title: Epidemiological and pathobiological profiles of Clostridium perfringens infections: review of consecutive series of 33 cases over a 13-year period.
abstract: BACKGROUND
  Although Clostridium perfringens (C. perfringens) is well known as the causative agent of several forms of enteric disease, precise epidemiological and pathobiological aspects are still unknown.
  
  
  METHODS
  We retrospectively reviewed the culture results of samples collected in our hospital from 2001 through 2013. In addition, for the detection and toxinogenic typing of C. perfringens, polymerase-chain-reaction amplification (PCR)-based rapid analysis was performed in 6 cases using DNA extracted from paraffin-embedded tissues.
  
  
  RESULTS
  A total of 35 samples from 33 cases were positive for C. perfringens, representing an incidence of 0.017% (35/205, 114). Among 33 patients, 21 patients manifested sepsis and 7 patients had bacteremia. One of the septic cases was complicated by fatal intravascular hemolysis and thus, the prevalence was estimated at 3.0% among C. perfringens infections (1/33). The direct causative disease or state for C. perfringens infection was identified in 18 patients: surgery or intervention for cancers, 8 patients; chemotherapy for cancer, 2 patients; surgery or intervention for non-neoplastic disease, 6 patients; liver cirrhosis, 3 patients, etc. PCR-based toxinogenic typing of C. perfringens detected the alpha-toxin gene only in tissue from a patient who died of massive hemolysis; none of the toxin genes could be amplified in the other 5 cases examined.
  
  
  CONCLUSIONS
  The prevalence of overt C. perfringens infection is low, but upon detection, infected patients should be carefully monitored for fatal acute hemolysis caused by type A C. perfringens. Furthermore, PCR-based rapid detection of C. perfringens and toxinogenic typing by archival pathological material is applicable as a diagnostic tool.
authors.affiliation: Department of Gastroenterology, Saitama Medical Center, Jichi Medical University Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shindo
authors.affiliation: Department of Pathology, Saitama Medical Center, Jichi Medical University Japan.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Dobashi
authors.affiliation: Division of Bacteriology, Central Clinical Laboratory, Saitama Medical Center, Jichi Medical University Japan.
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Department of Microbiology, Tokyo Metropolitan Institute of Public Health Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Monma
authors.affiliation: Department of Gastroenterology, Saitama Medical Center, Jichi Medical University Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Miyatani
authors.affiliation: Department of Gastroenterology, Saitama Medical Center, Jichi Medical University Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003016:Clostridium perfringens / Q000302:isolation & purification*; D005260:Female; D005738:Gas Gangrene / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies
keywords: Clostridium perfringens; alpha-toxin; fatal acute hemolysis; polymerase-chain-reaction amplification