The Clostridium species is a gram positive, anaerobic, rod-shaped microbe that is known to produce many toxins. Most infections by the Clostridium species involve C. botulinum, C. difficile, and C. perfringens. However, other types of Clostridium species are also clinically relevant, such as C. septicum and C. tertium. We discuss a case of a 79-year-old patient with a past medical history of prostate cancer and alcohol abuse who presented to the hospital after being found down. They were admitted to the ICU for septic shock, and initial blood cultures grew C. septicum, C. tertium, and E. coli. A CT of the abdomen and pelvis with IV contrast showed pneumoperitoneum and a loculated pericolic fluid collection concerning for colon perforation. Initially the patient had a benign abdominal exam, but later developed significant distention and tenderness that required an emergent exploratory laparotomy and total abdominal colectomy. The patient was found to have three separate colon perforations, and no malignancy on histopathology. C. septicum is a highly virulent pathogen, and there are several cases reporting C. septicum-associated endocarditis, aortitis, and endophthalmitis. It is also associated with colon and hematologic malignancies and neutropenia. Common risk factors for C. tertium include immunocompromised status, neutropenia, hematologic malignancy, exposure to beta-lactam antibiotics, cirrhosis, and intestinal mucosal damage. It seems to have low virulence and low mortality when treated correctly. It is important that any patient found to have Clostridium bacteremia be evaluated for a gastrointestinal source and treated promptly and appropriately.

Collet-Sicard syndrome is a unilateral palsy of the lower cranial nerves IX, X, XI, and XII, resulting from lesions at the skull base that affect the jugular foramen and hypoglossal canal. Common causes of the lesions include basilar skull fractures, carotid artery dissections, and malignancy. Infectious and inflammatory etiologies have also been reported. A 63-year-old male with a history of uncontrolled diabetes was admitted for dysphagia, right ear pain, drainage, and right-sided facial droop after recent local trauma and surgical instrumentation of the right ear. Culture of the external auditory canal grew Pseudomonas aeruginosa. Triple phase bone scan demonstrated osteomyelitis at the skull base due to complications from otitis externa. The patient's presentation was consistent with Collet-Sicard syndrome, and he was subsequently treated with a six-week course of ciprofloxacin. This patient demonstrates a unique case since his malignant otitis externa spread locally and led to skull base osteomyelitis and subsequently developed Collet-Sicard syndrome. His uncontrolled diabetes likely played a role in his disease progression.

Objective: Although Las Vegas is a major tourist hub, it is not among the counties that are under CDC surveillance for Clostridioides difficile infection (CDI), a major nosocomial infection. To determine the distribution of C. difficile ribotypes in the Las Vegas area, we collected stool samples from CDI-positive patients at the University Medical Center (UMC). Methods: We included adult patients diagnosed with CDI and provided informed consent. C. difficile was isolated from the stool samples and ribotyped. Demographic information was also obtained and analyzed. All information was compared to the surveillance data from the CDC. Results: We identified more frequently in male patients than in the CDC data. Less than half of the patients used antibiotics prior to the infection. We observed several comorbidities in our patient sample pool, with cardiovascular disease and diabetes being the most prevalent comorbidities. Hypervirulent C. difficile strain 027 was the most prevalent ribotype. Except for two samples of ribotype 076, all other samples represented unique singlet ribotypes. Four of these ribotypes (160, 302, 363, and 813) have not been explicitly reported in humans. Conclusions: Due to the unique environment created by the tourism industry in Las Vegas, this population is exposed to national and international visitors. This study shows the pre-COVID landscape of C. difficile ribotypes in Las Vegas and offers valuable insights into the varieties of C. difficile that are currently infecting this community.