Clostridium perfringens.  Unless you’re a microbiologist, doctor, or foodpoisoning lawyer, you may not have even heard of Clostridium perfringens, which is the third leading cause of foodpoisoning in the United States, and recently caused a devastating outbreak at Central Louisiana State Hospital in which 40 were sickened and 3 died after eating contaminated chicken salad.

What is it?

Clostridium perfringens is an anaerobic, Gram-positive, sporeforming rod (anaerobic means unable to grow in the presence of free oxygen). It is widely distributed in the environment and frequently occurs in the intestines of humans and many domestic and feral animals. Spores of the organism persist in soil, sediments, and areas subject to human or animal fecal pollution.

What is the illness typically like?

Perfringens food poisoning is the term used to describe the common foodborne illness caused by C. perfringens. A more serious but rare illness is also caused by ingesting food contaminated with Type C strains. The latter illness is known as enteritis necroticans or pig-bel disease.

The common form of perfringens poisoning is characterized by intense abdominal cramps and diarrhea which begin 8-22 hours after consumption of foods containing large numbers of those C. perfringens bacteria capable of producing the food poisoning toxin. The illness is usually over within 24 hours but less severe symptoms may persist in some individuals for 1 or 2 weeks. A few deaths have been reported as a result of dehydration and other complications.

Necrotic enteritis (pig-bel) caused by C. perfringens is often fatal. This disease also begins as a result of ingesting large numbers of the causative bacteria in contaminated foods. Deaths from necrotic enteritis (pig-bel syndrome) are caused by infection and necrosis of the intestines and from resulting septicemia. This disease is very rare in the U.S.

Infective dose–The symptoms are caused by ingestion of large numbers (greater than 10 to the 8th) vegetative cells. Toxin production in the digestive tract (or in test tubes) is associated with sporulation. This disease is a food infection; only one episode has ever implied the possibility of intoxication (i.e., disease from preformed toxin).

How is Clostridium perfringens illness diagnosed?

Perfringens poisoning is diagnosed by its symptoms and the typical delayed onset of illness. Diagnosis is confirmed by detecting the toxin in the feces of patients. Bacteriological confirmation can also be done by finding exceptionally large numbers of the causative bacteria in implicated foods or in the feces of patients.

What foods are most often implicated in Clostridium perfringens outbreaks?

In most instances, the actual cause of poisoning by C. perfringens is temperature abuse of prepared foods. Small numbers of the organisms are often present after cooking and multiply to food poisoning levels during cool down and storage of prepared foods. Meats, meat products, and gravy are the foods most frequently implicated.

How common is Clostridium perfringens foodpoisoning?

Perfringens poisoning is one of the most commonly reported foodborne illnesses in the U.S. There were 1,162 cases in 1981, in 28 separate outbreaks. At least 10-20 outbreaks have been reported annually in the U.S. for the past 2 decades. Typically, dozens or even hundreds of person are affected. It is probable that many outbreaks go unreported because the implicated foods or patient feces are not tested routinely for C. perfringens or its toxin. CDC estimates that about 10,000 actual cases occur annually in the U.S.

Target Populations:

Institutional feeding (such as school cafeterias, hospitals, nursing homes, prisons, etc.) where large quantities of food are prepared several hours before serving is the most common circumstance in which perfringens poisoning occurs. The young and elderly are the most frequent victims of perfringens poisoning. Except in the case of pig-bel syndrome, complications are few in persons under 30 years of age. Elderly persons are more likely to experience prolonged or severe symptoms.