Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment

Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment

Q. 1

Regarding clostridium perfringens gas gangrene false is ?

 A

Clostridium perfringens is the most common cause of gas gangrene

 B

Naegler reaction positive

 C

Most important toxin is hyaluronidase

 D

Food poisoning strain of clostridium perfringens produces heat resistant spores

Q. 1

Regarding clostridium perfringens gas gangrene false is ?

 A

Clostridium perfringens is the most common cause of gas gangrene

 B

Naegler reaction positive

 C

Most important toxin is hyaluronidase

 D

Food poisoning strain of clostridium perfringens produces heat resistant spores

Ans. C

Explanation:

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

Q. 2

All of the following statements regarding Clostridium perfringens are true, EXCEPT:

 A

It is the commonest cause of gas gangrene

 B

It is normally present in human faeces

 C

The principal toxin of C. perfringens is the alpha toxin

 D

Gas gangrene producing strains of C. perfringens produce heat resistant spores

Q. 2

All of the following statements regarding Clostridium perfringens are true, EXCEPT:

 A

It is the commonest cause of gas gangrene

 B

It is normally present in human faeces

 C

The principal toxin of C. perfringens is the alpha toxin

 D

Gas gangrene producing strains of C. perfringens produce heat resistant spores

Ans. D

Explanation:

Spores of clostridium perfringens are killed within 5 minutes by boiling, it is also killed by autoclaving at 121 degree Celsius for 15 minutes. But spores of clostridium perfringens which produce food poisoning are heat resistant.
 
Clostridium perfringens produces multiple exotoxins and is classified into five types (A to E).

The most important exotoxin alpha toxin, is a phospholipase that hydrolyzes lecithin and sphingomyelin, thus disrupting the cell membranes of various host cells, including erythrocytes, leukocytes, and muscle cells. 
 
Gas Gangrene occur due to alpha toxin. In this, infection passes along the muscle bundles, producing rapidly spreading edema and necrosis as well as conditions that are more favorable for growth of the bacteria.
 
Ref: Sherris Medical Microbiology, 5th Edition, Chapter 29; Principles and Practice of Clinical Bacteriology By Stephen H. Gillespi, 2nd Edition, Page 569; Textbook of Microbiology and Immunology By Parij, Page 239

Q. 3

Life threatening intravascular hemolysis occurs with sepsis due to which organism:

 A

Clostridium perfringens

 B

Mycoplasma pneumonia

 C

Pseudomona

 D

Klebsiella

Q. 3

Life threatening intravascular hemolysis occurs with sepsis due to which organism:

 A

Clostridium perfringens

 B

Mycoplasma pneumonia

 C

Pseudomona

 D

Klebsiella

Ans. A

Explanation:

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.


Q. 4

Bacteria most frequently cultured in the setting of emphysematous cholecystitis is:

 A

Clostridium

 B

Streptococcus

 C

Salmonella

 D

Klebsiella

Q. 4

Bacteria most frequently cultured in the setting of emphysematous cholecystitis is:

 A

Clostridium

 B

Streptococcus

 C

Salmonella

 D

Klebsiella

Ans. A

Explanation:

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.


Reference:
Harrisons Principles of Internal Medicine, 18th Edition, Page 2622

 


Q. 5

Gasterointestinal enteritis necroticans is caused by – 

 A

Clostridium difficale 

 B

Clostridium perfringens

 C

Botulinum

 D

C. Jejuni

Q. 5

Gasterointestinal enteritis necroticans is caused by – 

 A

Clostridium difficale 

 B

Clostridium perfringens

 C

Botulinum

 D

C. Jejuni

Ans. B

Explanation:

Ans is ‘b’ i.e. Cl. perfringens 

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


Q. 6

Naegler’s reaction is shown by ?

 A

Clostradium tetani

 B

Clostridium welchii

 C

Mycobacterium tuberculosis

 D

Mycobacterium leprae

Q. 6

Naegler’s reaction is shown by ?

 A

Clostradium tetani

 B

Clostridium welchii

 C

Mycobacterium tuberculosis

 D

Mycobacterium leprae

Ans. B

Explanation:

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


Q. 7

39.Which one of the following organisms is not associatied with synergistic gangrene:

 A

Esherichia

 B

Staphylococcus

 C

Clostridium

 D

Peptostreptococcus

Q. 7

39.Which one of the following organisms is not associatied with synergistic gangrene:

 A

Esherichia

 B

Staphylococcus

 C

Clostridium

 D

Peptostreptococcus

Ans. C

Explanation:

Ans is c i.e. Clostridium 


Q. 8

Rhabdomyolysis and Myoglobinuria may be seen in:

 A

Viperbite

 B

Multiple Hornet Stings

 C

Clostridium Perfringes

 D

All of the above

Q. 8

Rhabdomyolysis and Myoglobinuria may be seen in:

 A

Viperbite

 B

Multiple Hornet Stings

 C

Clostridium Perfringes

 D

All of the above

Ans. D

Explanation:

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.


Q. 9

Which of the following is responsible for crepitations in wounds:        

September 2011

 A

Staphylococcus

 B

Mycobacterium

 C

Streptococcus

 D

Clostridium

Q. 9

Which of the following is responsible for crepitations in wounds:        

September 2011

 A

Staphylococcus

 B

Mycobacterium

 C

Streptococcus

 D

Clostridium

Ans. D

Explanation:

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.


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