Microbiology, parasitology & COVID-19

Gram positive bacteria

C. perfringens / C. septicum



Last author update: 20 January 2022
Last staff update: 20 January 2022

Copyright: 2022, PathologyOutlines.com, Inc.

PubMed Search: C. perfringens[TI] OR C. septicum[TI]

Asad Ullah, M.D.
Hasan Samra, M.D.
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Cite this page: Ullah A, Samra H. C. perfringens / C. septicum. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/microbiologyperfringenssepticum.html. Accessed December 7th, 2022.
Definition / general
Essential features
  • Gram positive, spore forming, rod shaped, anaerobic
  • Ubiquitous in environment, soil and human intestinal tracts
  • Cause: significant trauma related gas gangrene, food poisoning and sepsis
Terminology
  • Clostridia, Eubacteriales, Clostridiaceae, Clostridium, Clostridium perfringens / septicum
Epidemiology
Sites
Pathophysiology
  • Production of alpha toxin (a phospholipase C) important virulence factor for myonecrosis
  • Collagenases, hyaluronidase, fibrinolysin, hemagglutinin and hemolysins mediates increase vascular permeability systemic spread of the infection
  • Food poisoning mediated by enterotoxin production (Future Microbiol 2014;9:361)
Clinical features
Diagnosis
  • Diagnosis is based on clinical observations
  • Necrotizing tissue Gram stain and anaerobic bacterial culture
  • Blood cultures (aerobic and anaerobic)
  • Reference: J Bone Joint Surg Am 2003;85:1454
Laboratory
  • Anaerobic growth in routine culture conditions, 37 °C
  • Growth on blood agar
  • Catalase negative
  • Small to medium sized gray colonies
  • Clostridium perfringens double zone hemolysis, differentiates from other Clostridium spp.
  • Matrix assisted laser desorption ionization time of flight (MALDI-TOF) mass spectrometry
    • Rapid alternative to 16S rRNA sequencing for identifying anaerobes isolated from solid culture media
  • Reference: J Bone Joint Surg Am 2003;85:1454
Case reports
Treatment
  • Surgical debridement of traumatic injuries
  • Wound cleansing, removal of dead tissue
  • Broad spectrum beta lactams
  • Hyperbaric oxygen may be useful
  • Food poisoning, self limiting
  • Reference: J Bone Joint Surg Am 2003;85:1454
Clinical images

Contributed by Hasan Samra, M.D.
Clostridium perfringens</i> isolated in culture

Clostridium perfringens isolated in culture

Microscopic (histologic) description
  • 1 x 6 micron large, rectangular rod shaped, gram positive bacteria
Microscopic (histologic) images

Contributed by Hasan Samra, M.D.
<i>Clostridium</i> sp.

Clostridium spp.

Videos

Clostridium perfringens - an osmosis preview

Differential diagnosis
  • Group A Streptococcus infection:
    • Appears as gram positive cocci on Gram stain
  • Vibrio vulnificus myositis:
    • Associated with clinical history of traumatic water injury
  • Pyomyositis due to Staphylococcus aureus:
    • Appears as gram positive cocci in clusters on Gram stain
  • Rhabdomyolysis:
    • Associated with clinical history of trauma or strenuous exercising
    • Culture negative
  • Bacillus cereus food poisoning:
    • Toxin producing facultatively anaerobic gram positive bacterium
    • Association with reheated food exposure
Board review style question #1

A 44 year old male construction worker presented to the emergency room with acute onset severe right thigh pain and altered mental status. Physical examination showed large bulla at the location of his pain and crepitance on palpation. Gram stain performed on the bulla aspirate showed large gram positive rods. What is the most likely organism?

  1. Clostridium difficile
  2. Clostridium perfringens
  3. Pseudomonas aeruginosa
  4. Streptococcus pyogenes
Board review style answer #1
B. Clostridium perfringens. Gas gangrene is a necrotic infection of soft tissue with high mortality rate, often necessitating amputation and commonly associated with Clostridium perfringens. While Streptococcus pyogenes could cause gangrene / necrotizing fasciitis, it is gram positive cocci. Pseudomonas aeruginosa is gram negative rod. While Clostridium difficile is gram positive rod, it is the causative agent of antibiotic associated diarrhea and not linked to necrotizing fasciitis.

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Reference: Clostridium perfringens / Clostridium septicum
Board review style question #2
For Clostridium septicum bacteremia, association with which of the following clinical conditions should be investigated?

  1. Bronchiectasis
  2. Colon cancer
  3. Diverticulitis
  4. Inflammatory bowel disease
Board review style answer #2
B. Colon cancer. Clostridium septicum is known to be associated with malignancy, most commonly of colonic or hematological origin and therefore in patients where this organism is isolated, efforts must be made to exclude an occult underlying condition. Association with any of the other mentioned choices has not been described.

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Reference: Clostridium perfringens / Clostridium septicum
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