An epidemiological review of gastrointestinal outbreaks associated withClostridium perfringens, North East of England, 2012–2014

Abstract

An anecdotal increase in C. perfringens outbreaks was observed in the North East of England during 2012-2014. We describe findings of investigations in order to further understanding of the epidemiology of these outbreaks and inform control measures. All culture-positive (>105 c.f.u./g) outbreaks reported to the North East Health Protection Team from 1 January 2012 to 31 December 2014 were included. Epidemiological (attack rate, symptom profile and positive associations with a suspected vehicle of infection), environmental (deficiencies in food preparation or hygiene practices and suspected vehicle of infection) and microbiological investigations are described. Forty-six outbreaks were included (83% reported from care homes). Enterotoxin (cpe) gene-bearer C. perfringens were detected by PCR in 20/46 (43%) and enterotoxin (by ELISA) and/or enterotoxigenic faecal/food isolates with indistinguishable molecular profiles in 12/46 (26%) outbreaks. Concerns about temperature control of foods were documented in 20/46 (43%) outbreaks. A suspected vehicle of infection was documented in 21/46 (46%) of outbreaks (meat-containing vehicle in 20/21). In 15/21 (71%) identification of the suspected vehicle was based on descriptive evidence alone, in 5/21 (24%) with supporting evidence from an epidemiological study and in 2/21 (10%) with supporting microbiological evidence. C. perfringens-associated illness is preventable and although identification of foodborne outbreaks is challenging, a risk mitigation approach should be taken, particularly in vulnerable populations such as care homes for the elderly.

Molecular Characterization of Clostridium perfringens Strains Isolated in Italy

“…Surprisingly, our study showed that none of the 5 C. perfringens deriving from contaminated food presented the cpe gene in contrast to that reported in the literature [ 7 , 8 ]. Rosignoli et al [ 39 , 40 ] reported a unique sample food typed A but associated with the cons variant, whereas all our C. perfringens isolates were associated with the aty allelic variant.…”

“…The new toxinotype F represents the formerly known CPE-positive strains of C. perfringens type A and encodes the CPA and CPE toxins upon sporulation. In this case, CPE is a typing toxin because its association with the cpa toxin genes has been demonstrated to be responsible for enterotoxigenic infections in humans [ 7 , 8 ] and animals [ 9 ]. The new type G produces the CPA toxin and the NetB toxin and is responsible for necrotic enteritis in poultry [ 10 ].…”

An update on the human and animal enteric pathogen Clostridium perfringens

“…In the European Union (EU) member countries, C. perfringens -linked food-poisoning outbreaks were projected at approximately 5 million cases per year (2011) 113 . C. perfringens has also been reported to affect elderly communities, especially in care homes (North East of England, 2012–2014; 83% of the outbreaks reported from care homes) 114 . C. perfringens -linked foodborne cases are suggested to be under-reported due to its self-limiting symptoms, thus the statistics published based on laboratory-confirmed cases may be lower than the actual numbers, suggesting a higher actual epidemiological impact.…”

Phylogenomic analysis ofClostridium perfringensidentifies isogenic strains in gastroenteritis outbreaks, and novel virulence-related features

“…In the context of disease control it is important to gain detailed genomic information to predict transmission modes for pathogens. Our analysis of care home isolates indicated a specific persistent clone may have been responsible for up to 9 individual gastrointestinal outbreaks in North East England over the 2013-2017 period, which represents the majority reported gastroenteritis outbreaks (>80%) in this area (10). Interestingly, a previous study indicated presence of persistent identical C. perfringens genotypes within care home settings, with several individuals harbouring identical strains (as determined via PFGE profiling) throughout a 9-month sampling period, however none of these isolates were positive for the cpe gene (87).…”

“…With this type of illness, symptoms are more severe than foodborne diarrhoea and are longer lasting (>3 days to several weeks), often chronic, and infections are more likely to be spread amongst cases (14). This type of C. perfringens infection has also been reported in elderly patients, especially those residing in care homes in the North East of England between 2012-2014 (83% of the outbreaks reported from care homes) (10). Although fatality due to C. perfringens diarrhoea is uncommon and hospitalisation rate is low, enterotoxigenic C. perfringens is reported to cause ~55 deaths/year in England and Wales according to the UK Food Standards Agency (15, 16).…”