Clostridial necrotizing enteritis, is a potentially fatal type of food poisoning caused by a β-toxin of Clostridium perfringens, Type C. It occurs in some developing countries, but was also documented in Germany following World War II, where it was called "Darmbrand". The toxin is normally inactivated by certain proteolytic enzymes and by normal cooking, but when these protections are impeded, and high protein is consumed, the disease emerges. Sporadic and extremely rare cases occur in diabetics. In New Guinea, where inhabitants generally have low protein diets apart from at tribal feasts, a number of factors compound to result in pigbel.
Signs and symptoms
CNE is a necrotizing inflammation of the small bowel. Clinical results may vary from mild diarrhea to a life-threatening sequence of severe abdominal pain, vomiting, bloody stool, ulceration of the small intestine with leakage into the peritoneal cavity and possible death within a single day due to peritonitis. Many patients exhibit meteorism and a fever. Fluid can enter the peritoneum. Sepsis can occur, with one case having 28,500 white blood cells per cubic milliliter.
Cause
All the factors collectively causing CNE are generally only present in the hinterlands of New Guinea and parts of Africa, Latin America, and Asia. These factors include protein deprivation, poor food hygiene, episodic meat feasting, staple diets containing trypsin inhibitors, and infection by Ascaris parasites which secrete a trypsin inhibitor. In New Guinea, the disease is usually spread through contaminated meat and perhaps by peanuts..
Treatment involves suppressing the toxin-producing organisms with antibiotics such as penicillin G or metronidazole. About half of seriously ill patients require surgery for perforation, persistent intestinal obstruction, or failure to respond to the antibiotics. An investigational toxoid vaccine has been used successfully in some developing countries but is not available outside of research.
In neonatal intensive-care units, the syndrome of neonatal necrotizing enterocolitis may be caused in a similar way by C. perfringens, C. butyricum, and C. difficile, but this has not been proved.
