Clostridium Perfringens

Question 1

Cl. perfringens

Answer 1

Cl. perfringens – Food-poisoning

• Reservoir:
  
  • soil, colon (humans & animals)
  • Raw meat and poultry
• Sources for foodborne illness:
  
  • Beef, poultry, gravies, pre-cooked foods *
  • Pre-cooked foods should be maintained over 60⁰C or under 5⁰C → warm temps allow spores to germinate and produce enterotoxin in foods
  • Pre-cooked food should be re-heated well before serving (heating destroys toxin *)

Question 2

Cl. perfringens symptoms

Answer 2

Cl. perfringens symptoms

• Self-limiting, watery diarrhea (1 or 2 days)
• Starts 8-18 hours after ingestion of contaminated food *
• Common cause of foodborne illness - 1 million cases in the US every year
• Diagnosis is mostly clinical
• Lab diagnosis helps establish diagnosis
  
  • Recovery of 105 organisms per gram of food
  • Recovery of 106 bacteria per gram of feces (collected within one day of onset)
  • Detection of toxins - immunoassays
• Treatment: Rehydration

Question 3

Cl. perfringens – Necrotizing enteritis

Answer 3

Cl. perfringens – Necrotizing enteritis

• Also called - Enteritis necroticans, pig-bel
• Acute, necrotizing destruction of jejunum
• Abdominal pain, vomiting, diarrhea & peritonitis
• Rarely seen
  
  • Most cases in Papua New Guinea
  • Associated with eating undercooked contaminated PORK with sweet potatoes

Question 4

Cl. perfringens: Gas gangrene- Soft tissue infections

Answer 4

Cl. perfringens: Gas gangrene- Soft tissue infections

• Cellulitis *
  
  • Localized edema and erythema
  • Gas formation in soft tissue *
  • Generally non-painful
• Suppurative myositis (fasciitis) *
  
  • Accumulation of pus (suppuration) in the muscle planes
  • No muscle necrosis, no systemic symptoms
• Myonecrosis *
  
  • Rapid destruction of muscle tissue
    
    • Gas formation in soft tissue – crepitus *
    • Necrotic bullae
  • Extremely painful
  • Systemic spread
  • High mortality, rapidly fatal (within 48 hours of onset)

Question 5

Cl. perfringens: Clostridial cellulitis

Answer 5

Cl. perfringens: Clostridial cellulitis

• Clostridia can be introduced into tissue during surgery or by a traumatic injury
• This patient suffered from a compound fracture of the tibia
• 5 days after the injury – discoloured skin, bullae and necrosis developed
• A serosanguineous exudate and subcutaneous gas were present
• There was no evidence of muscle necrosis
• The patient was treated
• Uneventful recovery

Question 6

Cl. perfringens: Gas gangrene (myonecrosis)

Answer 6

Cl. perfringens: Gas gangrene (myonecrosis)

• Necrotizing soft-tissue infection of skeletal muscle (myonecrosis)
• Entry of organism into tissue:
  
  • Contamination of wounds with soil/fecal matter *
  • Open wounds (crush injuries, compound fractures)
• Acute & increasing pain
• swelling at wound site
• Brownish skin discolouration, bullae
• Edema, gas, exudates *
  
  • Gas formation
    
    • Fermentation of tissue carbs, lipids, amino acids → gas accumulates → crepitus (can be felt under skin) *
• Systemic signs → fever, tachycardia
• Untreated – 100% fatal
• 1000 cases reported in the US every year

Question 7

What this?

Answer 7

Cl. perfringens: Gas gangrene (myonecrosis)

Question 8

Cl. Perfringens: Soft tissue infections

Answer 8

Cl. Perfringens: Soft tissue infections

• Diagnosis: mainly Clinical
  
  • Lab tests - confirmatory
  • Gram stain: GPRods+ no WBCs * + other bacteria
  • Culture: anaerobically on Blood agar –
    
    • double-zone hemolysis of colonies *
• Treatment:
  
  • Debridement of wounds, delayed closure
  • Clindamycin and penicillin *
  • Hyperbaric chamber – sometimes useful