Clostridium perfringens is an anaerobic, Gram-positive, sporeforming rod (anaerobic means unable to grow in the presence of free oxygen). It is widely distributed in the environment and frequently occurs in the intestines of humans and many domestic and feral animals. Spores of the organism persist in soil, sediments, and areas subject to human or animal fecal pollution.
Nature of Acute Disease:
Perfringens food poisoning is the term used to describe the common foodborne illness caused by C. perfringens. A more serious but rare illness is also caused by ingesting food contaminated with Type C strains. The latter illness is known as enteritis necroticans or pig-bel disease.
Nature of Disease:
The common form of perfringens poisoning is characterized by intense abdominal cramps and diarrhea which begin 8-22 hours after consumption of foods containing large numbers of those C. perfringens bacteria capable of producing the food poisoning toxin. The illness is usually over within 24 hours but less severe symptoms may persist in some individuals for 1 or 2 weeks. A few deaths have been reported as a result of dehydration and other complications.
Necrotic enteritis (pig-bel) caused by C. perfringens is often fatal. This disease also begins as a result of ingesting large numbers of the causative bacteria in contaminated foods. Deaths from necrotic enteritis (pig-bel syndrome) are caused by infection and necrosis of the intestines and from resulting septicemia. This disease is very rare in the U.S.
The symptoms are caused by ingestion of large numbers (greater than 10 to the 8th) vegetative cells. Toxin production in the digestive tract (or in test tubes) is associated with sporulation. This disease is a food infection; only one episode has ever implied the possibility of intoxication (i.e., disease from preformed toxin).
Diagnosis of Human Illness:
Perfringens poisoning is diagnosed by its symptoms and the typical delayed onset of illness. Diagnosis is confirmed by detecting the toxin in the feces of patients. Bacteriological confirmation can also be done by finding exceptionally large numbers of the causative bacteria in implicated foods or in the feces of patients.
In most instances, the actual cause of poisoning by C. perfringens is temperature abuse of prepared foods. Small numbers of the organisms are often present after cooking and multiply to food poisoning levels during cool down and storage of prepared foods. Meats, meat products, and gravy are the foods most frequently implicated.
Relative Frequency of Disease:
Perfringens poisoning is one of the most commonly reported foodborne illnesses in the U.S. There were 1,162 cases in 1981, in 28 separate outbreaks. At least 10-20 outbreaks have been reported annually in the U.S. for the past 2 decades. Typically, dozens or even hundreds of person are affected. It is probable that many outbreaks go unreported because the implicated foods or patient feces are not tested routinely for C. perfringens or its toxin. CDC estimates that about 10,000 actual cases occur annually in the U.S.
Course of Disease and Complications:
The disease generally lasts 24 hours. In the elderly or infirm, symptoms may last 1-2 weeks. Complications and/or death only very rarely occur.
Institutional feeding (such as school cafeterias, hospitals, nursing homes, prisons, etc.) where large quantities of food are prepared several hours before serving is the most common circumstance in which perfringens poisoning occurs. The young and elderly are the most frequent victims of perfringens poisoning. Except in the case of pig-bel syndrome, complications are few in persons under 30 years of age. Elderly persons are more likely to experience prolonged or severe symptoms.
Standard bacteriological culturing procedures are used to detect the organism in implicated foods and in feces of patients. Serological assays are used for detecting enterotoxin in the feces of patients and for testing the ability of strains to produce toxin. The procedures take 1-3 days.
Clostridium perfringens is a common infectious cause of outbreaks of foodborne illness in the United States, especially outbreaks in which cooked beef is the implicated source. This report describes two outbreaks of C. perfringens gastroenteritis following St. Patrick’s Day meals in Ohio and Virginia during 1993.
In November, 1985, a large outbreak of C. perfringens gastroenteritis occurred among factory workers in Connecticut. Forty-four percent of the 1,362 employees were affected. Four main-course foods served at an employee banquet were associated with illness, but gravy was implicated by stratified analysis. The gravy had been prepared 12-24 hours before serving, had been improperly cooled, and was reheated shortly before serving. The longer the reheating period, the less likely the gravy was to cause illness.
Since December 1981, FDA has investigated 10 outbreaks in 5 states. In two instances, more than one outbreak occurred in the same feeding facility within a 3-week period. One such outbreak occurred on 19 March 1984, involving 77 prison inmates. Roast beef served as a luncheon meat was implicated as the food vehicle and C. perfringens was confirmed as the cause by examining stools of 24 patients. Most of the patients became ill 8-16 hours after the meal. Eight days later, on 27 March 1984, a second outbreak occurred involving many of the same persons. The food vehicle was ham. Inadequate refrigeration and insufficient reheating of the implicated foods caused the outbreaks. Most of the other outbreaks occurred in institutional feeding environments: a hospital, nursing home, labor camp, school cafeteria, and at a fire house luncheon.