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A rapidly fatal case of enteritis necroticans in a 24 year old man with diabetes was caused by Clostridium perfringens type C. The role of beta toxin in the disease is discussed. This type has not been previously described as a causative agent in necrotising bowel disease of man outside endemic areas.
Clostridium difficile is a well documented cause of antibiotic associated diarrhoea in hospitalised patients, but may account for only approximately 20% of all cases. This leader reviews the current knowledge and understanding of the pathogenesis, epidemiology, and diagnosis of non-food borne Clostridium perfringens diarrhoea. Although enterotoxigenic C perfringens has been implicated in some C difficile negative cases of antibiotic associated diarrhoea, C perfringens enterotoxin detection methods are not part of the routine laboratory investigation of such cases. Testing for C perfringens enterotoxin in faecal samples from patients with antibiotic associated diarrhoea and sporadic diarrhoea on a routine basis would have considerable resource implications. Therefore, criteria for initiating investigations and optimum laboratory tests need to be established. In addition, establishing the true burden of C perfringens antibiotic associated diarrhoea is important before optimum control and treatment measures can be defined.
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Two cases of peracute haemorrhagic enteritis in the dog are reported. Gram-positive bacilli, which were shown in one case to be Clostridium welchii were found adhering to the necrotic epithelial surfaces in parts of the gastrointestinal tract in both cases. Large numbers of C welchii were recovered from the intestines of both dogs.
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A case of chronic intermittent diarrhoea in a dog is reported. Large numbers of Clostridium perfringens type A were recovered from the faeces. A toxin neutralised by C perfringens type A antitoxin was demonstrated in the same samples. No clear predisposing factors contributing to the condition could be determined. The dog recovered following a 10 day course of metronidazole at 20 mg/kg/day per os and a change to a bland diet.
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Forty-two Clostridium perfringens type A strains isolated from cases of diarrhoea in pigs were tested for their ability to sporulate and produce enterotoxin in three different sporulation media. Enterotoxin was produced by 11 of the 42 C perfringens type A isolates (26.2 per cent). Thirteen isolates (30.9 per cent) produced spores at a frequency of 10 per cent or more. Spore production was recorded in 24 (57.1 per cent) of the isolates. The titres of enterotoxin produced by the isolates ranged from 1:2 to 1:64. The enterotoxin produced was compared with that produced by a reference strain and found to be identical. Ninety-eight of 106 sow sera from four different farms were found to possess antibodies to C perfringens type A enterotoxin with titres ranging from 1:2 to 1:64. Spores of C perfringens type A were detected in pig faeces and intestinal contents in 20 of 23 cases of enteritis at levels of up to 5 x 10(6) cells/g of faeces. Smaller numbers of spores, up to 2 x 10(4)/g were present in five of 10 samples from non-diarrhoeic pigs. Enterotoxin was demonstrated by Vero cell assay in five of the 23 samples from diarrhoeic pigs but in none of the 10 samples from non-diarrhoeic animals. It was clear from these studies that C perfringens type A strains in pigs could sporulate and produce enterotoxin in vitro and in vivo and that enteritis might be associated with sporulating organisms in vivo.
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