1. Clostridium Perfringens: Its Significance, Incidence, and Prevention Bobbi Johnson, PhD Walden University

2. Clostridium Perfringens History Is also referred to as Clostridium Welchii Was discovered in 1892 by George Nuttall and William Welch

3. What is Clostridium Perfringens? It is an “anaerobic (unable to grow in oxygen), spore-forming gram-positive bacterium that is found in many environmental sources as well as in the intestines of humans and animals” (Center for Disease Control and Prevention, 2011). It is a bacteria which can also be found in soils and sewages.

4. Toxins Clostridium Perfringens Type A Clostridium Perfringens Type B Clostridium Perfringens Type C Clostridium Perfringens Type D Clostridium Perfringens Type E

5. Clostridium Perfringens Type A Most common in humans Produces alpha toxins Apart of the normal flora of a cow’s intestines Causes gastrointestinal disease hemorrhagic bowel syndrome (HBS) Kills more than 80% of animals within 24- 36 hours after first initial symptom Causes mild food poisoning lasting up to 24 hours

6. Clostridium Perfringens Type B Produces alpha, beta, and epsilon toxins Rarely found in humans Mostly in animals Enterotoxemia is found in lambs, young calves, and foals

7. Clostridium Perfringens Type C Produces alpha and beta toxins First case in humans was during the 1940’s Found in inappropriately cooked meats that are eaten by protein deficient populations Causes necrosis of the intestines Causes septicemia (blood in the bacteria that is associated with severe infections)

8. Clostridium Perfringens Type D Produces alpha and epsilon toxins Causes enterotoxaemia (affecting small intestines in animals Swollen kidneys Lung Oedema (fluid in the lungs) Brain Oedemia (swelling) Results from a change in feed that is protein rich

9. Clostridium Perfringens Type E Produces alpha and iota toxins Causes hemorrhagic enteritis Enterotoxaemia in animals Rarely found in humans

10. Incident Report for Humans Incident Report for Humans Most commonly reported foodborne illness Between 10-20 outbreaks were reported annually in the U.S. during the past two decades even though hundreds of individuals are infected Center for Disease Control and Prevention (CDC) estimated that nearly a million of these cases occur annually in the U.S.

11. Who is Considered at Risk? Infants Young children Elderly

12. Target Populations That Are Affected School cafeteriasHospitals Nursing homes Prisons

13. Foods that are associated with Clostridium Perfringens Stew Soups Gravy Lamb Fish Shrimp Crab Beans Potato salad Macaroni and cheese

14. Symptoms in Humans Symptoms in Humans Recognized 8-12 hours after food consumption Extreme abdominal pain Diarrhea Nausea Illness lasting up to 24 hours Dehydration Fever and vomiting is not associated

15. What Causes Clostridium Food Poisoning? Improper food handling ◦ Foods that are not properly stored or prepared correctly Poor temperature control ◦ Foods left at room temperature between 68- 140 degrees F

16. How is it Diagnosed? How is it Diagnosed? Researchers detect the illness by the type of bacteria toxin found in stool samples or through various tests, which can conclude the number of bacteria found in samples.

17. How Can It Be Treated? How Can It Be Treated? Oral rehydration IV fluids Electrolyte replacement Antibiotics are NOT suggested

18. Prevention Prevention Keep hot foods hot! ◦ Cook foods above 140 degrees F Keep cold foods cold! ◦ Within two hours from cooking a meal, leftover foods should be placed into the refrigerator or freezer at a temperature of 40 degrees F or less Leftover foods ◦ Reheating should be at least 165 degrees F

19. Additional Reading Additional Reading http://www.foodpoisonjournal.com/foodborne-illness- outbreaks/clostridium-perfringens-information-and-statistics/ http://www.foodpoisonjournal.com/foodborne-illness- outbreaks/clostridium-perfringens-information-and-statistics/ http://www.cdc.gov/Features/ClostridiumPerfringens/ http://textbookofbacteriology.net/clostridia.html http://www.fda.gov/Food/ScienceResearch/LaboratoryMethods/Bacteriolog icalAnalyticalManualBAM/UCM070878 http://www.fda.gov/Food/ScienceResearch/LaboratoryMethods/Bacteriolog icalAnalyticalManualBAM/UCM070878 http://www.cehs.siu.edu/fix/medmicro/clost.htm

20. References References Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from http://www.cdc.gov/foodborneburden/clostridium-perfringens.htmlhttp://www.cdc.gov/foodborneburden/clostridium-perfringens.html GlobalSecurity.org. (2011). Clostridium Perfringens Toxins. Retrieved from http://www.globalsecurity.org/wmd/intro/bio_clostridium.htm http://www.globalsecurity.org/wmd/intro/bio_clostridium.htm PubMed Health. (2010). Thrombocytopenia. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001612/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001612/ Extension. Progress in the Understanding of Hemorrhagic Bowel Syndrome. Retrieved from http://www.extension.org/pages/25183/progress-in-the- understanding-of-hemorrhagic-bowel-syndrome#Epidemiologyhttp://www.extension.org/pages/25183/progress-in-the- understanding-of-hemorrhagic-bowel-syndrome#Epidemiology Iowa State University. (2004). Epsilon Toxin of Clostridium Perfringens. Retrieved from http://www.cfsph.iastate.edu/Factsheets/pdfs/epsilon_toxin_clostridium.pdfhttp://www.cfsph.iastate.edu/Factsheets/pdfs/epsilon_toxin_clostridium.pdf MedlinePlus. (2011). Septicemia. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/001355.htm http://www.nlm.nih.gov/medlineplus/ency/article/001355.htm U.S. Food and Drug Administration. (2009). BBB Clostridium Perfringens. Retrieved from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodborneP athogensNaturalToxins/BadBugBook/ucm070483.htm http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodborneP athogensNaturalToxins/BadBugBook/ucm070483.htm

21. References References Wrongdiagnosis. (2011). Prevalence and Incidence of Clostridium Perfringens Food Posioning. Retrieved from http://www.wrongidagnosis.com/c/clostridium_perfringens_food_poisoning/prevalen ce.htm http://www.wrongidagnosis.com/c/clostridium_perfringens_food_poisoning/prevalen ce.htm University of Florida IFAS Extension. (2009). Preventing Foodborne Illness Associated with Clostridium Perfringens. Retrieved from http://edis.ifas.ufl.edu/fs101 http://edis.ifas.ufl.edu/fs101 Ohio State University. (1994). Clostridium Perfringens Not the 24 Hour Flu. Retrieved from http://ohioline.osu.edu/hyg-fact/5000/5568.htmlhttp://ohioline.osu.edu/hyg-fact/5000/5568.html Illinois Department of Public Health. (2011). Clostridium Perfringens. Retrieved from http://www.idph.state.il.us/Bioterrorism/factsheets/clostridium.htmhttp://www.idph.state.il.us/Bioterrorism/factsheets/clostridium.htm FoodSafety.gov. (2011). Clostridium Perfringens. Retrieved from http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/cperfringens/index.html http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/cperfringens/index.html Thefreedictionary.com. (2011). Enterotoxaemia. Retrieved from http://medical- dictionary.thefreedictionary.com/enterotoxaemiahttp://medical- dictionary.thefreedictionary.com/enterotoxaemia