Clostridium perfringens
Background
- Gram positive, rod-shaped obligate anaerobe
- Food-borne pathogen, associated with previously cooked or poorly reheated meats, poultry, and gravy
Clinical Features
- Incubation 6-24h
- Cramping abdominal pain
- Nausea with minimal vomiting
- Watery, nonbloody diarrhea
- Rarely febrile
Differential Diagnosis
Acute diarrhea
Infectious
- Viral (e.g. rotavirus)
- Bacterial
- Campylobacter
- Shigella
- Salmonella (non-typhi)
- Escherichia coli
- E. coli 0157:H7
- Yersinia enterocolitica
- Vibrio cholerae
- Clostridium difficile
- Parasitic
- Toxin
Noninfectious
- GI Bleed
- Appendicitis
- Mesenteric Ischemia
- Diverticulitis
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
- Inflammatory bowel disease
Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[1]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Traveler's Diarrhea
- Giardia lamblia
- Cryptosporidiosis
- Entamoeba histolytica
- Cyclospora
- Clostridium perfringens
- Listeriosis
- Helminth infections
- Marine toxins
- Ciguatera
- Scombroid poisoning
- Paralytic shellfish poisoning
- Neurotoxic shellfish poisoning
- Diarrheal shellfish poisoning
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Evaluation
- If profuse diarrhea or clinical dehydration, check electrolytes, CBC
- Consider stool studies if:
- Signs of hypovolemia
- Fever >38.5
- Blood or pus in diarrhea
- Symptoms >2-3 days
- Elderly, immunocompromised, or recent hospitalization
- Consider abdominal CT if concern for other critical intrabdominal pathology
Management
- Self-limited illness, supportive care only
Disposition
- Majority of patients can be treated as an outpatient
- Observe or admit patients with severe dehydration and evidence of end-organ complications, significant comorbidities/immunosuppression, or inability to adequately orally rehydrate at home
See Also
External Links
References
Tintinalli's
- ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.