Myonecrosis caused by Clostridial sp is called gas gangrene. C
perfringens is readily found in soil samples, contaminated
surgical and other objects, and the intestinal contents of animals and
humans. It is also present in raw meat and poultry.13 Factors
that may facilitate the growth of C perfringens include
penetration of deep tissue, the presence of a foreign body, extensive tissue
devitalization, tissue anoxia, polymicrobial infections, and an
anaerobic environment. Necrotizing enteritis is
a rare condition associated with β-enterotoxin
produced by C perfringens type C. It occurs in
children with protein-calorie malnutrition, or when diets contain trypsin
inhibitors (sweet potatoes) or when infested by Ascaris parasites
that secrete a trypsin inhibitor. Myonecrosis may occur after trauma, postoperatively,
or spontaneously in the presence of another primary pathology. These
toxins also have systemic effects such as direct cardiodepressive
effects. Nontraumatic myonecrosis occurs occasionally from Clostridia
in the gastrointestinal tract of immunocompromised hosts. Clostridial
myonecrosis is heralded by acute and progressive pain at the site
of injury with local, tense swelling, pallor, and a thin hemorrhagic
exudate. Pallor gives way to a bronze or magenta discoloration,
and hemorrhagic purplish bullae appear. Crepitus from gas production
is suggestive but not pathognomonic and may not be present at all.14 A
peculiar offensive odor, sometimes described as sweet, may be noted,
with a brown serosanguinous discharge. Eventually, the muscle becomes “gangrenous”—black,
friable, and liquefied. On the other hand, C perfringens can also
cause a simple localized cellulitis indistinguishable from group
A streptococcal cellulitis. Diagnosis is based on clinical manifestations, including
the characteristic appearance of necrotic muscle noted at surgery.
Systemic findings include tachycardia disproportionate to the degree
of fever, pallor, diaphoresis, hypotension, renal failure, and changes
in mental status. Untreated clostridial myonecrosis can lead to disseminated
myonecrosis, suppurative visceral infection, sepsis, and death within
hours.
Food poisoning caused by C perfringens is usually
a self-limited illness due to the ingestion of the organism that
elaborates enteric toxins. C. perfringens enterotoxin
is responsible for the symptoms of common human food poisoning and
acts by forming pores after interacting with intestinal tight junction
proteins. Symptoms may also result from toxin ingestion itself.
Typically, the illness starts 8 to 12 hours after ingestion of contaminated products
containing high numbers of organisms. Symptoms usually last less
than 24 hours and include nausea, severe abdominal pain, and profuse
nonbloody, watery diarrhea. Fever is absent, and vomiting is uncommon. Necrotizing
enteritis is a rare but life-threatening food-borne illness.15Neonatal
necrotizing enterocolitis may be caused by C perfringens,
C butyricum, and C difficile. The role
of these organisms needs further elucidation.Neutropenic
enterocolitis (typhlitis) is a similar syndrome that occurs in the
cecum of neutropenic patients. Clostridium septicum is the
usual agent. Symptoms are fever, abdominal pain, and diarrhea. Initial
treatment is with antibiotics, but surgical resection may be necessary.