zoonoses and communicable diseases common to ... - PAHO/WHO

CLOSTRIDIAL FOOD POISONING 83from the absorption into the bloodstream of toxins produced in the intestine by thevarious types of C. perfringens that form part of the normal intestinal flora.The Disease in Man: The disease is contracted upon ingestion of foods (especiallyred meat and fowl) in which C. perfringens type A has multiplied. It is nowknown that illness is caused by thermoresistant strains, which can survive at 100°Cfor more than an hour, as well as by thermolabile and hemolytic strains, which areinactivated after approximately 10 minutes at 100°C.The incubation period is from 6 to 24 hours after ingestion, but has been as shortas two hours in a few people, which indicates that the food ingested contained preformedtoxin. The disease begins suddenly, causing abdominal cramps and diarrhea,but usually not vomiting or fever. It lasts a day or less and its course is benign,except in debilitated persons, in whom it may prove fatal. Food poisoning caused byC. perfringens type A does not usually require medical treatment.In recent years, an intestinal infection with diarrhea not associated with food consumptionhas been described. The disease is due to an infection caused by colonizationof C. perfringens in the intestine and the production of enterotoxin. Its clinicalpicture is very different from that of clostridial food poisoning and more closelyresembles an infection caused by Salmonella or Campylobacter. In England, a seriesof cases was described involving 50 elderly patients (ages 76 to 96) who were hospitalizedwith diarrhea not associated with food consumption. The diarrhea lastedfor an average of 11 days, but lasted for a shorter period in two-thirds of the patients.Sixteen of 46 patients had bloody stools (Larson and Borriello, 1988).Necrotic enteritis produced by the ingestion of food contaminated with C. perfringenstype C is characterized by a regional gangrene in the small intestine, especiallythe jejunum.A rare type of necrotizing enteritis caused by C. perfringens type A was describedin the Netherlands in a 17-year-old girl. The patient recovered after resection ofthree meters of her intestine and intravenous treatment with gentamicin, cefotaxime,and metronidazole for seven days. Counterimmunoelectrophoresis of blood samplesindicated the presence of antibodies for the alpha toxin that is predominant in typeA. A similar illness appeared in Germany and Norway after the Second World War.Currently, necrotic enteritis is rare in the Western world, though some cases amongadolescents and the elderly have been described (Van Kessel et al., 1985).On rare occasions, gastroenteritis due to C. perfringens type D has been confirmedin man. This type causes enterotoxemia in sheep and goats.The Disease in Animals: C. perfringens type A is part of the normal flora of theintestine, where it does not usually produce its characteristic alpha toxin. Few casesof illness caused by type A have been confirmed in cattle. In California and Oregon(USA), a disease produced by type A in nursing lambs (“yellow lamb disease”) hasbeen described. The disease occurs in spring, when there is a large population ofnursing animals. The lambs suffer depression, anemia, jaundice, and hemoglobinuria.They die 6 to 12 hours after the onset of clinical symptoms (Gillespie andTimoney, 1981).Type B is the etiologic agent of “lamb dysentery,” which occurs in Great Britain,the Middle East, and South Africa. It usually attacks lambs less than 2 weeks old. Itis characterized by hemorrhagic enteritis, and is frequently accompanied by ulcerationof the mucosa. It also affects calves and colts.