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Small bowel (small intestine)

Infectious disorders

Clostridium


Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 16 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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Clostridium difficile
● Causes bloody diarrhea after antibiotics (antibiotic associated colitis)
● Other risk factors include inflammatory bowel disease, colectomy with ileostomy or other bowel surgery (Anaerobe 2011;17:52)
● Due to cytotoxin, but locally invasive only
● Nosocomial spread

Clostridium perfringens
● Causes watery diarrhea
● Produces enterotoxin, and usually noninvasive
● Transmitted from meat, poultry, fish

Clostridium perfringens, type C strain
● Produces severe necrotizing enterocolitis of jejunum and ileum (enteritis necroticans) with perforation, also called pigbel, a pidgin English term for abdominal pain after a pig feast, reflecting a 1963 cluster of cases
● Occurred after World War II in previously starved children/adults after eating large meals of meat and vegetables
● Currently associated with severe protein malnutrition in Asia, Africa, South Pacific
● Rarely occurs in developed countries in patients with diabetes
● High mortality rate unless diagnose early and treat with antibiotics or surgical excision of necrotic bowel
● Preventative vaccine is available for toxin

Case reports
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● 66 year old woman with Type 2 diabetes mellitus who developed severe abdominal pain and bloody diarrhea from cooked turkey sausage (Mod Pathol 2002;15:66)

Clinical images
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Clostridium difficile enteritis 9 years after total proctocolectomy

Gross description
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● Segmental necrosis of proximal jejunum

Micro description
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● Ischemic changes with necrotic villi, inflammatory cells and fibrinoid necrosis of vessel

Micro images
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Various images


Crypt eruption and pseudomembranes

End of Small bowel (small intestine) > Infectious disorders > Clostridium


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