Necrotizing Enterocolitis Associated with Clostridium perfringens Type A in Previously Healthy North American Adults

Sobel, Jeremy; Mixter, Charles G.; Kolhe, Priti; Gupta, Amita; Guarner, Jeannette; Zaki, Sherif R.; Hoffman, Neil A.; Songer, J. Glenn; Fremont‐Smith, Maurice; Fischer, Marc; Killgore, George; Britz, Phyllis; MacDonald, Clifford

doi:10.1016/j.jamcollsurg.2005.02.029

Cited by 55 publications

(38 citation statements)

References 29 publications

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“…It has now been clearly established that certain C. perfringens strains are capable of inducing necrotic enteritis in broilers, pigs, lambs, horses, felines, and humans 13, 35, 36, 37, 38. Currently, the cause of C. perfringens overgrowth in the gastrointestinal tracts of humans or other mammals, including dogs, is not always known.…”

Section: Discussionmentioning

confidence: 99%

Endoscopically Visualized Lesions, Histologic Findings, and Bacterial Invasion in the Gastrointestinal Mucosa of Dogs with Acute Hemorrhagic Diarrhea Syndrome

Unterer¹,

Busch²,

Leipig³

et al. 2013

Veterinary Internal Medicne

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BackgroundEtiology of hemorrhagic gastroenteritis (HGE) syndrome in dogs is unknown and histopathologic and microbial investigations have only been performed post mortem.ObjectiveTo identify characteristic intra vitam endoscopic and histologic mucosal lesions, as well as bacterial species, within the mucosa of dogs with HGE.AnimalsTen dogs diagnosed with HGE were included. Eleven dogs with gastroduodenoscopy and different intestinal diseases were used as controls for microbial changes. Dogs pretreated with antibiotics or diagnosed with any disease known to cause bloody diarrhea were excluded from the study.MethodsIn this prospective study, gastrointestinal biopsies were collected from 10 dogs with HGE. Endoscopic and histologic changes were assessed according to WSAVA guidelines. Biopsies from the stomach, duodenum, ileum, and colon were investigated by histology and by immunohistochemistry for the presence of Clostridium spp. and parvovirus. The first duodenal biopsy taken with a sterile forceps was submitted for bacterial culture.ResultsAcute mucosal lesions were only found in the intestines, not in the stomach. Clostridium spp., identified as Clostridium perfringens in 6/9 cases, were detected on the small intestinal mucosa in all dogs with HGE, either by culture or immunohistopathology. In the control group, C. perfringens could only be cultured in one of 11 dogs.Conclusions and Clinical ImportanceThe results of this study demonstrate an apparent association between C. perfringens and the occurrence of acute hemorrhagic diarrhea. The term “HGE,” which implies the involvement of the stomach, should be renamed as “acute hemorrhagic diarrhea syndrome.”

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Section: Discussionmentioning

confidence: 99%

Endoscopically Visualized Lesions, Histologic Findings, and Bacterial Invasion in the Gastrointestinal Mucosa of Dogs with Acute Hemorrhagic Diarrhea Syndrome

Unterer¹,

Busch²,

Leipig³

et al. 2013

Veterinary Internal Medicne

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“…CNE is a health problem in developing countries where people are in a state of chronic malnutrition. The risk factors of CNE include prolonged protein deprivation that leads to protease depletion, consumption of sweet potatoes (which contain trypsin inhibitors, and trypsin degrades the β toxin in the intestines thereby preventing the development of CNE), ample pork consumption and ascariasis (in which the pathogen produces a potent trypsin inhibitor to prevent its own digestion) (2,3). Pigbel is the term for necrotizing enteritis caused by C. perfringens type C in Papua New Guinea where many children die of the disease and poorly cooked pork is consumed by protein-deficient people (9).…”

Section: Discussionmentioning

confidence: 99%

Necrotizing Duodenitis Caused by <i>Clostridium perfringens</i> Type A in a Japanese Young Man

et al. 2012

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A 21-year-old Japanese man with a history of marked body weight loss over a short period of time died of necrotizing duodenitis caused by Clostridium perfringens (C. perfringens) type A. C. perfringens type A is considered to usually cause self-limiting gastroenteritis. Necrotizing enteritis sometimes occurs due to C. perfringens in developing countries; however, it is primarily caused by the type C strain and its site of onset is typically the jejunum or ileum. This is a rare case of necrotizing duodenitis caused by C. perfringens type A in a Japanese young man. Physicians need to be more aware of this emerging fatal disease in developed countries.

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“…In the early 1960s this syndrome was recognized as a common condition in Papua New Guinea (PNG) where it affected young adults and children. The introduction of the Clostridium perfringens was traced to poorly cooked meat especially pork 1 , hence the name 'pigbel'. With the improvement in standards of living and hygiene after the world war, these cases disappeared from Germany, but in several countries including Thailand, PNG, Uganda and Ghana cases have been identified 2,3,4 .…”

Section: Discussionmentioning

confidence: 99%

“…Poor cooking hygiene, especially of meat, predisposes to the proliferation of Clostridium perfringens type C1. This organism produces a β-toxin which has severe necrotising effects on tissues 1,4 . C perfringens type C is normally present in pig intestine and is also excreted in pig faeces 5,6 thus poorly cooked pork was touted to be the main cause of pig-bel in PNG where it reached epidemic proportions in the early 1960s.…”

Section: Discussionmentioning

confidence: 99%

Ward Round-An acute abdominalemergency

Irabor¹,

Adesina²

2010

Mal. Med. J

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A 32 year old unemployed male was brought into the Accidents and Emergency Department of the University College Hospital, Ibadan, with a 2-day history of severe generalized abdominal pain, fever, vomiting and abdominal distension. He had been previously well until 2 days prior to presentation when he had abdominal pain with loose stools. He went to a general practitioner and anti-ulcer drugs plus metronidazole tablets were prescribed. His condition did not improve and he developed a fever, became constipated and his abdominal girth started increasing with worsening of the pain. Examination at the emergency department showed a young adult male who looked acutely ill, he was febrile but not pale or jaundiced. His tongue was dry and coated with brownish material. The main findings were on abdominal examination; his abdomen was distended, tense and generally tender. There was a vague mass in the left iliac fossa which was tender. Auscultation revealed a silent abdomen. Rectal examination only yielded some mucus but not blood. The diagnosis entertained was of a perforated left-sided colon cancer with differentials of typhoid perforation or perforated amoebic colitis. Plain abdominal x-rays ordered showed dilated small bowel with multiple air/fluid levels with an isolated loop of gas-filled bowel on the left side. A consideration of small bowel volvulus was also entertained at that juncture. He was resuscitated and had an emergency exploratory laparotomy. Findings at surgery showed a 20cm length of jejunum that was a dusky red colour with a clear-cut demarcation between the affected part and a less erythematous but still rather hyperaemic part of the jejunum (Figure 1). The involvement of the mesentery of the affected part was also evident as a triangular thickened segment was also dusky-red. There were no enlarged mesenteric lymph nodes and there was about 500ml of serous peritoneal fluid. He had jejunal resection with end to end anastomosis using 3-0 Vicryl suture in 2 layers. He had an uneventful post-operative course and recovered bowel functions on the 4th post-operative day. He was discharged on the 9th post-operative day. The histopathology report of the resected small bowel stated 'acute on chronic jejunitis with peritonitis'. He has been seen for follow-up several times at the surgical outpatient clinic and he remains in good health.

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Necrotizing Enterocolitis Associated with Clostridium perfringens Type A in Previously Healthy North American Adults

Cited by 55 publications

References 29 publications

Endoscopically Visualized Lesions, Histologic Findings, and Bacterial Invasion in the Gastrointestinal Mucosa of Dogs with Acute Hemorrhagic Diarrhea Syndrome

Endoscopically Visualized Lesions, Histologic Findings, and Bacterial Invasion in the Gastrointestinal Mucosa of Dogs with Acute Hemorrhagic Diarrhea Syndrome

Necrotizing Duodenitis Caused by <i>Clostridium perfringens</i> Type A in a Japanese Young Man

Ward Round-An acute abdominalemergency

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