1. Clostridium Perfringens: Its Significance, Incidence, and Prevention Bobbi Johnson, PhD Walden University PUBH Instructor: Dr. Stephen Arnold Summer, 2011
Presentation is addressed to representatives from the Center for Disease Control and Prevention, U.S. Food and Drug Administration, various health departments, and other citizens. This presentation will define the foodborne agent, incident report, target populations, the cause and effect of the agent, and prevention.

2. Clostridium Perfringens History
Is also referred to as Clostridium Welchii
Was discovered in by George Nuttall and William Welch
References:
1) Pictures retrieved from 2) History retrieved from

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.
Notes:
Although clostridium perfringens is one of the most common foodborne illnesses in the United States, it typically carries five strains, which is type A, B, C, D, and E. Humans only suffer from types A and C, which will be further discussed.
References:
1) Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from

4. Toxins Clostridium Perfringens Type A Clostridium Perfringens Type B
Clostridium Perfringens Type C
Clostridium Perfringens Type D
Clostridium Perfringens Type E
Notes:
There are five strains of clostridium perfringens (A-E). Type A and C strain is mostly common in humans.

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 hours after first initial symptom
Causes mild food poisoning lasting up to 24 hours
Notes:
Alpha toxin is produced in all clostridium types. Alpha toxin is produced in all clostridium types. This type of toxin can cause liver damage, vascular leakage, acute pulmonary disease, and thrombocytopenia (a blood disorder in which an abnormal number of circulating platelets are found in the bloodstream) (PubMed Health, 2010).
Hemorrhagic bowel syndrome is a fatal “digestive tract disease [that] has been reported with increasing frequency in adult dairy cows” (Extension, 2011, par. 1).
References:
GlobalSecurity.org. (2011). Clostridium Perfringens Toxins. Retrieved from
PubMed Health. (2010). Thrombocytopenia. Retrieved from
Extension. Progress in the Understanding of Hemorrhagic Bowel Syndrome. Retrieved from

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
Notes:
Beta toxin is a very fatal necrotizing toxin that causes potassium and fluid leakage from cells (Iowa State University, 2004). With epsilon toxin, there appears to be little to absolutely no information regarding its effects on humans (Iowa State University, 2004). However, this toxin can cause neurologic problems.
Enterotoxemia is correlated to clostridium type B, which is common in lambs, young calves, and foals. Some of the symptoms may involve listlessness, bloody diarrhea, and recumbency (Iowa State University, 2004).
References:
GlobalSecurity.org. (2011). Clostridium Perfringens Toxins. Retrieved from
PubMed Health. (2010). Thrombocytopenia. Retrieved from
Iowa State University. (2004). Epsilon Toxin of Clostridium Perfringens. Retrieved from

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)
References:
GlobalSecurity.org. (2011). Clostridium Perfringens Toxins. Retrieved from
2) Septicemia information: MedlinePlus. (2011). Septicemia. Retrieved from

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
References:
1) GlobalSecurity.org. (2011). Clostridium Perfringens Toxins. Retrieved from

9. Clostridium Perfringens Type E
Produces alpha and iota toxins
Causes hemorrhagic enteritis
Enterotoxaemia in animals
Rarely found in humans
Notes:
Iota toxins cause necrosis and vascular permeability
Enterotoxaemia is “a condition characterized by the presence in the blood of toxins produced in the intestines” (Thefreedictionary.com, 2011, sec. 1)
References:
GlobalSecurity.org. (2011). Clostridium Perfringens Toxins. Retrieved from
Thefreedictionary.com. (2011). Enterotoxaemia. Retrieved from

10. Incident Report for Humans
Most commonly reported foodborne illness
Between 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.
Notes:
It is mentioned that many of the outbreaks go unrecognized because of the “implicated foods or patient feces are not tested routinely for clostridium perfringens or its toxin” (Wrongdiagnosis, 2011, par. 1).
References:
U.S. Food and Drug Administration. (2009). BBB Clostridium Perfringens. Retrieved from
2) Wrongdiagnosis. (2011). Prevalence and Incidence of Clostridium Perfringens Food Posioning. Retrieved from
3) Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from

11. Who is Considered at Risk?
Infants
Young children
Elderly
Notes:
The elderly may experience more severe symptoms that could last between 1-2 weeks.
References:
1) Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from
2) FoodSafety.gov. (2011). Clostridium Perfringens. Retrieved from

12. Target Populations That Are Affected
School cafeterias
Hospitals
Nursing homes
Prisons
Notes:
School cafeterias, hospitals, nursing homes, and prisons are places where a vast majority of food is prepared several hours before serving, in which clostridium perfringens spores can form, therefore, allowing the bacteria to spread and infect others.
References:
U.S. Food and Drug Administration. (2009). BBB Clostridium Perfringens. Retrieved from

13. Foods that are associated with Clostridium Perfringens
Stew
Soups
Gravy
Lamb
Fish
Shrimp
Crab
Beans
Potato salad
Macaroni and cheese
Notes:
The main sources of where clostridium perfringens are found: beef, poultry, gravy
References:
1) University of Florida IFAS Extension. (2009). Preventing Foodborne Illness Associated with Clostridium Perfringens. Retrieved from

14. 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
References:
Ohio State University. (1994). Clostridium Perfringens Not the 24 Hour Flu. Retrieved from
Illinois Department of Public Health. (2011). Clostridium Perfringens. Retrieved from
Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from

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 degrees F
Notes:
If food is undercooked, sitting in room temperature, or if leftovers are not reheated to at least 165 Fahrenheit, this can cause the formation of clostridium perfringens.
Once a meal is complete, the preparer should properly place food into the refrigerator a half hour or a hour after meal has been prepared in order to prevent the clostridium spores from forming, from which the bacteria can immensely grow.
References:
1) Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from

16. 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.
References:
1) Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from

17. How Can It Be Treated? Oral rehydration IV fluids
Electrolyte replacement
Antibiotics are NOT suggested
References:
1) Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from

18. Prevention Keep hot foods hot! Keep cold foods cold! Leftover foods
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
References:
1) Ohio State University. (1994). Clostridium Perfringens Not the 24 Hour Flu. Retrieved from

19. Additional Reading
outbreaks/clostridium-perfringens-information-and-statistics/
icalAnalyticalManualBAM/UCM070878

20. References
Center for Disease Control and Prevention. (2011). Clostridium Perfringens. Retrieved from
GlobalSecurity.org. (2011). Clostridium Perfringens Toxins. Retrieved from
PubMed Health. (2010). Thrombocytopenia. Retrieved from
Extension. Progress in the Understanding of Hemorrhagic Bowel Syndrome. Retrieved from understanding-of-hemorrhagic-bowel-syndrome#Epidemiology
Iowa State University. (2004). Epsilon Toxin of Clostridium Perfringens. Retrieved from
MedlinePlus. (2011). Septicemia. Retrieved from
U.S. Food and Drug Administration. (2009). BBB Clostridium Perfringens. Retrieved from athogensNaturalToxins/BadBugBook/ucm htm

21. References
Wrongdiagnosis. (2011). Prevalence and Incidence of Clostridium Perfringens Food Posioning. Retrieved from ce.htm
University of Florida IFAS Extension. (2009). Preventing Foodborne Illness Associated with Clostridium Perfringens. Retrieved from
Ohio State University. (1994). Clostridium Perfringens Not the 24 Hour Flu. Retrieved from
Illinois Department of Public Health. (2011). Clostridium Perfringens. Retrieved from
FoodSafety.gov. (2011). Clostridium Perfringens. Retrieved from
Thefreedictionary.com. (2011). Enterotoxaemia. Retrieved from dictionary.thefreedictionary.com/enterotoxaemia