What is Clostridium perfringens Infection (Clostridium Perfringens)?
Clostridium perfringens is a type of bacteria that doesn’t need oxygen to survive. It’s known for causing various seriousness of stomach and bowel infections in people, with symptoms from diarrhea to necrotizing enterocolitis, which is a severe intestinal condition, and myonecrosis, which refers to the death of muscle tissue. This harmful bacteria produces numerous toxins that cause these conditions and has the ability to form spores that can endure harsh environmental conditions.
What Causes Clostridium perfringens Infection (Clostridium Perfringens)?
Clostridium perfringens is a bacterium first discovered in 1891 by Dr. William H. Welch. He found it while conducting an autopsy at The Johns Hopkins Hospital. This bacterium has had a few names over time, including Bacillus aerogenes capsulatus and Bacillus welchii. Its current name, Clostridium perfringens, comes from Latin words meaning “burst through.”
We can categorize this bacterium based on the six main toxins it can produce. These are known as: alpha-toxin (CPA), beta-toxin (CPB), epsilon-toxin (ETX), iota-toxin (ITX), enterotoxin (CPE), and necrotic enteritis B-like toxin (NetB). Depending on which toxins a strain produces, it can be classified as one of seven types, labeled A through G.
The tough spores of C. perfringens are able to survive even the heat of cooking. This means that if food isn’t stored properly, the bacterium can grow in it. Outbreaks are often linked to gravy, poultry, or meats that haven’t been heated or reheated correctly.
Risk Factors and Frequency for Clostridium perfringens Infection (Clostridium Perfringens)
Certain toxins, specifically Type A and Type C, are known to cause diseases in humans. Type A is usually the cause of food poisoning and non-foodborne diarrheal diseases related to the C. perfringens bacteria. According to the CDC, this bacteria is responsible for 5% of disease outbreaks, leading to 10% of illnesses and causing 4% of hospital admissions. These outbreaks often involve an average of 24 people, and there can be around 1,200 outbreak-linked diseases in a year. It has been observed that males (65%) are slightly more affected, with most cases aged between 20 and 49. Undercooked beef and poultry are commonly how the bacteria is spread. Outbreaks happen throughout the year, but they are most common in November and December. This bacteria is one of the top five causes of foodborne disease outbreaks in the US, and it’s even more prevalent around the world.
Type C toxin was linked with a certain disease, enteritis necroticans, which was common in Germany after World War II (1944-1949) and in Papua New Guinea’s highlands. In these areas, the diseases were respectively known as Darmbrand and Pigbel. It’s believed that severe malnutrition can make someone more susceptible to a type C infection. Between the 1960s and 1970s, Pigbel was the leading cause of death in children over one year of age. Although a vaccination campaign in the 1980s reduced the number of cases, this disease still causes a lot of sickness and death today.
Signs and Symptoms of Clostridium perfringens Infection (Clostridium Perfringens)
Food poisoning and diarrheal diseases caused by other factors can be identified through a medical history and physical examination. Symptoms such as abdominal pain, severe watery diarrhea, and throwing up usually start around 8 to 16 hours after eating raw or undercooked meat or poultry.
In rare cases, the condition may worsen to a stage known as “abdominal sepsis”. This serious situation can lead to abnormal changes in blood pressure, heart rate, and body temperature control. On top of this, the patient may also experience a bloated and tender abdomen, confusion or changes in thinking, and a stiff belly that creates a drum-like sound when tapped. These are signs of a serious medical and surgical emergency.
Clostridial myonecrosis, or “gas gangrene”, often develops after a physical injury. However, it can also occur spontaneously in people with blood flow issues or diabetes. The symptoms include skin infection at the site, fever, and chills. The infected wound may swell, become tender, and form fluid-filled blisters that may release an unpleasant smell. Despite these visible signs, the symptoms often heavily overshadow them. If the infection spreads into the deeper tissues, it could cause the death of fat, muscle, or nerve tissues. If not treated in time, this can lead to severe conditions like septic shock, complications with clotting, and severe respiratory distress, which carry a high risk of death.
Testing for Clostridium perfringens Infection (Clostridium Perfringens)
When doctors suspect a C. perfringens infection, which is a type of bacteria, they will do several tests on a stool sample. These tests can include stool culture and toxin testing, as well as checks for white blood cells, eggs from parasites, and parasites themselves. This helps in figuring out the cause of the symptoms. If the infection is severe, doctors may also use imaging methods, like X-rays or CT scans, to see exactly where in the body the infection is present.
An outbreak of foodborne disease, or food poisoning, is when two or more people get sick from eating the same contaminated food. Information about how many people got sick, how many had to go to the hospital, and how many died should be shared with local health officials and the Centers for Disease Control and Prevention.
Doctors can confirm the infection by finding a large amount of C. perfringens bacteria in a stool sample. During an outbreak, if at least two affected individuals have positive stool cultures or the bacteria’s toxin is detected in their stool samples, the source of the outbreak is confirmed as C. perfringens. The bacteria can also be confirmed as the source if it’s found in high amounts in the suspected food.
In cases of clostridial myonecrosis, which is a severe muscle infection caused by the C. perfringens bacteria, doctors will do an X-ray or a CT scan of the affected area. They’ll also do several blood tests, including a complete blood count to see the numbers of different blood cells, a metabolic panel to test how the body is functioning, blood culture to check for bacteria in the blood, creatine kinase levels to assess muscle damage, arterial blood gases to measure the levels of oxygen and carbon dioxide, and lactic acid to see how well oxygen is being used by the body’s cells.
Treatment Options for Clostridium perfringens Infection (Clostridium Perfringens)
Usually, acute diarrhea caused by C. perfringens bacteria gets better on its own and only requires treatment to maintain a patient’s water and salt balance. Antibiotics are typically unnecessary.
There’s an exception, however. Clostridial sepsis is a medical emergency that can result in low blood pressure and rapid heart rate due to the bacteria destroying red blood cells. In this situation, early treatment with specific antibiotics – penicillin G and clindamycin, tetracycline, or metronidazole – combined with surgery to remove dead tissue, can help to prevent death. However, without removing the source of infection (source control), the patient may not respond to other treatments.
If there’s a suspicion of clostridial myonecrosis, which is a severe bacterial infection that destroys muscle tissue, immediate surgical consultation is needed. This should not be delayed for test results. Fast administration of broad-spectrum antibiotics is crucial. Moreover, hyperbaric oxygen therapy, where patients breathe in pure oxygen in a pressurized room or tube, has been shown to improve recovery in severe infection cases.
What else can Clostridium perfringens Infection (Clostridium Perfringens) be?
Acute infectious diarrhea, or severe diarrhea due to an infection, can be caused by several different viruses and bacteria, including:
- Norovirus
- Salmonella
- Campylobacter
- Staphylococcus aureus
- Escherichia coli (specifically the type that produces Shiga toxin)
Abdominal sepsis, a serious infection that spreads throughout the body and can cause organ failure, could be a result of conditions like:
- Appendicitis
- Infectious colitis
- Ischemic colitis
- A peptic ulcer that has burst
- Pancreatitis
Clostridial myonecrosis, also known as gas gangrene, is a severe bacterial infection that destroys muscle tissue. It can be caused by various types of bacteria, which include:
- Escherichia coli
- Klebsiella
- Streptococcus pyogenes
- Staphylococcus aureus
- Anaerobic bacteria such as Bacteroides and Peptostreptococcus
What to expect with Clostridium perfringens Infection (Clostridium Perfringens)
Most cases of food poisoning and diarrhea not related to food typically get better on their own. Patients who are hospitalized because of these conditions generally need fluids and will be allowed to resume their normal diet as soon as their bodies can handle it. Usually, people recover quite well from these conditions. Nonetheless, certain severe conditions like clostridial myonecrosis and sepsis are medical emergencies with unpredictable outcomes.
Early detection and treatment, which may include surgery, are extremely important for these conditions. Despite receiving suitable treatment, the mortality rate stands at 20 to 30%. Without treatment, these conditions are invariably fatal.
Possible Complications When Diagnosed with Clostridium perfringens Infection (Clostridium Perfringens)
Food poisoning and diarrheal diseases usually present minimal complications if the fluid imbalance in the body is adequately managed. However, an infection that spreads into the bloodstream can result in the destruction of red blood cells and a severe, generalized infection that can lead to organ failure and shock.
A certain type of toxin produced by a subcategory of bacteria can lead to the death of tissues in a part of the small intestine called the jejunum. This condition, often referred to as enteritis necroticans or pigbel, commonly occurs in countries with limited resources, especially Papua New Guinea, after eating pork. This disease has also been linked with eating pork intestines in regions with more resources. Moreover, the ingestion of sweet potatoes, which contain substances that inhibit the breakdown of the toxin in the intestine, can often worsen the disease. People suffering from pigbel often experience symptoms such as abdominal swelling, pain, and a swollen intestine with parts of it undergoing tissue death.
A related condition, known as clostridial myonecrosis, might necessitate extensive tissue cleaning, amputation, and could result in severe system-wide infection, leading to complications like:
- Shock (failure of the cardiovascular system)
- Encephalopathy (brain disease)
- Acute respiratory distress syndrome (severe lung failure)
- Death
Preventing Clostridium perfringens Infection (Clostridium Perfringens)
Many cases of food poisoning and diarrhea not linked to food, caused by C. perfringens, occur because of uncooked or undercooked meat or poultry. This highlights the importance of teaching people about safe food handling rules to prevent the spread of such diseases. If you have health conditions like diabetes or vascular disease, which make you more prone to severe infections, you must seek immediate medical help if you experience skin infection (cellulitis) or get injured. This prompt action is needed because your chances of experiencing a quick, severe infection are higher.