โ Scribed by Barceloux, Donald G.
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Clostridium perfringens (Veillon & Zuber) Hauduroy et al. ( C. perfringens ) is a strict anaerobic, gram -positive, spore -forming bacterium that causes a variety of human and veterinary diseases. In 1892, William H. Welch and George Nuttall discovered these bacteria in gangrenous wounds. At that time, they designated the bacteria as Bacillus aerogenes capsulatus . Foodborne disease from C. perfringens was fi rst described by L.S. McClung in 1945. 1 Although C. perfringens is largely recognized as the chief cause of clostridial myonecrosis (gas gangrene), it is the third most commonly reported cause of human foodborne gastrointestinal disease in the United States after Salmonella spp. and Staphylococcus aureus with 10 -20 reported annual outbreaks in the United States. 2 C. perfringens is serotyped A -E, based on distinct combinations of major and minor clostridial toxins (e.g., alpha, beta, epsilon, iota). Epsilon toxin is a bioterrorism select agent. Serotypes A and C are associated with human disease, whereas serotypes B, D, and E are associated with veterinary diseases. All fi ve serotypes elaborate ฮฑ -toxin (a variant of phospholipase C), which is the toxin responsible for clostridial myonecrosis. About 5% of serotype A isolates also elaborate Clostridial perfringens enterotoxin, which mediates the vast majority of foodborne diseases from C. perfringens . 3 Serotype C produces ฮฒ -toxin that causes rare cases of human necrotic enteritis. In Germany and Denmark during WWII, outbreaks of this necrotic form of enteritis occurred in soldiers, who were given large meals after days to weeks of starvation. The disease was named " Darmbrand. " 4 In the early 1960s in Papua New Guinea, outbreaks of enteritis necroticans occurred in natives after large pig feasts lasting several days. In the native dialect, this disease was called " Pigbel. " In both settings, C. perfringens type C was isolated in peritoneal fl uid and food. Most reported foodborne outbreaks associated with C. perfringens are mild diseases caused by C. perfringens type A. The term " cafeteria diarrhea " has been applied to food poisoning outbreaks from C. perfringens because these outbreaks often occur following consumption of meals prepared in schools, prisons, hospitals, and cruise ships.
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Clinical professor of medicine, department of emergency medicine David geffen school of medicine University of california at los angeles Los angeles, california Senior partner, cep america Emeryville, california Staff physician, department of emergency medicine Pomona valley hospital medicine center