Clostridium perfringens

Background

Microbiology

• Often encapsulated short Gram-variable bacilli of varying length
• Found in soil and human (and animal) gut flora
• Makes necrotizing extracellular toxins
• Multiple types, based on production of major toxins, though only type A (and rarely type C) cause disease in humans
  • Toxins include alpha-toxin (CPA), beta-toxin (CPB), epsilon-toxin (ETX), iota-toxin (ITX), enterotoxin (CPE), and necrotic enteritis B-like toxin (NetB)

Type	Toxins	Clinical Notes
A	CPA only	foodborne illnesses associated with poorly heated food and meat; gas gangrene in patients with necrotic bowel
C	CPA and CPB ±CPE	pork product ingestion followed by enteritis necroticans (hemorrhagic necrosis of the jejunum), particularly in Papua New Guinea
all others	Various	do not cause disease in humans

Epidemiology

• Spores can survive cooking at normal temperatures
• Foodborne illness is usually associated with improperly heated or reheated gravy, beef, poultry, or other meat

Clinical Manifestations

• Acute infectious diarrhea
• Abdominal sepsis
• Cellulitis and myonecrosis

Management

• For gas gangrene, typically requires surgical debridement and penicillin G
  • Consider adding clindamycin for theoretical decreased toxin production in toxic shock syndrome
• Otherwise, generally susceptible to erythromycin, chloramphenicol, cefazolin, cefoxitin, ceftriaxone, piperacillin, carbapenems, metronidazole, vancomycin, and linezolid