Portal de Periódicos da CAPES

Enteritis necroticans caused by Clostridium perfringens type a

2004; Elsevier BV; Volume: 144; Issue: 3 Linguagem: Inglês

10.1016/j.jpeds.2003.09.039

1097-6833

Tadashi Iwanaka, Hiroshi Kawashima, Hiroshi Kishimoto, Mikio Kakinuma, Kazuaki Arai, Jun Sakùrai, Masahiro Nagahama,

Clostridium difficile and Clostridium perfringens research

An 8-year-old boy presented with gradual onset of fever, vomiting, diarrhea, and abdominal pain, which progressed to abdominal distention. His white blood cell count and C-reactive protein level were 11,300 /μL and 19.3 mg/dL, respectively. He underwent emergent laparotomy, which revealed hyperemic and edematous bowel from mid-jejunum to mid-ileum with two small perforations, resulting in resection of 100 cm of the jejunum, and creation of jejunostomy and ileostomy. Histologic examination of the resected bowel showed extensive inflammation and necrosis with areas of pseudomembrane formation (Fig 1). Anaerobic bacterial culture and microbiological assay of his stool detected type A of Clostridium perfringens (C perfringens) with positive α-toxin and negative β-, ε-, and ι-toxins. Immunohistochemistry on the surface of mucosa of the paraffin-embedded bowel tissue using antibodies of α- and β-toxins confirmed infection of type A of C perfringens causing enteritis necroticans (Fig 2). Immunohistochemistry was valuable in planning the course of treatment. He received oral vancomycin, metronidazole, and probiotics therapy using Lactobacillus kasei, Bifidobacterium breve, and oligosaccharide. His course of recovery was uneventful. A source of the causative micro-organism, and the reason why a healthy, well-nourished boy acquired this gastrointestinal infection are still unclear.Fig 2Immunohistochemistry using α-toxin antibody. Positive stained rod-shaped bacilli are shown in the pseudomembrane on the surface of intestinal mucosa.View Large Image Figure ViewerDownload (PPT) Strains of C perfringens are classified into five groups (types A through E) based on the production of four major toxins called α-, β-, ε-, and ι-toxins. Type A strain causes gas gangrene in humans, whereas type C strain is a common cause of enteritis necroticans called Pigbel.1.Sakurai J. Nagahama M. Ochi S. Major toxins of Clostridium perfringens.J Toxicol. 1997; 16: 195-214Google Scholar Enteritis necroticans by type A of C perfringens has been reported only in newborn infants,2.Warren S. Schreiber J.R. Epstein M.F. Necrotizing enterocolitis and hemolysis associated with Clostridium perfringens.Am J Dis Child. 1984; 138: 686-688PubMed Google Scholar with no report in healthy children or adults in developed countries. We encourage awareness of this fulminant, yet rarely recognized, surgical entity.