Clostridium Perfringens Food Poisoning

Clostridium perfringens food poisoning is an intoxication caused by enterotoxin released in the small bowel after ingestion of large numbers of type A organisms in food.

• Foods implicated are cooked meat, poultry, gravies and stews prepared in bulk, cooled slowly and reheated inadequately; spores survive cooking and germinate in warm food.
• Incubation is 8 to 16 hours (range 6 to 24).
• A severe necrotising enteritis (pigbel) is caused by type C strains producing beta toxin, linked to feasts of pork or meat in protein-deprived populations with low trypsin activity (sweet potato diet trypsin inhibitors, ascariasis).

Food poisoning: sudden watery diarrhoea and crampy central abdominal pain; vomiting and fever are uncommon; lasts 12 to 24 hours.

• Pigbel: abdominal pain, bilious vomiting, distension, bloody diarrhoea, shock, and peritonitis from segmental jejunal necrosis.
• Differential diagnosis: Bacillus cereus diarrhoeal syndrome, staphylococcal poisoning, norovirus, enterotoxigenic E coli, Salmonella, mesenteric ischaemia, intussusception, volvulus.
• Complications: dehydration, hypokalaemia; with type C disease, intestinal necrosis, perforation, stricture, malabsorption, septicaemia and death.

Clinical, supported by the incubation period and a shared meal.

• Confirmation: enterotoxin detection in stool by immunoassay or PCR, or counts of more than 10^5 organisms per gram in food or 10^6 per gram in stool.
• Electrolytes, urea, creatinine, lactate and full blood count when severe.
• Pigbel: erect and supine abdominal radiographs (dilated loops, thickened wall, pneumatosis), ultrasound or CT; surgical review.

Supportive

• Oral rehydration with low osmolarity solution (50 to 100 mL/kg over 4 hours), or Ringer lactate for severe dehydration (adults 1 to 2 L over 1 hour then reassess; children 20 mL/kg boluses).
• Replace potassium (20 to 40 mmol per litre of fluid) if low.

Pharmacological

• Antibiotics are not indicated for food poisoning, which resolves in 24 hours.
• Avoid antimotility agents.
• Pigbel: bowel rest, nasogastric decompression, intravenous fluids, benzylpenicillin 2 to 4 million units IV every 6 hours in adults (children 50,000 units/kg every 6 hours) plus metronidazole 500 mg IV every 8 hours (children 7.5 mg/kg every 8 hours); parenteral nutrition for prolonged ileus; antitoxin where available.
• Ascaris treatment once stable: albendazole 400 mg single dose.

Procedures: laparotomy for peritonitis, perforation or failure of medical therapy, with resection of necrotic bowel.

Special groups: malnourished children (admit, early nutritional support), elderly (fluids guided by cardiac and renal status).

Red flags: bilious vomiting, distension, bloody stool, peritonism, shock.

Follow-up: public health reporting of clusters; cool cooked meat within 2 hours, refrigerate at 5 C or less, reheat to above 74 C; vaccination of pigbel-endemic communities where available.