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 (nontyphi)
  • Escherichia coli
    • E. coli 0157:H7
  • Yersinia enterocolitica
  • Vibrio cholerae
  • Clostridium difficile
• Parasitic
  • Giardia lamblia
  • Cryptosporidium
  • Entamoeba histolytica
  • Cyclospora
• Toxin
  • Staphylococcus aureus
  • Bacillus cereus

Noninfectious

• GI Bleed
• Appendicitis
• Mesenteric Ischemia
• Diverticulitis
• Adrenal Crisis
• Thyroid Storm
• Toxicologic exposures
• Antibiotic or drug-associated

Watery Diarrhea

• Enterotoxigenic E. coli (most common cause of watery diarrhea)
• 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

Diffuse Abdominal pain

• Abdominal aortic aneurysm
  • Aortocaval fistula
• Acute gastroenteritis
• Aortoenteric fisulta
• Appendicitis (early)
• Bowel obstruction
  • Large bowel obstruction
    • Ogilvie's syndrome
  • Small bowel obstruction
• Bowel perforation
• Gastroparesis
• Diabetic ketoacidosis
• 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
  • Oral or IV rehydration
  • Analgesia, antiemetics

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

• Clostridium
• Acute diarrhea, Gastroenteritis

References

Tintinalli's

Authors

Claire