Fatal necrotizing colitis following a foodborne outbreak of enterotoxigenic Clostridium perfringens type A infection
Fatal necrotizing colitis following a foodborne outbreak of enterotoxigenic Clostridium perfringens type A infection
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DOI：
10.1086/429829
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发表时间：
2005-05-15
影响因子：
11.8
通讯作者：
Crutcher, JM
中科院分区：
文献类型：
--
作者：
Bos, J;Smithee, L;Crutcher, JM
背景。产肠毒素 A 型产气荚膜梭菌是美国食源性疾病的第三大原因，估计每年导致 250,000 例典型的轻度自限性胃肠道疾病。方法。进行了一项回顾性队列研究，以确定一小群胃肠道疾病病例的病因，其中包括严重坏死性结肠炎病例。该研究的参与者包括俄克拉荷马州精神病患者寄宿护理机构的居民和工作人员 (n = 20)。作为环境调查的一部分，对住宿护理设施的食物准备和食物储存区域进行了检查。该调查包括对产气荚膜梭菌分离株和尸检时收集的组织标本进行广泛的微生物学和分子检测。结果。食用高风险食品后，共发现 7 例（3 例确诊，4 例疑似）食源性产气荚膜梭菌 A 型病例（发病率为 35%）。三名居民患上急性坏死性结肠炎；其中2人死亡。每位确诊感染的患者均出现便秘或粪便嵌塞的证据。在每位坏死性结肠炎患者的样本上培养产气荚膜梭菌肠毒素 (CPE) 阳性 A 型产气荚膜梭菌。尽管统计分析未能暗示食物来源，但分离株携带染色体 cpe 基因，支持食源性起源。结论。这项研究证实，食源性 CPE 阳性 A 型产气荚膜梭菌会影响结肠，导致潜在致命的坏死性结肠炎。药物引起的便秘和粪便嵌塞，导致结肠粘膜组织长时间暴露于 A 型产气荚膜梭菌毒素，导致坏死性结肠炎的发展。
Background. Enterotoxigenic Clostridium perfringens type A is the third leading cause of foodborne disease in the United States, resulting annually in an estimated 250,000 cases of a typically mild, self-limiting gastrointestinal illness.Methods. A retrospective cohort study was conducted to determine the cause of a small cluster of cases of gastrointestinal illness, which included cases of severe necrotizing colitis. Participants in the study consisted of residents and staff of a residential care facility for the mentally ill in Oklahoma (n = 20). An inspection of food preparation and food storage areas of the residential care facility was conducted as part of an environmental investigation. The investigation included extensive microbiological and molecular testing of the C. perfringens isolates and tissue specimens collected at autopsy.Results. A total of 7 (3 confirmed and 4 probable) cases of foodborne enterotoxigenic C. perfringens type A were identified (attack rate, 35%) after the consumption of high-risk foods. Three residents developed acute necrotizing colitis; 2 of them died. Each patient with confirmed infection presented with evidence of constipation or fecal impaction. C. perfringens enterotoxin (CPE)-positive C. perfringens type A was cultured on samples from each patient with necrotizing colitis. Although statistical analyses failed to implicate a food source, the isolates carried a chromosomal cpe gene, which supports a foodborne origin.Conclusions. This study confirms that foodborne CPE-positive C. perfringens type A can affect the colon, resulting in potentially fatal necrotizing colitis. Drug-induced constipation and fecal impaction, resulting in prolonged exposure of the colonic mucosal tissue to C. perfringens type A toxins, contributed to the development of necrotizing colitis.