Document Detail


Fatal necrotizing colitis following a foodborne outbreak of enterotoxigenic Clostridium perfringens type A infection.
MedLine Citation:
PMID:  15844055     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Enterotoxigenic Clostridium perfringens type A is the third leading cause of foodborne disease in the United States, resulting annually in an estimated 250,000 cases of a typically mild, self-limiting gastrointestinal illness. METHODS: A retrospective cohort study was conducted to determine the cause of a small cluster of cases of gastrointestinal illness, which included cases of severe necrotizing colitis. Participants in the study consisted of residents and staff of a residential care facility for the mentally ill in Oklahoma (n = 20). An inspection of food preparation and food storage areas of the residential care facility was conducted as part of an environmental investigation. The investigation included extensive microbiological and molecular testing of the C. perfringens isolates and tissue specimens collected at autopsy. RESULTS: A total of 7 (3 confirmed and 4 probable) cases of foodborne enterotoxigenic C. perfringens type A were identified (attack rate, 35%) after the consumption of high-risk foods. Three residents developed acute necrotizing colitis; 2 of them died. Each patient with confirmed infection presented with evidence of constipation or fecal impaction. C. perfringens enterotoxin (CPE)-positive C. perfringens type A was cultured on samples from each patient with necrotizing colitis. Although statistical analyses failed to implicate a food source, the isolates carried a chromosomal cpe gene, which supports a foodborne origin. CONCLUSIONS: This study confirms that foodborne CPE-positive C. perfringens type A can affect the colon, resulting in potentially fatal necrotizing colitis. Drug-induced constipation and fecal impaction, resulting in prolonged exposure of the colonic mucosal tissue to C. perfringens type A toxins, contributed to the development of necrotizing colitis.
Authors:
John Bos; Lauri Smithee; Bruce McClane; R F Distefano; Francisco Uzal; J Glenn Songer; Sue Mallonee; James M Crutcher
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.     Date:  2005-04-14
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  40     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-21     Completed Date:  2006-06-28     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e78-83     Citation Subset:  IM    
Affiliation:
Oklahoma State Department of Health, Oklahoma City, OK 73117-1299, USA. johneb@health.state.ok.us
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MeSH Terms
Descriptor/Qualifier:
Adult
Bacterial Toxins / isolation & purification,  metabolism
Clostridium Infections / epidemiology*
Clostridium perfringens / isolation & purification*,  metabolism
Cohort Studies
Disease Outbreaks*
Enterocolitis, Necrotizing / epidemiology*,  microbiology*
Fatal Outcome
Female
Food Microbiology*
Humans
Intestines / microbiology,  pathology
Male
Middle Aged
Residential Facilities
Retrospective Studies
Grant Support
ID/Acronym/Agency:
AI019844-21/AI/NIAID NIH HHS; AI056177-02/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Bacterial Toxins

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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