Clinical Syndromes - Clostridium perfringens

Clinical Syndromes

C. perfringens produces a variety of clinical syndromes as follows:(a) soft tissue infections, (b) food poisoning, (c) necrotizing enteritis, and (d) septicemia.

◗ Soft tissue infections

Soft tissue infections caused by C. perfringens can be (a) cellu-litis, (b) fasciitis and suppurative myositis, and (c) clostridial myonecrosis or gas gangrene.

Cellulitis: Clostridia can invade the fascial planes and causeanaerobic cellulitis with gas formation in the soft tissues. The bacteria produce minimal toxin and do not invade the muscle tissues

Fasciitis and suppurative myositis: The cellulitis progressesto suppurative myositis, which is associated with collection of pus in the muscle planes. In this condition, both muscle necrosis and systemic symptoms are absent.

Gas gangrene: Gas gangrene or clostridial myonecrosisis a serious and life- threatening condition. The incuba-tion period is variable. It may be as short as 7 days or as long as 6 weeks after clostridia are introduced into the tis-sue by trauma or surgery. The onset of the disease is rapid and is associated with increasing pain, tenderness, and edema of the affected part and systemic signs of toxemia. Accumulation of gas in the tissues—caused by metabolic activity of the rapidly dividing clostridia—is characteristic of the disease, hence the name gas gangrene. Production and accumulation of gas make the tissues crepitant. There is a thin watery discharge from the wound, and subsequently the discharge becomes serosanguineous. In untreated cases, the condition progresses very fast with extensive muscle necro-sis, shock, renal failure, and even death within 48 hours of onset of the disease. The clostridial toxins typically cause extensive hemolysis and bleeding, and finally death occurs due to circulatory failure.

◗ Food poisoning

Clostridial food poisoning is caused by some strains of C. perfringens type A. These strains produce spores, which areheat resistant. They typically produce enterotoxin, but produc-tion of alpha- and theta-toxin is very minimal.

Food poisoning is caused by ingestion of cold and warmed up meat dishes contaminated with large numbers (108–109) of C. perfringens type A strains. Incubation period is short, between8 and 24 hours. Abdominal cramps and watery diarrhea—but absence of nausea, vomiting, or fever—are characteristic presen-tations of this condition. The disease is self-limiting and recov-ery occurs within 24–48 hours.

◗ Necrotizing enteritis

Necrotizing enteritis caused by C. perfringens type C is an acute necrotizing condition of the jejunum. The condition is char-acterized by abdominal pain, bloody diarrhea, shock, and peritonitis. It is severe and often fatal. Immunization with type C toxoid has been reported to protect against this condition. This condition is known as “Pigbel” in Papua New Guinea, where it is very common and as “Darmbrand” (meaning “fire bowels”) in Germany. The sporadic cases have also been reported from East Africa, Thailand, and Nepal.

◗ Septicemia

This is a life-threatening situation with the isolation of bacteria in blood culture