Clinical manifestations Food poisoning,
gas gangrene,
clostridial necrotizing enteritis,
bacteremia, tissue
necrosis, emphysematous
cholecystitis, and more illnesses/diseases have been linked to infections associated with
C. perfringens.
Food poisoning Clostridium perfringens is a common cause of food poisoning in the United States.
C. perfringens produces spores, and when these
spores are consumed, they produce a toxin that causes diarrhea. Foods cooked in large batches and held at unsafe temperatures (between 40 °F and 140 °F) are the source of
C. perfringens food poisoning outbreaks, commonly linked to meats such as poultry, beef, and pork.
C. perfringens can proliferate in foods that are improperly stored due to the spore's ability to survive normal cooking temperatures. The type A toxin of
C. perfringens, also known as the CPA, is responsible for food poisoning. Food poisoning is characterized by acute abdominal pain, diarrhea, and, in some cases, vomiting, typically occurring 6 to 24 hours after the ingestion of contaminated food. Unlike many other foodborne illnesses, fever is usually absent. Symptoms are usually self-limiting and resolve within 24 to 48 hours; however, severe dehydration can occur in cases of significant fluid loss. Symptoms of dehydration include dry mouth, decreased urine output, dizziness, and fatigue. Severe symptoms such as diarrhea that persists for more than 48 hours, the inability to keep fluids down, or signs of severe dehydration may necessitate medical attention. Most people are able to recover from
C. perfringens food poisoning without treatment. However, people who experience diarrhea are usually instructed to drink water or rehydration solutions.
Food poisoning incidents In January 2017, a mother and her son sued a restaurant in
Rochester, New York, United States, as they and 260 other people became sick after eating food contaminated with
C. perfringens. "Officials from the Monroe County Department of Public Health closed down the Golden Ponds after more than a fourth of its Thanksgiving Day guests became ill. An inspection revealed a walk-in refrigerator with food spills and mold, a damaged gasket preventing the door from closing, and mildew growing inside." In July 2018, 647 people reported symptoms after eating at a
Chipotle Mexican Grill restaurant in
Powell, Ohio, United States. Stool samples tested by the
CDC tested positive for
C. perfringens. In November 2018, approximately 300 people in Concord,
North Carolina, United States, became sick after eating food at a church barbecue that tested positive for
C. perfringens. In 2021, a foodborne illness outbreak in
Homer, Alaska, affected approximately 80 employees of South Peninsula Hospital and was traced to Cubano sandwiches served during staff meals. The
Alaska Department of Health and Social Services identified the likely cause as
C. perfringens. No hospitalizations were reported, and the outbreak was contained to hospital staff. Such localized outbreaks are considered uncommon in Alaska when not tied to a national foodborne incident.
Gas gangrene Clostridium perfringens is the most common bacterial agent for
gas gangrene, also known as clostridial
myonecrosis. Gas gangrene is induced by
α-toxin that embeds itself into the plasma membrane of cells and disrupts normal cellular function by altering membrane structure.
Necrotizing enteritis Clostridium perfringens food poisoning can also lead to another disease, known as enteritis necroticans or
clostridial necrotizing enteritis, (also known as pigbel); this is caused by
C. perfringens type C. This infection is often fatal. Large numbers of
C. perfringens grow in the intestines and secrete exotoxin. This exotoxin causes necrosis of the intestines, varying levels of hemorrhaging, and perforation of the intestine. Inflammation usually occurs in sections of the jejunum, midsection of the small intestine. Symptoms cover a wide range and can vary in severity. The clinical signs range from mild diarrhea to more severe manifestations such as intense abdominal pain, vomiting, bloody stools, and even septic shock.
Perfringolysin O (
pfoA)-positive
C. perfringens strains were also associated with the rapid onset of
necrotizing enterocolitis in preterm infants. This is rare as it makes up less than 1% of bloodstream isolates but is highly fatal with a reported mortality rate of 27% to 58%. A strain of
C. perfringens might be implicated in
multiple sclerosis (MS) nascent (
Pattern III) lesions. Tests in
mice found that two strains of intestinal
C. perfringens that produced epsilon toxins (ETX) caused MS-like damage in the brain, and earlier work had identified this strain of
C. perfringens in a human with MS. MS patients were found to be 10 times more likely to be immune-reactive to the epsilon toxin than healthy people. Greatly increased rates of gut colonization by type B and D
C. perfringens are seen in MS patients.
Diagnosis The diagnosis of
Clostridium perfringens food poisoning relies on laboratory detection of the bacterium or its toxin in either a patient's stool sample or contaminated food linked to the illness. A positive stool culture would have growth of at least 10 cfu/g of C.
perfringens. Stool studies include
WBCs,
ova, and parasites in order to rule out other potential
etiologies.
ELISA testing is used to detect the CPA toxin. Diagnosis of
C. perfringens food poisoning is relatively uncommon for several reasons. Most individuals with this foodborne illness do not seek medical care or submit a stool sample for testing, and routine testing for
C. perfringens is not typically performed in clinical laboratories. Additionally, public health laboratories generally conduct testing for this pathogen only in the event of an outbreak. The diagnosis of gas gangrene typically involves several methods to confirm the infection. Imaging techniques such as
X-rays,
CT scans, or
MRIs can reveal gas bubbles or tissue changes indicative of muscle damage. Additionally, bacterial staining or culture of fluid taken from the wound helps identify
Clostridium perfringens and other bacteria responsible for the infection. In some cases, a
biopsy is performed, where a sample of the affected tissue is analyzed for signs of damage or necrosis.
Prevention C. perfringens spores can multiply within a temperature range of 59°F (15°C) to 122°F (50°C). To prevent bacterial growth, leftovers should be refrigerated within two hours of preparation, with their temperature chilled down to below 40 °F (4 °C). Large portions of food that contain meat, should be divided into smaller containers before refrigeration to ensure even cooling. Before serving leftovers, they should be reheated to at least 165°F (74°C) to destroy any bacteria that may have grown during storage. Canned vegetables, smoked or cured meats, and salted or smoked fish require additional attention. Preventing
gas gangrene involves taking precautions to avoid bacterial infections. Healthcare providers follow strict protocols to prevent infections, including those caused by
Clostridium perfringens. To reduce the risk of gas gangrene, individuals should clean wounds thoroughly with soap and water and seek medical attention for deep or difficult to clean wounds. It is also essential to monitor injuries for changes in skin condition or the onset of severe pain. Additionally, working with healthcare providers to manage underlying conditions that affect circulation or weaken the immune system can further reduce the risk of infection. However,
C. perfringens shows different resistance patterns with about 20% of strains being resistant to clindamycin, and 10% being resistant to metronidazole.
C. perfringens is often more susceptible to vancomycin when compared to other pathogenic clostridia, making it an alternative option for treatment in some cases. For foodborne illness caused by
C. perfringens, treatment is typically unnecessary. Most people who suffer from food poisoning caused by
C. perfringens usually fight off the illness without the need of any antibiotics. Extra fluids should be drunk consistently until diarrhea dissipates. == Research ==