Clostridium perfringens food intoxication has an incubation period of 10-12 hours. Patients have abdominal cramping and diarrhea, but no vomiting or fever. The illness is self-limited within 24-48 hours, and it is associated with meats, poultry, and dried or precooked foods.
CASES/YEAR
965,958 (US); 19,319,160 (Global)
OTHER NAMES
C. welchii food poisoning; Enteritis necroticans (pigbel or pig-bel);
INCUBATION
Usually 10-12 hours (range of 6-24 hours); [CCDM]
INITIAL SYMPTOMS
Duration is <24 hours with abdominal cramping and diarrhea, but no vomiting or fever; Usually from infected human carriers; [Harrisons, p. 404] Vomiting/fever are unusual. {Merck Manual, p. 1468]
COMMENTS
Nausea may be present, but fever is usually absent. The illness is usually self-limited in 24-48 hours. C. perfringens food intoxication is associated with meats, poultry, and dried or precooked foods. [Foodborne Illnesses. MMWR. 4/16/04] Abnormal colony counts are >100,000 per gram of food or >1,000,000 per gram of stool. C. perfringens are spore-forming bacteria that can survive cooking temperatures. Stews, gravies, or meat pies held at room temperature act as growth media for the bacteria. The toxin is formed in the intestinal tract of the host to produce the diarrhea. Preventive measures are to eat meat while it is still hot from initial cooking. Otherwise, use a properly designed chiller, and reheating should be thorough. The organism is present in the soil and in the GI tracts of cattle, fish, pigs, poultry, and healthy people. [CCDM, p. 220-1] Pigbel is acute necrotizing enterocolitis (bloody diarrhea and shock) that has been reported after high protein meals in New Guinea natives (pig feasts) and in prisoners of war whose diets may have deficient in protein and proteases needed to destroy the toxin. [PPID, p. 1363] C. perfringens Type A causes self-limited diarrhea. In developing countries, C. perfringens Type C cause enteritis necroticans of the proximal small intestines with bloody diarrhea and perforation in some cases. Coinfection with Strongyloides in seen in many cases and may facilitate clostridial infection. [Cecil, p. 1897]
DIAGNOSTIC
Culture or testing for toxin in the stool; The stool culture must include a colony count because C. perfringens is a normal inhabitant of the intestines. [CCDM]
SIGNS & SYMPTOMS
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G abdominal pain
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G blood in stool
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G diarrhea
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G nausea, vomiting
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*bowel obstruction
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*shock
SOURCE
Eating Contaminated Food, Eating Contaminated or Infected Meat, Eating Contaminated Produce
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Fish and Shellfish, Swine, Human
RISK FACTORS
- Eat undercooked meat or fish
TREATMENT
Antibiotics not indicated for C. perfringens food poisoning; [Merck Manual, p. 1469] For treatment of enteritis necroticans, see Merck Manual, p. 1468.
REFERENCES FOR CASES/YEAR
1. (US) CDC 2011 estimate = 965,958;
2. (Global) Estimate global cases/yr at 20 X US cases/yr;