Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment
Anaerobic myositis or myonecrosis or gas gangrene
- Abundant formation of exotoxin & production of gas.
- Clostridiae invade fascial planes(fasciitis)
- Minimal toxin production but no invasion of muscle tissue.
- Lesions vary from limited ‘gas abscess’ to extensive involvement of limbs.
- Seropurulent discharges with offensive odor produced
- GG is rarely infection of single clostridium; several species found in association:
- Anaerobic streptococci & facultative anaerobes (E.coli,Stap,Proteus)
- Cl.perfringens is most frequently encountered(60%)
- Followed by Cl.Novyi
- Cl.septicum(20-40%)
- Essential factor
- Trauma
- lncubation period
- 10-48 hours
- Symptoms
- Pain
- Crepitus
- Death is due to circulatory failure
- Treatment
- Mainstay of therapy
- Surgery
- Doc
- Clindamycin + penicillin
- Hyperbaric O
Non-traumatic gas gangrene
- Hematogenous seeding of normal muscle with histotoxic Clostridia principally
- C. perfringens
- C. septicum
- C. novyi
- Symptoms
- Confusion
- Sudden onset of severe pain in absence of trauma.
- Mortality rate is very high (67-100%)
- Most serious complication of clostridial invasion of healthy muscle tissue (rhabdomyolysis)
Food poisoning:
- Usually caused by Type A strains(produces heat resistance spores)
- Cytotoxin mediated
Gangrenous appendicitis:
- Cl.perfringens Type A & occasionally by Type D
Necrotizing enteritis:
- Caused by Type C strains(β toxin)
- Associated Factor:Ingestion of high protein meal with trypsin inhibitors
- Symptoms:acute abdominal pain, bloody diarrhea vomiting; signs of peritonitis.
Biliary tract infection:
- Rare but serious -EC & PCS
Gasterointestinal enteritis necroticans
- Associated with C.perfringens type A
Brain abscess & meningitis:
- Rare
Panophthalmitis:
- Rare
Thoracic infections
Emphysematous cholecystitis
Urogenital infections(myoglbinuria)
LABORATORY DIAGNOSIS:
Specimen:
- Wound swabs
- human faeces
- necrosed tissue
- muscle fragments,
- exudates from active parts etc.
Microscopy:
- Gram +ve, non-motile, capsulated bacilli.
- Spores are rarely observed in Cl.perfringens
Culture:
- On RCM→ meat turned pink but not digested
- On blood agar → target hemolysis
Nagler’s Reaction
- Rapid detection of Cl.perfringens from clinical sample
- Done to detect the lecithinase activity of alpha toxin
- Characteristics opalescence is produced around colonies in +ve test due to breakdown of lipoprotein complex in the medium
Reverse CAMP Test:
- Used for differentiation of Cl.perfringens from other clostridium species.
- CAMP +ve Group B Streptococcus is streaked in SBA & Cl.perfringens is streaked perpendicular to it “arrowhead”(enhanced) hemolysis is seen between growth of Cl.perfringens & Group B streptococcus
Exam Question
Anaerobic myositis or myonecrosis or gas gangrene
- Several species found in association:
- Anaerobic streptococci & facultative anaerobes (E.coli,Stap,Proteus)
- Cl.perfringens is most frequently encountered(60%)
Non-traumatic gas gangrene
- Hematogenous seeding of normal muscle with histotoxic Clostridia principally
- Most serious complication of clostridial invasion of healthy muscle tissue (rhabdomyolysis)
Food poisoning:
- Usually caused by Type A strains(produces heat resistance spores)
- Cytotoxin mediated
Gangrenous appendicitis
Necrotizing enteritis
Biliary tract infection:
Gasterointestinal enteritis necroticans
- Associated with C.perfringens type A
Emphysematous cholecystitis
Urogenital infections(myoglbinuria)
LABORATORY DIAGNOSIS:
Specimen:
- Wound swabs
- human faeces
- necrosed tissue
- muscle fragments,
- exudates from active parts etc.
Microscopy:
- Gram +ve, non-motile, capsulated bacilli.
- Spores are rarely observed in Cl.perfringens
Culture:
- On RCM→ meat turned pink but not digested
- On blood agar → target hemolysis
Nagler’s Reaction
- Rapid detection of Cl.perfringens from clinical sample
Reverse CAMP Test:
- CAMP +ve Group B Streptococcus is streaked in SBA & Cl.perfringens is streaked perpendicular to it “arrowhead”(enhanced) hemolysis is seen between growth of Cl.perfringens & Group B streptococcus
Don’t Forget to Solve all the previous Year Question asked on Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment