Clostridium perfringens food poisoning
Following ingestion of the pathogen, there is local infection of the gut with the subsequent production of toxin in the human intestine. Clostridium perfringens is further classified into 5 types (A-E), based on the expression of 4 toxins. One enterotoxin that has been frequently implicated in food poisoning outbreaks is the C perfringens enterotoxin. The organisms that produce this toxin are usually type A.
Clostridium perfringens food poisoning has been associated with inadequately cooked meat, poultry, and legumes. Institutional outbreaks have also been reported.
After a median incubation period of 11 hours, patients develop acute watery, non-bloody diarrhea with mucus. Abdominal cramping is common. Vomiting, anorexia, and low-grade fever may be present occasionally. The usual duration of symptoms is 7-11 days.
Rarely, the disease can be much more severe. Hemorrhagic necrosis of the jejunum has been reported following infection with C perfringens type A, although this rare condition has been more frequently associated with the enterotoxin of C perfringens type C. Known as pigbel, C perfringens-mediated enteritis necroticans of the jejunum is most commonly described in the developing setting but has also been reported in the United States in association with the consumption of "chitterlings" (pig intestines).
A variety of other enteric pathogens can cause a similar syndrome of watery diarrhea. Clinically, a definite diagnosis of C perfringens food poisoning is not usually possible. The toxin can be identified in stool, but that test is not routinely available.
Treatment is symptomatic and focused on maintaining hydration.
A05.2 – Foodborne Clostridium perfringens [Clostridium welchii] intoxication
70014009 – Food poisoning due to Clostridium perfringens
Differential Diagnosis & Pitfalls
- Other bacterial pathogens including Salmonella, Shigella, Campylobacter, Escherichia coli, Bacillus cereus, Staphylococcus aureus, and Clostridioides difficile – Culture or antigen testing can be performed.
- Viral pathogens including the rotaviruses, noroviruses, or adenoviruses – Stool can be sent for rotavirus antigen or polymerase chain reaction (PCR) testing.
- Parasites including Giardia or Cryptosporidium – Stool may be sent for ova and parasite examination or antigen testing.
- Inflammatory bowel disease (ulcerative colitis, Crohn disease)