Clostridium perfringens
From IDWiki
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
