Clostridium perfringens

Clostridium perfringens
Photomicrograph of Gram-positive Clostridium perfringens bacilli.
Scientific classification
Kingdom:	Bacteria
Phylum:	Firmicutes
Class:	Clostridia
Order:	Clostridiales
Family:	Clostridiaceae
Genus:	Clostridium
Species:	C. perfringens
Binomial name
Clostridium perfringens Veillon & Zuber 1898 Hauduroy et al. 1937

Clostridium perfringens (formerly known as C. welchii, or Bacillus welchii) is a Gram-positive, rod-shaped, anaerobic, spore-forming pathogenic bacterium of the genus Clostridium.^[1] C. perfringens is everpresent in nature and can be found as a normal component of decaying vegetation, marine sediment, the intestinal tract of humans and other vertebrates, insects, and soil. It has the shortest reported generation time of any organism at 6.3 minutes in thioglycollate medium.^[2]

C. perfringens is the third most common cause of food poisoning in the United Kingdom and the United States though it can sometimes be ingested and cause no harm.

Infections due to C. perfringens show evidence of tissue necrosis, bacteremia, emphysematous cholecystitis, and gas gangrene, which is also known as clostridial myonecrosis. The toxin involved in gas gangrene is known as α-toxin, which inserts into the plasma membrane of cells, producing gaps in the membrane that disrupt normal cellular function. C. perfringens can participate in polymicrobial anaerobic infections. Clostridium perfringens is commonly encountered in infections as a component of the normal flora. In this case, its role in disease is minor.

The action of C. perfringens on dead bodies is known to mortuary workers as tissue gas and can be halted only by embalming.

Mobility

Although they lack flagella, C. perfringens bacteria are able to glide across surfaces because their bodies are lined with filaments from end-to-end. The hypermotile variants such as SM101, are often found arising on the edges of colonies on agar plates. Video microscopy of their gliding movement suggest that they form long, thin filaments that allow them to move rapidly like bacteria with flagella. Genome sequencing was used to identify the cause(s) of the hypermotile phenotype and their direct derivatives. In comparing them, strains SM124 and SM127, hypermotile derivatives of strains SM101 and SM102, respectively, contained 10 and 6 nucleotide polymorphisms (SNPs) relative to their parent strains. A mutation in cell division genes is the common feature of the hypermotile strains.^[3]

Food poisoning

In the United Kingdom and United States, C. perfringens bacteria are the third most common cause of foodborne illness, with poorly prepared meat and poultry, or food properly prepared but left to stand too long, the main culprits in harboring the bacterium.^[4] The clostridium perfringens enterotoxin (CPE) mediating the disease is heat-labile (inactivated at 74 °C (165 °F)). It can be detected in contaminated food (if not heated properly), and feces.^[5] Incubation time is between six and 24 (commonly 10-12) hours after ingestion of contaminated food.

Since C. perfringens forms spores that can withstand cooking temperatures, if cooked food is let stand for long enough, germination can ensue and infective bacterial colonies develop. Symptoms typically include abdominal cramping, diarrhea, vomiting, and fever. The whole course usually resolves within 24 hours. Very rare, fatal cases of clostridial necrotizing enteritis (also known as pigbel) have been known to involve "Type C" strains of the organism, which produce a potently ulcerative β-toxin. This strain is most frequently encountered in Papua New Guinea.

Many cases of C. perfringens food poisoning likely remain subclinical, as antibodies to the toxin are common among the population. This has led to the conclusion that most of the population has experienced food poisoning due to C. perfringens.

Despite its potential dangers, C. perfringens is used as the leavening agent in salt rising bread. The baking process is thought to reduce the bacterial contamination, precluding negative effects.^[6]

Infection

Clostridium perfringens is the most common bacterial agent for gas gangrene, which is necrosis, putrefaction of tissues, and gas production. It is caused primarily by Clostridium perfringens alpha toxin. The gases form bubbles in muscle (crepitus) and the characteristic smell in decomposing tissue. After rapid and destructive local spread (which can take only hours), systemic spread of bacteria and bacterial toxins may cause death. This is a problem in major trauma and in military contexts. C. perfringens grows readily on blood agar plate in anaerobic conditions, and often produces a double zone of beta hemolysis.

Research published in 2014 suggested that a strain of C. perfringens might be implicated in multiple sclerosis (MS). Tests in mice found that a toxin made by a rare strain of C. perfringens caused MS-like damage in the brain, and earlier work had identified this strain of C. perfringens in a human with MS.^[7] MS patients were found to be ten times more immune-reactive to the epsilon toxin than healthy people.^[8]

Diagnosis

C. perfringens can be diagnosed by Nagler's reaction where the suspect organism is cultured on an egg yolk media plate. One side of the plate contains anti-alpha-toxin, while the other side does not. A streak of suspect organism is placed through both sides. An area of turbidity will form around the side that does not have the anti-alpha-toxin, indicating uninhibited lecithinase activity. Other tests/reactions: Catalase: Negative, Spot indole: Positive, Lecithinase: Positive, Lipase: Negative, Litmus Milk: Stormy Fermentation, Reverse CAMP plate: Positive, Gas Liquid Chromatography products: (Acetic, Butyric and Lactic Acids).

Treatment

If suspected on clinical grounds, treatment should begin without waiting for lab results. Traumatic wounds should be cleaned. Wounds that cannot be cleaned should not be stitched shut. Penicillin prophylaxis kills many clostridia and is thus useful for dirty wounds and lower leg amputations. A high infectious dose is required; the carrier state persists for several days.

Food poisoning incidents

On May 7, 2010, 42 residents and 12 staff members at a Louisiana state psychiatric hospital experienced vomiting, abdominal cramps, and diarrhea. Within 24 hours, three patients had died. The outbreak was linked to chicken which was cooked a day prior to being served and was not cooled down according to hospital guidelines. The outbreak affected 31% of the residents of the hospital and 69% of the staff who ate the chicken. It is unknown how many of the affected residents ate the chicken.^[9]

In May 2011, a man died after allegedly eating food contaminated with the bacteria on a transatlantic American Airlines flight. The man's wife and daughter are suing American and LSG Sky Chefs, the German company that prepared the inflight food.^[10]

In December 2012, a 46-year-old woman died two days after eating a Christmas Day meal at a pub in Hornchurch, Essex, England. She was among about 30 people to fall ill after eating the meal. Samples taken from the victims contained C.perfringens. The hotel manager and the cook were jailed for offences arising from the incident.^[11]

In December 2014, 87-year-old Bessie Scott died three days after eating a church potluck supper in Nackawic, New Brunswick, Canada. Over 30 other people reported signs of gastrointestinal illness, diarrhea and abdominal pain. The province's acting chief medical officer says Clostridium perfringens is the bacteria that most likely caused the woman’s death.^[12]

References

1. Ryan, Kenneth J.; Ray, C. George (2004). Sherris Medical Microbiology : an Introduction to Infectious Diseases (4th ed.). New York: McGraw-Hill. p. 310. ISBN 0-83-858529-9.
2. "BioNumber Details Page". BioNumbers.
3. Liu, Hualan; McCord, Kristin D.; Howarth, Jonathon; David, Popham L.; Jensen, Roderick V.; Melville, Stephen B. (July 2014). "Hypermotility in Clostridium perfringens Strain SM101 Is Due to Spontaneous Mutations in Genes Linked to Cell Division". Journal of Bacteriology 196 (13): 2405–2412. doi:10.1128/JB.01614-14.
4. Warrell; et al. (2003). Oxford Textbook of Medicine (4th ed.). Oxford University Press. ISBN 0-19-262922-0.
5. Murray; et al. (2009). Medical Microbiology (6th ed.). Mosby Elsevier. ISBN 978-0-323-05470-6.
6. Juckett, Gregory; et al. (November 2008). "The Microbiology of Salt Rising Bread" (PDF). West Virginia Medical Journal (22). Retrieved 22 July 2015.
7. "Multiple sclerosis 'linked to food bug'". BBC. 29 January 2014. Retrieved 29 January 2014.
8. http://www.foxnews.com/health/2014/01/29/bacterial-toxin-may-trigger-multiple-sclerosis-research-finds/?intcmp=trending
9. "Fatal Foodborne Clostridium perfringens Illness at a State Psychiatric Hospital — Louisiana, 2010". Centers for Disease Control and Prevention. Retrieved 16 November 2013.
10. Mohn, Tanya (1 December 2011). "Passenger dies in-flight, family says airline to blame". Overhead Bin. MSNBC. Retrieved 2012-02-13.
11. "Pub chef and manager jailed over Christmas dinner that left a diner dead". The Guardian. 23 January 2015. Retrieved 3 August 2015.
12. "Woman's death likely caused by bacteria from Christmas supper". CBC. 12 December 2014.

External links

• Clostridium perfringens genomes and related information at PATRIC, a Bioinformatics Resource Center funded by NIAID
• Pathema-Clostridium Resource