Clostridium perfringens

Categorization
Cell Wall: Gram Positive Shape: Spore-forming Rod
Metabolism: Obligate Anaerobe
Transmission
  • Tissue Infection
    • C. perfringens spores are commonly found in the soil and can infect wounded tissue. The anaerobic, necrotic environment of wounded tissue allows spores to germinate and elaborate powerful exotoxins which promote further tissue necrosis. C. perfringens is no longer terribly common but was especially worrisome for soldiers in battlefields.
  • Gastrointestinal Infection
    • C. perfringens spores may exist in contaminated meat products and germinate in relatively anaeorobic environments of the GI system following ingestion.
Virulence Factors
  • C. perfringens possesses nearly twenty different exotoxins and enterotoxins. Exotoxins include a variety which lead to tissue destruction and promote rapid necrosis.
Clinical Consequences
  • Overview
    • C. perfringens can cause a variety of pathologies with a range of clinical seriousness. Tissue infections may begin as fairly localized infections but can also manifest as rapidly spreading necrosis. Gastrointestinal infection usually manifests as a self-limited bout of food poisoning.
  • Cellulitis
    • These are relatively well-localized infections of the skin's dermis. Fermentation of extracellular sugars by C. perfringens characteristically produces a large amount of gas which becomes trapped under overlying skin, giving it a crackly consistency described as "crepitation".
  • Necrotizing Fasciitis
    • C. perfringens can spread along fascial planes, leaving a wake of tissue necrosis. Spread can be rapid or slow and is often associated with overlying crepitation.
  • Clostridial Myonecrosis (Gas Gangrene)
    • Gas gangrene involves spread of C. perfringens into adjacent skeletal muscle and is usually the result of deep wound infections often associated with battlefield injuries. Infection of muscle is rapidly necrotic and produces large amounts of gas which is observed as extensive crepitation. Systemic failure of multiple organs is often observed in this setting.
  • Food Poisoning
    • Remarkably, despite the above, GI system infection of C. perfringens due to ingestion of spore-contaminated meats usually manifests as a bout of self-limited watery infectious diarrhea due to elaboration of enterotoxins with an incubation time of greater than 8h.
Treatment
  • Tissue Infections
    • Surgical debridement should be performed immediately. Hyperbaric oxygen is of dubious value but is occasionally performed with the notion that C. perfringens is an obligate anaerobe. When antibiotics are administered, natural penicillin can be used.