Clostridial necrotizing enteritis

Clostridial necrotizing enteritis (CNE), is a potentially fatal type of food poisoning caused by a β-toxin of Clostridium perfringens,[1] Type C. It occurs in some developing countries, but was also documented in Germany following World War II, where it was called "Darmbrand" (meaning bowel necrosis). The toxin is normally inactivated by certain proteolytic enzymes and by normal cooking, but when these protections are impeded, and high protein is consumed, the disease emerges.

Clostridial necrotizing enteritis
Other namesEnteritis necroticans or Pigbel
SpecialtyInfectious disease, Gastroenterology

Sporadic and extremely rare cases occur in diabetics. In New Guinea, where inhabitants generally have low protein diets apart from at tribal feasts, a number of factors compound to result in pigbel.[2]

Signs and symptoms

CNE is a necrotizing inflammation of the small bowel (especially the jejunum but also the ileum). Clinical results may vary from mild diarrhea to a life-threatening sequence of severe abdominal pain, vomiting (often bloody), bloody stool, ulceration of the small intestine with leakage (perforation) into the peritoneal cavity and possible death within a single day due to peritonitis. Many patients exhibit meteorism and a fever. Fluid can enter the peritoneum.

Sepsis can occur, with one case having 28,500 white blood cells per cubic milliliter.[3]

Cause

All the factors collectively causing CNE are generally only present in the hinterlands of New Guinea and parts of Africa, Latin America, and Asia. These factors include protein deprivation (causing inadequate synthesis of trypsin protease (an enzyme), to which the toxin is very sensitive), poor food hygiene, episodic meat feasting, staple diets containing trypsin inhibitors (sweet potatoes), and infection by Ascaris parasites which secrete a trypsin inhibitor. In New Guinea (origin of the term "pigbel"), the disease is usually spread through contaminated meat (especially pork) and perhaps by peanuts. (CNE was also diagnosed in post World War II Germany, where it was known as Darmbrand or "bowel fire").

Diagnosis

An abdominal x-ray shows multiple dilated loops of small bowel and gas. The abdomen can be tender, distended, and soft. A differential diagnosis can be an intussusception.

Treatment

Treatment involves suppressing the toxin-producing organisms with antibiotics such as penicillin G or metronidazole. About half of seriously ill patients require surgery for perforation, persistent intestinal obstruction, or failure to respond to the antibiotics. An investigational toxoid vaccine has been used successfully in some developing countries but is not available outside of research.

Other clostridial toxemias
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See also

References
  1. "Clostridial Necrotizing Enteritis: Anaerobic Bacteria: Merck Manual Professional". Retrieved 2008-12-19.
  2. "Pigbel, Clostridial Enteritis Necrotans, Much Nastier than C diff Diarrhoea - Resus". Resus. 2014-09-04. Archived from the original on 2018-03-30. Retrieved 2018-03-30.
  3. "The Beast in the Belly | DiscoverMagazine.com". Discover Magazine. Retrieved 2018-04-12.
Classification
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