Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment

Most common toxin is hyaluronidase [Ref Ananthanarayan p. 251, 252, 253; Greenwood 16^thie p. 231]

• Clostridium are gram positive spore forming rods.

– The spores enable these organisms to survive in adverse conditions e.g. in soil and dust and on skin.

–  Most species are obligate anaerobes i.e. their spores do not germinate and growth does not normally proceed unless a suitably low redox potential (Eb) exists.

Clostridium perfringens

Clostridium perfringens cause two important diseases:?

Gas gangrene

• “Clostridium perfringens is the commonest cause of gas gangrene”.
• The disease is characterized by rapidly spreading edema, myositis and necrosis of tissues, gas production and profound toxemia.
• Clostridium perfringens produces several toxins and other substance which have a role in the pathogenesis of gas gangrene.
• “a Toxin a phospholipase lecithinase” is generall^y considered to he the most important toxin in the pathogenesis of gas gangrene.

-It is produced by all types of clostridium perfringens and most abundantly by type “A” strains.

– It is the most important toxin biologically and is responsible _.for profound toxemia of the gas gangrene. – It is a “phospholipase”.

Other factors which also have a role in virulence:-

Hyaluronida.ve

• It breaks down intercellular cement substance and promotes the spread of the infection along the tissue planes

Collagenases and other proteinases

• They break down tissues and virtually liquefy muscles.

Clostridium food poisoning:-

• Clostridium perfringens is an important cause of food poisoning.
• The _.food poisoning is caused due to ingestion of spores.
• The spores of the clostridium perfringens strains that cause food poisoning are heat resistant. –The unique feature of spores produced by food poisoning strains of clostridium perfringens is that they are heat resistant that can survive boiling for several hours.

Remember

– Only those strains of clostridia which are associated with food poisoning produce heat resistant spores Where as

– The classic strains of this species do not have heat resistant spores. These spores are inactivated within few minutes by boiling.

• Typical_, food poisoning strains of clostridium perfringens occur as carrier state.
• These strains also occur in animals thus meat is often contaminated with heat resistant spores.
• The vehicle of infection is usually a precooked meat food that has been allowed to stand at a temperature.
• The heat resistance of the spores ensures their survival in cooking.

– During the cooling period they germinate in the anaerobic environment produced by the cooked meat and multiply.

– Anyone who eats this meat will consume the equivalent of cooked meat broth culture of the organisms.

– Large numbers of clostridia are thus consumed which may pass unharmed by the gastric acid due to high protein in the meat and reach the intestines where they produce the enterotoxin.

– After an incubation period of 8-24 hours abdominal pain diarrhoea set in.

Naegeler reaction

• ft is used to detect alpha toxin which is a phospholipase (lecithinase C)

– Lecithinase or phospholipase in the presence of Ca⁺⁺ and Mg^‘ ions splits lecithin into phosphorylcholine and diacylglycerol. This reaction is seen as an “opalescence” in serum or egg yolk media.

Procedure

• CI perfringens is grown on a plate where one half of the plate is covered with alpha antitoxin.
• The half portion of the plate without the antitoxin produces opalescene.

– Pho.spholipase or a toxin splits the lecithin into phosphorylcholine and diacyl glycerol. Which is seen as opalescnee.

• The other half of the plate where alpha antitoxin is present does not demonstrate opalescence because here alpha toxin or phospholipase is neutralized by the toxin.

Life threatening intravascular hemolysis occur due to a toxin with lecithinase activity seen in clostridium perfringens sepsis.

Ref: Harrison’s principles of internal medicine, 18th edition ; Page :881.

Bacteria most frequently cultured in emphysematous cholecystitis include anaerobes, such as C. welchii or C. perfringens, and aerobes, such as E. coli. This condition occurs frequently in elderly men and in patients with diabetes mellitus.

Ans is ‘b’ i.e. Cl. perfringens 

Necrotising enteritis (enteritis necroticans or Pigbel) is caused by Cl. perfringens.

Ans. is ‘b’ i.e., Clostridium welchii 

Ans is c i.e. Clostridium 

Answer is D (All of the above):

Bacterial infections from clostridium species and streptococcus and envenomations from Russel Viper and Hornet may all cause rhabdomyolysis.

Ans. D: Clostridium

Crepitus may be palpated as a result of infection by gas forming organism

Established pathogens of gas gangrene group are Cl. Perfringenes, Cl. Septicum and Cl. novyi

Crepitus

A sound can be created when two rough surfaces in the human body come into contact— for example, in osteoarthritis or rheumatoid arthritis when the cartilage around joints has eroded away and the joint ends grind against one another

• When the fracture surfaces of two broken bones rub together, it produces a sound. Crepitus is a common sign of bone fracture.
• In soft tissues, crepitus can be produced when gas is introduced into an area where it normally isn’t present.
• The term can also be used when describing the sounds produced by lung conditions such as interstitial lung disease—these are also referred to as “rales”.
• Crepitus is often loud enough to be heard by the human ear, although a stethoscope may be needed to detect instances caused by respiratory diseases.
• In times of poor surgical practice, post-surgical complications involved anaerobic infection by Clostridium perfringens strains, which can cause gas gangrene in tissues, also giving rise to crepitus.
• Subcutaneous crepitus (or surgical emphysema) is a crackling sound resulting from subcutaneous emphysema, or air trapped in the subcutaneous tissues.

Subcutaneous emphysema/ SCE/ SE/ Tissue emphysema/ Sub Q air

• It occurs when gas or air is present in the subcutaneous layer of the skin.
• Subcutaneous refers to the tissue beneath the cutis of the skin, and emphysema refers to trapped air.
• Since the air generally comes from the chest cavity, subcutaneous emphysema usually occurs on the chest, neck and face, where it is able to travel from the chest cavity along the fascia.
• Subcutaneous emphysema has a characteristic crackling feel to the touch, a sensation that has been described as similar to touching Rice Krispies; this sensation of air under the skin is known as subcutaneous crepitation.