Necrotizing enterocolitis associated with clostridium perfringens type A in previously healthy north american adults.
BACKGROUND
Necrotizing enteritis associated with Clostridium perfringens type C ("pigbel") is a well-known syndrome in severely protein-deprived populations in the Pacific. It is exceedingly rare in the developed world. C perfringens type A is a common cause of acute gastroenteritis and, in a handful of infections, has been reported in association with a syndrome resembling necrotizing enteritis.


METHODS
This study includes a case series and literature review. Charts and autopsy reports from four patients with adult necrotizing enterocolitis (ANEC) were reviewed. C perfringens isolates were subtyped by mouse bioassay and pulsed-field gel electrophoresis. Fixed tissue specimens were tested with an anticlostridial antibody using an immunohistochemical assay.


RESULTS
Between 2000 and 2003, ANEC developed in four previously healthy men; three died. The small bowel was affected in three patients and the colon in two patients. Portal or mesenteric vein thrombosis occurred in three patients. C perfringens type A was isolated from three patients and immunohistochemical assay demonstrated clostridial antigens limited to affected areas of the intestine of all four. The nonculture positive patient had a strong epidemiologic link to one of the others, and a compatible clinical course. C perfringens of the same pulsed-field gel electrophoresis-defined molecular subtyped was isolated from stool samples of one patient, his wife, and food from a restaurant they patronized.


CONCLUSIONS
ANEC associated with C perfringens type A infection occurred in four North American adults. Culture for C perfringens type A should be performed in cases of ANEC. Alternative tests such as immunohistochemical assay were diagnostically useful. Additional research might uncover virulence factors, host factors, and the burden of disease in the population.
Sobel
Jeremy
J
Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Mixter
Charles G
CG
Kolhe
Priti
P
Gupta
Amita
A
Guarner
Jeannette
J
Zaki
Sherif
S
Hoffman
Neil A
NA
Songer
J Glenn
JG
Fremont-Smith
Maurice
M
Fischer
Marc
M
Killgore
George
G
Britz
Phyllis H
PH
MacDonald
Clifford
C
D000328:Adult; D003015:Clostridium Infections / Q000175:diagnosis*; D003016:Clostridium perfringens / Q000145:classification* / Q000302:isolation & purification; D020345:Enterocolitis, Necrotizing / Q000382:microbiology*; D017809:Fatal Outcome; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply; D007511:Ischemia / Q000209:etiology; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000209:etiology; D008642:Mesenteric Veins / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis; D011169:Portal Vein / Q000473:pathology; D020246:Venous Thrombosis / Q000209:etiology