Clostridium perfringens

Aka: Clostridium perfringens, Gas Gangrene, Anaerobic Cellulitis, Clostridial Myonecrosis

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II. Pathophysiology

  1. Clostridia are anaerobic, spore forming, non-motile Gram Positive Rods
    1. Germinate, mature, reproduce and release exotoxin under anaerobic conditions
  2. Tissue infection with gas-producing Anaerobic Bacteria (also occurs with Type I Necrotizing Fasciitis)
  3. Typically caused by penetrating Skin Injury with compromised soft tissue vascular supply and necrosis
    1. Resulting anaerobic environment allows for spore germination and Bacterial growth

III. Causes: Clostridial Myonecrosis (Gas Gangrene)

  1. Clostridium perfringens or Clostridium welchii (Traumatic source)
    1. Clostridium perfringens colonizes soil
  2. Clositridium septicum (spontaneous source without skin break)
  3. Clostridium sordellii (gynecologic source)
  4. Other organisms
    1. Clostridium species may also cause a more subacute anerobic Cellulitis
    2. Clostridium novyi
    3. Clostridium histolyticum

IV. Types: Clostridium perfringens Infections

  1. Wound Infections
    1. Clostridium perfringens germinates and matures in necrotic, devitalized, anaerobic tissue
  2. Clostridial Myonecrosis
    1. Wound Infections may track along Muscles and subcutaneous tissue
    2. Results in Muscle breakdown (myonecrosis) and black fluid discharge
  3. Food Poisoning
    1. Among the most common causes of Food Poisoning in the U.S. with a typically benign course
      1. Incidence (U.S.): 970,000 cases with 440 hospitalizations and 26 deaths (0.0027% mortality) per year
    2. Ingested Clostridium perfringens causes watery Diarrhea (with fever, Headache) via in-vivo toxin production
    3. Most cases have onset 6-16 hours after ingestion and self-resolve by 24 hours
      1. However, a severe variant causes hemorrhagic necrosis of the jejunum
    4. Sources
      1. Pre-cooked meats
      2. Dried foods
      3. Meats or gravy
      4. Poultry

V. Findings

  1. See Necrotizing Soft Tissue Infection
  2. Skin Wound progression
    1. History of deep contaminated wound (Surgery, Trauma)
    2. Onset Sudden pain at wound site
    3. Local swelling and edema of wound site
    4. Thin hemorrhagic exudate
  3. Toxemia
  4. Severe Hypotension
  5. Renal Failure
  6. Fever
  7. Foul discharge from wound
  8. Subcutaneous crepitus

VI. Labs

  1. See Necrotizing Soft Tissue Infection
  2. Complete Blood Count (CBC)
    1. Hemoconcentration
      1. Hematocrit may increase to 50-80%
    2. Marked Leukocytosis
      1. Leukemoid Reaction may occur with increased White Blood Cell Count to 50,000 to 150,000/mm3
  3. Wound smear
    1. Gram Positive encapsulated rods

VII. Imaging

  1. See Necrotizing Soft Tissue Infection
  2. Gas in fascial plains

VIII. Differential Diagnosis

  1. See Necrotizing Soft Tissue Infection

IX. Management

  1. See Necrotizing Fasciitis
  2. Extensive, early surgical Debridement
  3. Consider hyperbaric oxygen chamber
  4. Antibiotics are typically broader to start to cover Necrotizing Fasciitis in general
  5. Primary protocol for specific Clostridium coverage
    1. Clindamycin 900 mg IV every 8 hours (reduces toxin production) AND
    2. Penicillin G 24 Million Units daily divided every 4 to 6 hours
  6. Alternative Antibiotics for specific Clostridium coverage
    1. Ceftriaxone 2 g IV every 12 hours OR
    2. Erythromycin 1 gram every 6 hours IV infusion
  7. Other Antibiotics options (check sensitivity first)
    1. Chloramphenicol 4 g daily
    2. Metronidazole

X. References

  1. (2021) Sanford Guide, IOS, accessed 3/5/2021
  2. Khidir and Eyre (2021) Crit Dec Emerg Med 34(10): 12-3
  3. Stevens (2014) Clin INfect Dis 59(2): 147-59 +PMID:24947530 [PubMed]
  4. Stevens (2017) N Engl J Med 377(23):2253-65 +PMID:29211672 [PubMed]

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Related Studies

Ontology: Clostridium perfringens (C0009063)

Definition (NCI_CDISC) Any bacterial organism that can be assigned to the species Clostridium perfringens.
Definition (NCI) A species of anaerobic, Gram positive, rod shaped bacteria assigned to the phylum Proteobacteria. This species is motile, hydrolyzes gelatin, produces enterotoxin, is beta-hemolytic and catalase negative. C. perfringens is a food borne pathogen, being the causative agent of pig-bel syndrome and gas gangrene.
Definition (MSH) The most common etiologic agent of GAS GANGRENE. It is differentiable into several distinct types based on the distribution of twelve different toxins.
Definition (CSP) most common etiologic agent of gas gangrene; differentiable into several distinct types based on the distribution of twelve different toxins.
Concepts Bacterium (T007)
MSH D003016
SnomedCT 8331005
LNC LP19598-9
English Clostridium welchii, Clostridium plagarum, C. perfringens, Clostridium perfringens (Veillon and Zuber 1898) Hauduroy et al. 1937, clostridium perfringens, clostridium welchii, c. perfringens, perfringens clostridium, CLOSTRIDIUM PERFRINGENS, Clostridium perfringens, Bacillus perfringens, Bacterium welchii, CLOSTRIDIUM WELCHII, Gas bacillus, Welchia perfringens, Clostridium perfringens (organism)
Swedish Clostridium perfringens
Czech Clostridium perfringens
Finnish Clostridium perfringens
Italian Clostridium welchii, Clostridium perfringens
Japanese クロストリジウム･パーフリンジェンス, Welch菌, ウェルシュ菌
Polish Laseczki zgorzeli gazowej, Clostridium perfringens, Laseczki Welcha
Norwegian Clostridium perfringens, Clostridium welchii
Spanish Clostridium perfringens (organismo), Clostridium perfringens, Clostridium welchii
French Clostridium perfringens, Clostridium welchii
German Clostridium perfringens, Clostridium welchii
Russian CLOSTRIDIUM PERFRINGENS, BACILLUS PERFRINGENS, BACTERIUM WELCHII
Dutch Clostridium perfringens, Clostridium welchii, Gasgangreenbacterie
Portuguese Clostridium perfringens, Clostridium welchii
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Gas Gangrene (C0017105)

Definition (MSH) A severe condition resulting from bacteria invading healthy muscle from adjacent traumatized muscle or soft tissue. The infection originates in a wound contaminated with bacteria of the genus CLOSTRIDIUM. C. perfringens accounts for the majority of cases (over eighty percent), while C. noyvi, C. septicum, and C. histolyticum cause most of the other cases.
Concepts Disease or Syndrome (T047)
MSH D005738
ICD9 040.0
ICD10 A48.0
SnomedCT 276198000, 186413007, 186407003, 80466000
English Gangrenes, Gas, Gas Gangrene, Gas Gangrenes, Gangrene, Gas, CLOSTRIDIAL MYONECROSIS <GAS GANGRENE>, clostridial myonecrosis (diagnosis), clostridial myositis, clostridial myonecrosis, clostridial myositis (diagnosis), gas gangrene (diagnosis), malignant edema (diagnosis), malignant edema, gas gangrene, gangrene due to gas, CLOSTRIDIAL MYONECROSIS GAS GANGRENE, Gas Gangrene [Disease/Finding], gangrene gas, Gas bacillus infection (disorder), Progressive emphysematous necrosis, Gas gangrene, Clostridial myonecrosis, Clostridial myositis, Gas bacillus infection, Malignant edema, Malignant oedema, Gas gangrene (disorder), Gas gangrene due to Clostridia, gangrene; gas gangrene, gangrene; gas, gas; gangrene, myonecrosis; Clostridium, Clostridium; gas-forming, Gas gangrene due to Clostridia, NOS, Gas gangrene, NOS, Clostridial myositis as a result of gas gangrene, Gas bacillus infection or gangrene
Japanese ガス壊疽, ｶﾞｽｴｿ
Swedish Gasgangrän
Czech gangréna plynatá, Plynatá gangréna
Finnish Kaasukuolio
Russian GANGRENA GAZOVAIA, ГАНГРЕНА ГАЗОВАЯ
German Gasbrand [Gasoedem], Gasgangraen, Gangrän, Gas-, Gasgangrän
Korean 가스 괴저
Polish Zakażenie przyranne, Zgorzel gazowa, Obrzęk złośliwy, Zakażenie Clostridium perfringens
Hungarian gáz gangraena
Norwegian Clostridiummyonekrose, Gassgangren
Dutch Clostridium; gasvormend, gangreen; gasgangreen, gangreen; gas, gas; gangreen, myonecrose; Clostridium, gasgangreen, Gangreen, gas-, Gasgangreen
Spanish edema maligno, gangrena gaseosa (trastorno), gangrena gaseosa por Clostridium, gangrena gaseosa, infección por bacilo gaseoso, mionecrosis por Clostridium, miositis clostridial, Gangrena gaseosa, Gangrena Gaseosa
Portuguese Gangrena gasosa, Gangrena Gasosa
French Gangrène gazeuse
Italian Gangrena gassosa
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Anaerobic cellulitis (C0241828)

Concepts Disease or Syndrome (T047)
SnomedCT 238401006
English cellulitis anaerobic, Anaerobic cellulitis (diagnosis), Anaerobic cellulitis, Anaerobic cellulitis (disorder), cellulitis; anaerobic, anaerobic; cellulitis
Dutch anaëroob; cellulitis, cellulitis; anaëroob
Spanish celulitis anaeróbica (trastorno), celulitis anaeróbica, celulitis por anaerobios
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Bacterial Infections

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