Dengue Hemorrhagic Fever, Uttaradit, Thailand

high blood glucose levels, and was on cytotoxic chemotherapy for previous 6 months. The risk for intestinal injury is high in severe liver disease and cytotoxic chemotherapy. Intestinal mucosal compromise may potentiate translocation of C. tertium to systemic circulation and metastatic foci. The second patient had no predisposing medical history before the present episode that might have resulted in acquisition of C. tertium from the soil. Both patients had pyrexia, necrotizing fasciitis, and gangrene of a lower limb with C. tertium as the sole bacterial isolate. Neither patient had neutropenia when they were first seen. This contrasts with earlier reports of C. tertium infections (predominantly bacteremia), which usually occurred in patients with preexisting neutropenia (3). Both patients improved with penicillin or vancomycin and metronidazole, and both isolates were susceptible to these three antibiotics in vitro. Therefore, we consider both isolates to be clinically important. The pathogenesis of infection caused by C. tertium is not well understood, since the organism does not produce exotoxins. No evidence exists to correlate oxygen sensitivity with bacterial enzyme production and pathogenicity in aerotolerant clostridia. Our report adds to the list of recently emerging diseases caused by C. tertium. The growing acceptance of this organism as a human pathogen will lead to better delineation and understanding of its pathogenic potential.