Clostridium Perfringens Toxins.

a. Clinical Syndrome.

(1) Characteristics. Clostridium perfringens is a common anaerobic bacterium associated with three distinct disease syndromes; gas gangrene or clostridial myonecrosis; enteritis necroticans (pig-bel); and clostridium food poisoning. Each of these syndromes has very specific requirements for delivering inocula of C. perfringens to specific sites to induce disease, and it is difficult to imagine a general scenario in which the spores or vegetative organisms could be used as a biological warfare agent. There are, however, at least 12 protein toxins elaborated, and one or more of these could be produced, concentrated, and used as a weapon. Waterborne disease is conceivable, but unlikely. The alpha toxin would be lethal by aerosol. This is a wellcharacterized, highly toxic phospholipase C. Other toxins from the organism might be co-weaponized and enhance effectiveness. For example, the epsilon toxin is neurotoxic in laboratory animals.

(2) Clinical Features. The clinical picture of aerosolized C. perfringens alpha toxin would be expected to be that of a serious acute pulmonary insult. Absorbed alpha toxin could produce vascular leak, hemolysis, thrombocytopenia, and liver damage. Other toxins admixed could modify the illness. There is insufficient information available to speculate on a clinical syndrome produced by other C. Perfringens toxins.

b. Diagnosis.

(1) Routine Findings. Clinical laboratory findings might include anemia (due to intravascular hemolysis), thrombocytopenia, elevated serum transaminases, and hypoxia.

(2) Differential Diagnosis. Pulmonary findings might lead to confusion with staphylococcal enterotoxin B (SEB) initially. Liver damage, hemolytic anemia, and thrombocytopenia are not associated with SEB and the pulmonary findings should be reversible in SEB.

(3) Specific Laboratory Diagnosis. Acute serum and tissue samples should be collected and rapidly transported to a reference laboratory. Specific immunoassay are available; however, their utility in diagnosis of human disease is unproven. The enterotoxin can be detected in fecal samples from human food poisoning cases, and bacteria are readily cultured from clinical samples.

c. Therapy. No specific treatment is available for C. pefringens intoxication. The organism itself is sensitive to penicillin, and consequently, this is the current drug of choice. Recent data indicate that clindamycin or rifampin may suppress toxin production and provide superior results in animal models.

d. Prophylaxis. There is no available prophylaxis against most C. perfringens toxins. Toxoids are being used to prevent enteritis necroticans in humans, and veterinary toxoids are in wide use.

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