aerobes only were isolated from 33 patients (48.5 %), nine (13.2 %) had only anaerobes, and 26 (38 %) had both aerobes and anaerobes. There were 99 aerobic isolates. Aerobes recovered icluded Pseudomonas aeruginosa, Staphylococcus aureus, Proteus spp., Klebsiella pneumoniae, and Haemophilus influenzae. There were 74 anaerobes isolated. Anaerobes included were anaerobic Gram-positive cocci, Bacteroides spp., and Clostridium spp. These findings demonstrate the polymicrobial bacteriology of COM in children. Cultures collected from the external auditory canals prior to their sterilization can be misleading.

  19. Brook I. Bacteriological features of chronic sinusitis in children. JAMA. 1981;246:967–69. Aspiration of chronically inflamed sinuses was performed in 40 children. The sinuses were the maxillary (15 cases), ethmoid (13), and frontal (seven). Pansinusitis was present in five patients. A total of 121 isolates (97 anaerobic and 24 aerobic) were recovered from 37 sinuses, Anaerobes were recovered from all specimens, and in 14 cases (38 %) mixed with aerobic organisms. The predominant anaerobes were Bacteroides spp., anaerobic Gram-positive cocci, and Fusobacterium spp. The predominant aerobes were Staphylococcus aureus, and Haemophilus spp. These findings illustrate the major role of anaerobes in chronic sinusitis in children.

  20. Brook I. Aerobic and anaerobic bacteriology of chronic mastoiditis in children. Am J Dis Child. 1981;135:478–9. Aspiration of chronically inflamed mastoids was performed in 28 children. A total of 90 isolates (61 anaerobic and 29 aerobic) were recovered from all mastoids sinuses, Anaerobes were recovered from 4 (17) specimens, aerobes only from one (4 %), and mixed anaerobes with aerobes in 19 (79 %). The predominant anaerobes were anaerobic gram negative bacilli, anaerobic Gram-positive cocci, and Clostridium, Actinomyces spp., and Fusobacterium spp. The predominant aerobes were Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. These findings illustrate the polymicrobial aerobic and anaerobic nature of chronic mastoiditis in children.

  21. Brook I. Aerobic and anaerobic bacteriology of peritonsillar abscess in children. Acta Pediatr Scand. 1981;70:831–5.

    Article  CAS  Google Scholar 

  22. Brook I, Martin WJ, Finegold SM. Effect of silver nitrate application on the conjunctival flora of the newborn and the occurrence of clostridial conjunctivitis. J Pediatr Ophthalmol Strabismus. 1978;15:173–83.

    Google Scholar 

  23. Brook I. Recovery of anaerobic bacteria from clinical specimens in 12 years at two military hospitals. J Clin Microbiol. 1988;26:1181–8.

    PubMed Central  CAS  PubMed  Google Scholar 

  24. Brook I. Facial gas gangrene after penetrating injury. Pediatr Infect Dis J. 1990;9:222–3.

    Article  CAS  PubMed  Google Scholar 

  25. Brook I. Microbiology and management of infectious gangrene in children. J Pediatr Orthop. 2004;24:587–92.

    Article  PubMed  Google Scholar 

  26. Brook I. Microbiology of necrotizing fasciitis associated with omphalitis in the newborn infant. J Perinatol. 1998;18:28–30. Thirty eight bacterial isolates (21 aerobic and facultative and 17 anaerobic) were recovered from 11 newborn infants with periumbilical necrotizing fasciitis. Aerobic or facultative bacteria only were present in 1 specimen (9 %), anaerobes only in 2 (18 %), and mixed aerobic and anaerobic flora in 8 (73 %). The predominant isolates were Peptostreptococcus spp., Bacteroides fragilis group; Clostridium spp., streptococcus group B; and Staphylococcus aureus, streptococcus group D, Escherichia coli, and Proteus mirabilis.

  27. Caya JG, Truant AL. Clostridial bacteremia during the first year of life: an analysis of 53 patients including two new cases. Anaerobe. 2000;6:1–9.

    Article  Google Scholar 

  28. Brook I. Infective endocarditis caused by anaerobic bacteria. Arch Cardiovasc Dis. 2008;101:665–76.

    Article  PubMed  Google Scholar 

  29. Barnes C, Gerstle JT, Freedman MH, et al. Clostridium septicum myonecrosis in congenital neutropenia. Pediatrics. 2004;114:e757–60.

    Article  PubMed  Google Scholar 

  30. Bratton SL, Krane EJ, Park JR, et al. Clostridium septicum infections in children. Pediatr Infect Dis J. 1992;11:569–75.

    Article  CAS  PubMed  Google Scholar 

  31. Pinzon-Guzman C, Bashir D, McSherry G, Beck MJ, Rocourt DV. Clostridium septicum gas gangrene in a previously healthy 8-year-old female with survival. J Pediatr Surg. 2013;48:e5–8.

    Article  PubMed  Google Scholar 

  32. Hunley TE, Spring MD, Peters TR, et al. Clostridium septicum myonecrosis complicating diarrhea-associated hemolytic uremic syndrome. Pediatr Nephrol. 2008;23:1171–5.

    Article  PubMed  Google Scholar 

  33. Williams EJ, Mitchell P, Mitra D, Clark JE. A microbiological hazard of rural living: Clostridium septicum brain abscess in a child with E coli 0157 associated haemolytic uraemic syndrome. BMJ Case Rep. 2012 Jun 25;2012 10.1136/bcr-2012-00642

  34. Smith-Slatas CL, Bourque M, Salazar JC. Clostridium septicum infections in children: a case report and review of the literature. Pediatrics. 2006;117:e796–805. A child who survived a severe case of C septicum myonecrosis involving both abdominal and thoracic cavities is presented. Forty seven cases of C septicum infection; of these, 22 (47 %) were cases of C septicum associated with myonecrosis were reviewed. Conditions related with C septicum infection in children were of 3 categories: patients with neutrophil dysfunction; patients with associated bowel ischemia; and patients with a history of trauma. Malignancies were found in 49% of the cases, cyclic or congenital neutropenia in 21 %, hemolytic-uremic syndrome in 11 %, structural bowel ischemia in 4 %, and local extremity trauma in 6 %. In addition, 6 % of the cases had no known underlying disorder.

  35. Brook I. Management of human and animal bite wounds: an overview. Adv Skin Wound Care. 2005;18:197–203.

    Article  PubMed  Google Scholar 

  36. Vidor C, Awad M, Lyras D. Antibiotic resistance, virulence factors and genetics of Clostridium sordellii. Res Microbiol. 2015;166:368–74. This review will summarise studies involving the genetics of C. sordellii, including an antibiotic resistance profile, the genetic determinants of virulence and mutagenesis of C. sordellii.

    Article  CAS  PubMed  Google Scholar 

  37. Jamal N, Teach SJ. Necrotizing fasciitis. Pediatr Emerg Care. 2011;27:1195–9.

    Article  PubMed  Google Scholar 

  38. Brook I. Microbiology and management of soft tissue and muscle infections. Int J Surg. 2008;6:328–38.

    Article  PubMed  Google Scholar 

  39. Uzal FA, Freedman JC, Shrestha A, et al. Towards an understanding of the role of Clostridium perfringens toxins in human and animal disease. Future Microbiol. 2014;9:361–77. Clostridium perfringens >16 toxins that cause histotoxic and intestinal infections in humans and animals were reviewed. C. perfringens uses chromosomally encoded alpha toxin (a phospholipase C) and perfringolysin O (a pore-forming toxin) during histotoxic infections. In contrast, this bacterium causes intestinal disease by employing toxins encoded by mobile genetic elements, including C. perfringens enterotoxin, necrotic enteritis toxin B-like, epsilon toxin and beta toxin. The intestinal disease-associated toxins vary in their target specificity, when they are produced (sporulation vs vegetative growth), and in their sensitivity to intestinal proteases. Producing many toxins with diverse characteristics likely imparts virulence flexibility to C. perfringens so it can cause an array of diseases.

  40. Grass JE1, Gould LH, Mahon BE. Epidemiology of foodborne disease outbreaks caused by Clostridium perfringens, United States, 1998–2010. Foodborne Pathog Dis. 2013;10:131–6.

  41. Bennett SD, Walsh KA, Gould LH. Foodborne disease outbreaks caused by Bacillus cereus, Clostridium perfringens and Staphylococcus aureus—United States, 1998–2008. Clin Infect Dis. 2013;57:425–33.

    Article  PubMed  Google Scholar 

  42. Grimwood K, Forbes DA. Acute and persistent diarrhea. Pediatr Clin North Am. 2009;56:1343–61.

    Article  PubMed  Google Scholar 

  43. Miyamoto K, Li J, McClane BA. Enterotoxigenic Clostridium perfringens: detection and identification. Microbes Environ. 2012;27:343–9.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Pedersen PV, Hansen FH, Halveg AB, Christiansen ED. Necrotizing enterocolitis of the newborn—is it gas-gangrene of the bowel? Lancet. 1976;2:715–6.

    Article  CAS  PubMed  Google Scholar 

  45. Howard FM, Flynn DM, Bradley JM, Noone P, Szawatkowski M. Outbreak of necrotising enterocolitis caused by Clostridium butyricum. Lancet. 1977;2:1099–102.

    Article  CAS  PubMed  Google Scholar 

  46. Sturm R, Staneck JL, Stauffer LR, Neblett 3rd WW. Neonatal necrotizing enterocolitis associated with penicillin-resistant, toxigenic Clostridium butyricum. Pediatrics. 1980;66:928–31.

    CAS  PubMed  Google Scholar 

  47. Brook I, Avery G, Glasgow A. Clostridium difficile in pediatric infection. J Infection. 1982;4:253–7.

    Article  CAS  Google Scholar 

  48. Warren S, Schreiber JR, Epstein MF. Necrotizing enterocolitis and hemolysis associated with Clostridium perfringens. Am J Dis Child. 1984;138:686–8.

    CAS  PubMed  Google Scholar 

  49. Novak RW, Klein RL, Novak PE. Necrotizing enterocolitis, hemolysis, and Clostridium perfringens. Am J Dis Child. 1985;139:114–5.

    CAS  PubMed  Google Scholar 

  50. Alfa MJ, Robson D, Davi M, Bernard K, Van Caeseele P, Harding GK. An outbreak of necrotizing enterocolitis associated with a novel clostridium species in a neonatal intensive care unit. Clin Infect Dis. 2002;35:S101–5.

    Article  PubMed  Google Scholar 

  51. de la Cochetiere MF, Piloquet H, des Robert C, Darmaun D, Galmiche JP, Roze JC. Early intestinal bacterial colonization and necrotizing enterocolitis in premature infants: the putative role of clostridium. Pediatr Res. 2004;56:366–70. The study explore the putative relationship between pathogen microorganisms and NEC, by conducted a prospective case–control study in 12 preterm infants with a new approach based on molecular techniques. It demonstrates that the use of molecular techniques based on the study of bacterial 16S rRNA genes allowed the recognition of C. perfringens species in three infants who later displayed symptoms of NEC.

    Article  PubMed  Google Scholar 

  52. Brook I. Microbiology and management of joint and bone infections due to anaerobic bacteria. J Orthop Sci. 2008;13:160–9. The review describes the microbiology, diagnosis, and management of septic arthritis and osteomyelitis due to anaerobic bacteria. The predominant anaerobes in arthritis are anaerobic Gram-negative bacilli (AGNB), Fusobacterium spp., Peptostreptococcus spp., Clostridium spp., and Propionibacterium acnes. Infection with P. acnes is associated with a prosthetic joint, previous surgery, and trauma. B. fragilis group is associated with distant infection, Clostridium spp. with trauma, and Fusobacterium spp. with oropharyngeal infection. The predominant anaerobes in osteomyelitis are Bacteroides, Peptostreptococcus, Fusobacterium, Clostridium spp. and P. acnes. Conditions predisposing to bone infections are vascular disease, bites, contiguous infection, peripheral neuropathy, hematogenous spread, and trauma. Pigmented Prevotella and Porphyromonas spp. are mostly isolated in skull and bite infections, members of the B. fragilis group in hand and feet infections, and Fusobacterium spp. in skull, bite, and hematogenous long bone infections.

  53. Brook I. Aerobic and anaerobic microbiology of necrotizing fasciitis in children. Pediatr Dermatol. 1996;13:281–4.

    Article  CAS  PubMed  Google Scholar 

  54. Levitt JM, Stam J. Clostridium perfringens panophthalmitis. Arch Ophthalmol. 1970;84:227–8.

    Article  CAS  PubMed  Google Scholar 

  55. Brook I. Microbiology and management of intra-abdominal infections in children. Pediatr Int. 2003;45:123–9.

    Article  PubMed  Google Scholar 

  56. Brook I. Anaerobic pulmonary infections in children. Pediatr Emerg Care. 2004;20:636–40.

    Article  PubMed  Google Scholar 

  57. Brook I. Brain abscess in children: microbiology and management. J Child Neurol. 1995;10:283–8.

    Article  CAS  PubMed  Google Scholar 

  58. Brook I. Microbiology and management of polymicrobial female genital tract infections in adolescents. J Pediatr Adolesc Gynecol. 2002;15:217–26.

    Article  PubMed  Google Scholar 

  59. Songer JG. Clostridia as agents of zoonotic disease. Vet Microbiol. 2010;140:399–404.

    Article  CAS  PubMed  Google Scholar 

  60. van de Wetering MD, Kuijpers TW, Taminiau JA, et al. Pseudomembranous and neutropenic enterocolitis in pediatric oncology patients. Support Care Cancer. 2003;11:581–6.

    Article  PubMed  Google Scholar 

  61. Meites E, Zane S, Gould C. Fatal Clostridium sordellii infections after medical abortions. N Engl J Med. 2010;363:1382–3.

    Article  CAS  PubMed  Google Scholar 

  62. Temple AM, Thomas NJ. Gas gangrene secondary to Clostridium perfringens in pediatric oncology patients. Pediatr Emerg Care. 2004;20:457–9.

    Article  PubMed  Google Scholar 

  63. Brook I, Wexler HM, Goldstein EJ. Antianaerobic antimicrobials: spectrum and susceptibility testing. Clin Microbiol Rev. 2013;26:526–46. The spectrum of efficacy, antimicrobial resistance mechanisms, and resistance patterns against anaerobic bacteria are described.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  64. Goldstein EJC, Citron DM, Goldman PJ, Goldman RJ. National survey of anaerobic culture and susceptibility methods: III. Anaerobe. 2008;14:68–72. The study assessed the status of anaerobic bacteriology in the US, in 150 hospitals. The antimicrobials most often tested in hospital labs were penicillin/ampicillin and clindamycin, metronidazole and cefotetan and ampicillin/sulbactam, piperacillin/tazobactam, cefoxitin, imipenem, and chloramphenicol. The survey suggested that while many labs are processing anaerobic cultures, especially blood cultures, the identification of isolates and the performance of antimicrobial susceptibility testing of isolates are in disarray and in great need of improvement.

  65. Appelbaum PC, Spangler SK, Pankuch GA, Philippon A, Jacobs MR, Shiman R, et al. Characterization of a beta-lactamase from clostridium clostridioforme. J Antimicrob Chemother. 1994;33:33–40.

    Article  CAS  PubMed  Google Scholar 

  66. Rafii F, Park M, Carman RJ. Characterization of an ATP-binding cassette from Clostridium perfringens with homology to an ABC transporter from clostridium hathewayi. Anaerobe. 2009;15:116–21.

    Article  CAS  PubMed  Google Scholar 

  67. Rafii F, Park M, Wynne R. Evidence for active drug efflux in fluoroquinolone resistance in Clostridium hathewayi. Chemotherapy. 2005;51:256–62.

    Article  CAS  PubMed  Google Scholar 

  68. Spigaglia P, Barbanti F, Mastrantonio P. Multidrug resistance in European Clostridium difficile clinical isolates. J Antimicrob Chemother. 2011;66:2227–34.

    Article  CAS  PubMed  Google Scholar 

  69. Hecht DW. Prevalence of antibiotic resistance in anaerobic bacteria: worrisome developments. Clin Infect Dis. 2004;39:92–7. The review describes how antibiotic-resistant anaerobic bacteria have become increasingly recognized as a confounding factor in the selection of therapeutic agents. It highlights how the use of potent, broadspectrum antibiotics as empirical therapy, along with appropriate adjunctive measures, has masked the magnitude of the antibiotic resistance problem that parallels that observed for non-anaerobic pathogens. It concludes that the use of standardized testing methods that recognize resistance and an understanding of resistance mechanisms have become essential for the treatment of patients and the development of new agents.

  70. Goldstein EJC, Citron DM, Cole RE, Rangel DM, Seid AS, Ostovari MI. Cefoxitin in the treatment of aerobic/anaerobic infections: prospective correlation of in vitro susceptibility methods with clinical outcome. Hospital Prac Symp Suppl. 1990;25 Suppl 4:38–45.

    Google Scholar 

  71. Aldridge K, Aldridge KE, Ashcraft D, Cambre K, Pierson CL, Jenkins SG, et al. Multicenter survey of the changing in vitro antimicrobial susceptibilities of clinical isolates of Bacteroides fragilis group, Prevotella, Fusobacterium, Porphyromonas, and Peptostreptococcus species. Antimicrob Agents Chemother. 2001;45:1238–43.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  72. Stevens DL, Laine BM, Mitten JE. Comparison of single and combination antimicrobial agents for prevention of experimental gas gangrene caused by Clostridium perfringens. Antimicrob Agents Chemother. 1987;31:213–8. The efficacy of antimicrobial therapy of experimental C. perfringens infection in mice showed that combination antimicrobial therapy did not improve survival compared to that achieved with metronidazole or clindamycin alone, and some combinations significantly reduced survival.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  73. Kaide CG, Khandelwal S. Hyperbaric oxygen: applications in infectious disease. Emerg Med Clin North Am. 2008;26:571–95.

    Article  PubMed  Google Scholar 

  74. Hillers VN, Medeiros L, Kendall P, et al. Consumer food-handling behaviors associated with prevention of 13 foodborne illnesses. J Food Prot. 2003;66:1893–9.

    PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

The author declares that he has no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

  1. Departments of Pediatrics and Medicine, Georgetown University School of Medicine, 4431 Albemarle St. NW, Washington, DC, 20016, USA

    Itzhak Brook

Authors
  1. Itzhak Brook
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Itzhak Brook.

Additional information

This article is part of the Topical Collection on Pediatric Infectious Diseases

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brook, I. Clostridial Infections in Children: Spectrum and Management. Curr Infect Dis Rep 17, 47 (2015). https://doi.org/10.1007/s11908-015-0503-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-015-0503-8

Keywords

Search

Navigation