Necrotizing enterocolitis associated with Clostridium perfringens type A in previously healthy north american adults

Jeremy Sobel, Charles G. Mixter, Priti Kolhe, Amita Gupta, Jeannette Guarner, Sherif Zaki, Neil A. Hoffman, J. Glenn Songer, Maurice Fremont-Smith, Marc Fischer, George Killgore, Phyllis H. Britz, Clifford MacDonald

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Necrotizing enteritis associated with Clostridium perfringens type C ("pigbel") is a well-known syndrome in severely protein-deprived populations in the Pacific. It is exceedingly rare in the developed world. C perfringens type A is a common cause of acute gastroenteritis and, in a handful of infections, has been reported in association with a syndrome resembling necrotizing enteritis. STUDY DESIGN: This study includes a case series and literature review. Charts and autopsy reports from four patients with adult necrotizing enterocolitis (ANEC) were reviewed. C perfringens isolates were subtyped by mouse bioassay and pulsed-field gel electrophoresis. Fixed tissue specimens were tested with an anticlostridial antibody using an immunohistochemical assay. RESULTS: Between 2000 and 2003, ANEC developed in four previously healthy men; three died. The small bowel was affected in three patients and the colon in two patients. Portal or mesenteric vein thrombosis occurred in three patients. C perfringens type A was isolated from three patients and immunohistochemical assay demonstrated clostridial antigens limited to affected areas of the intestine of all four. The nonculture positive patient had a strong epidemiologic link to one of the others, and a compatible clinical course. C perfringens of the same pulsed-field gel electrophoresis-defined molecular subtyped was isolated from stool samples of one patient, his wife, and food from a restaurant they patronized. CONCLUSIONS: ANEC associated with C perfringens type A infection occurred in four North American adults. Culture for C perfringens type A should be performed in cases of ANEC. Alternative tests such as immunohistochemical assay were diagnostically useful. Additional research might uncover virulence factors, host factors, and the burden of disease in the population.

Original languageEnglish (US)
Pages (from-to)48-56
Number of pages9
JournalJournal of the American College of Surgeons
Volume201
Issue number1
DOIs
StatePublished - Jul 2005
Externally publishedYes

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Necrotizing Enterocolitis
Clostridium perfringens
Enteritis
Pulsed Field Gel Electrophoresis
Mesenteric Veins
Restaurants
Gastroenteritis
Virulence Factors
Portal Vein
Infection
Spouses
Biological Assay
Population
Intestines
Autopsy
Colon
Thrombosis
Antigens
Food
Antibodies

ASJC Scopus subject areas

  • Surgery

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Necrotizing enterocolitis associated with Clostridium perfringens type A in previously healthy north american adults. / Sobel, Jeremy; Mixter, Charles G.; Kolhe, Priti; Gupta, Amita; Guarner, Jeannette; Zaki, Sherif; Hoffman, Neil A.; Songer, J. Glenn; Fremont-Smith, Maurice; Fischer, Marc; Killgore, George; Britz, Phyllis H.; MacDonald, Clifford.

In: Journal of the American College of Surgeons, Vol. 201, No. 1, 07.2005, p. 48-56.

Research output: Contribution to journalArticle

Sobel, J, Mixter, CG, Kolhe, P, Gupta, A, Guarner, J, Zaki, S, Hoffman, NA, Songer, JG, Fremont-Smith, M, Fischer, M, Killgore, G, Britz, PH & MacDonald, C 2005, 'Necrotizing enterocolitis associated with Clostridium perfringens type A in previously healthy north american adults', Journal of the American College of Surgeons, vol. 201, no. 1, pp. 48-56. https://doi.org/10.1016/j.jamcollsurg.2005.02.029
Sobel, Jeremy ; Mixter, Charles G. ; Kolhe, Priti ; Gupta, Amita ; Guarner, Jeannette ; Zaki, Sherif ; Hoffman, Neil A. ; Songer, J. Glenn ; Fremont-Smith, Maurice ; Fischer, Marc ; Killgore, George ; Britz, Phyllis H. ; MacDonald, Clifford. / Necrotizing enterocolitis associated with Clostridium perfringens type A in previously healthy north american adults. In: Journal of the American College of Surgeons. 2005 ; Vol. 201, No. 1. pp. 48-56.
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abstract = "BACKGROUND: Necrotizing enteritis associated with Clostridium perfringens type C ({"}pigbel{"}) is a well-known syndrome in severely protein-deprived populations in the Pacific. It is exceedingly rare in the developed world. C perfringens type A is a common cause of acute gastroenteritis and, in a handful of infections, has been reported in association with a syndrome resembling necrotizing enteritis. STUDY DESIGN: This study includes a case series and literature review. Charts and autopsy reports from four patients with adult necrotizing enterocolitis (ANEC) were reviewed. C perfringens isolates were subtyped by mouse bioassay and pulsed-field gel electrophoresis. Fixed tissue specimens were tested with an anticlostridial antibody using an immunohistochemical assay. RESULTS: Between 2000 and 2003, ANEC developed in four previously healthy men; three died. The small bowel was affected in three patients and the colon in two patients. Portal or mesenteric vein thrombosis occurred in three patients. C perfringens type A was isolated from three patients and immunohistochemical assay demonstrated clostridial antigens limited to affected areas of the intestine of all four. The nonculture positive patient had a strong epidemiologic link to one of the others, and a compatible clinical course. C perfringens of the same pulsed-field gel electrophoresis-defined molecular subtyped was isolated from stool samples of one patient, his wife, and food from a restaurant they patronized. CONCLUSIONS: ANEC associated with C perfringens type A infection occurred in four North American adults. Culture for C perfringens type A should be performed in cases of ANEC. Alternative tests such as immunohistochemical assay were diagnostically useful. Additional research might uncover virulence factors, host factors, and the burden of disease in the population.",
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AU - Sobel, Jeremy

AU - Mixter, Charles G.

AU - Kolhe, Priti

AU - Gupta, Amita

AU - Guarner, Jeannette

AU - Zaki, Sherif

AU - Hoffman, Neil A.

AU - Songer, J. Glenn

AU - Fremont-Smith, Maurice

AU - Fischer, Marc

AU - Killgore, George

AU - Britz, Phyllis H.

AU - MacDonald, Clifford

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N2 - BACKGROUND: Necrotizing enteritis associated with Clostridium perfringens type C ("pigbel") is a well-known syndrome in severely protein-deprived populations in the Pacific. It is exceedingly rare in the developed world. C perfringens type A is a common cause of acute gastroenteritis and, in a handful of infections, has been reported in association with a syndrome resembling necrotizing enteritis. STUDY DESIGN: This study includes a case series and literature review. Charts and autopsy reports from four patients with adult necrotizing enterocolitis (ANEC) were reviewed. C perfringens isolates were subtyped by mouse bioassay and pulsed-field gel electrophoresis. Fixed tissue specimens were tested with an anticlostridial antibody using an immunohistochemical assay. RESULTS: Between 2000 and 2003, ANEC developed in four previously healthy men; three died. The small bowel was affected in three patients and the colon in two patients. Portal or mesenteric vein thrombosis occurred in three patients. C perfringens type A was isolated from three patients and immunohistochemical assay demonstrated clostridial antigens limited to affected areas of the intestine of all four. The nonculture positive patient had a strong epidemiologic link to one of the others, and a compatible clinical course. C perfringens of the same pulsed-field gel electrophoresis-defined molecular subtyped was isolated from stool samples of one patient, his wife, and food from a restaurant they patronized. CONCLUSIONS: ANEC associated with C perfringens type A infection occurred in four North American adults. Culture for C perfringens type A should be performed in cases of ANEC. Alternative tests such as immunohistochemical assay were diagnostically useful. Additional research might uncover virulence factors, host factors, and the burden of disease in the population.

AB - BACKGROUND: Necrotizing enteritis associated with Clostridium perfringens type C ("pigbel") is a well-known syndrome in severely protein-deprived populations in the Pacific. It is exceedingly rare in the developed world. C perfringens type A is a common cause of acute gastroenteritis and, in a handful of infections, has been reported in association with a syndrome resembling necrotizing enteritis. STUDY DESIGN: This study includes a case series and literature review. Charts and autopsy reports from four patients with adult necrotizing enterocolitis (ANEC) were reviewed. C perfringens isolates were subtyped by mouse bioassay and pulsed-field gel electrophoresis. Fixed tissue specimens were tested with an anticlostridial antibody using an immunohistochemical assay. RESULTS: Between 2000 and 2003, ANEC developed in four previously healthy men; three died. The small bowel was affected in three patients and the colon in two patients. Portal or mesenteric vein thrombosis occurred in three patients. C perfringens type A was isolated from three patients and immunohistochemical assay demonstrated clostridial antigens limited to affected areas of the intestine of all four. The nonculture positive patient had a strong epidemiologic link to one of the others, and a compatible clinical course. C perfringens of the same pulsed-field gel electrophoresis-defined molecular subtyped was isolated from stool samples of one patient, his wife, and food from a restaurant they patronized. CONCLUSIONS: ANEC associated with C perfringens type A infection occurred in four North American adults. Culture for C perfringens type A should be performed in cases of ANEC. Alternative tests such as immunohistochemical assay were diagnostically useful. Additional research might uncover virulence factors, host factors, and the burden of disease in the population.

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