Necrotizing Enterocolitis Associated with Clostridium perfringens Type A in Previously Healthy North American Adults
| Autor: | Marc Fischer, Amita Gupta, Neil A. Hoffman, J. Glenn Songer, Charles G. Mixter, Jeremy Sobel, Priti Kolhe, Jeannette Guarner, Phyllis Britz, Clifford MacDonald, Maurice Fremont-Smith, George Killgore, Sherif R. Zaki |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Pathology Clostridium perfringens Population Virulence Autopsy medicine.disease_cause Gastroenterology Enteritis Necrosis Fatal Outcome Mesenteric Veins Enterocolitis Necrotizing Ischemia Internal medicine Mesenteric Vascular Occlusion medicine Humans Clostridiaceae Intestinal Mucosa education Venous Thrombosis education.field_of_study biology Portal Vein business.industry Middle Aged medicine.disease biology.organism_classification Necrotizing enterocolitis Clostridium Infections biology.protein Surgery Antibody business |
| Zdroj: | Journal of the American College of Surgeons. 201:48-56 |
| ISSN: | 1072-7515 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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