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 24 November 2017

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Necrotizing enteritis with C perfringens type A in healthy subjects

A study in the latest Journal of the American College of Surgeons suggests that culture for C perfringens type A should be performed in cases of adult necrotizing enterocolitis and that alternative tests such as immunohistochemical assay are diagnostically useful.

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Necrotizing enteritis associated with Clostridium perfringens type C is a well-known syndrome in severely protein-deprived populations in the Pacific.

It is exceedingly rare in the developed world.

C perfringens type A is a common cause of acute gastroenteritis and, in a handful of infections, has been reported in association with a syndrome resembling necrotizing enteritis.

Dr Sobel and colleagues reviewed case series, literature, charts and autopsy reports from 4 patients with adult necrotizing enterocolitis.

The small bowel was affected in 3 patients and the colon in 2 patients
Journal of the American College of Surgeons

C perfringens isolates were subtyped by mouse bioassay and pulsed-field gel electrophoresis.

The researchers tested fixed tissue specimens were tested with an anticlostridial antibody using an immunohistochemical assay.

The research team found that between 2000 and 2003, adult necrotizing enterocolitis developed in 4 previously healthy men, of which 3 died.

The team observed that the small bowel was affected in 3 patients and the colon in 2 patients.

The researchers noted that portal or mesenteric vein thrombosis occurred in 3 patients.

C perfringens type A was isolated from 3 patients and immunohistochemical assay was undertaken.

The researchers demonstrated that clostridial antigens was limited to affected areas of the intestine of all 4 patients.

The nonculture positive patient had a strong epidemiologic link to 1 of the others, and a compatible clinical course.

The research team isolated C perfringens of the same pulsed-field gel electrophoresis-defined molecular subtyped from stool samples of one patient.

The team reported that C perfringens was also isolated from this patient's wife, and food from a restaurant they patronized.

Dr Sobel concludes, “Adult necrotizing enterocolitis associated with C perfringens type A infection occurred in 4 North American adults.

“Culture for C perfringens type A should be performed in cases of adult necrotizing enterocolitis.”

“Alternative tests such as immunohistochemical assay were diagnostically useful.”

“Additional research might uncover virulence factors, host factors, and the burden of disease in the population.”

J Am Coll Surg 2005: 201(1): 48-56
01 July 2005

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