An unusual case of colitis. DM, 55yo. Previously well woman was referred by GP for lower abdominal pain and vomiting Noticed increasing flatus 5/7 prior Loose BM x 3/7 relieved by immodium Crampy abdominal pain ++ Multiple episodes of N+V. History. Nil anorexia/weight loss
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Bili : 8
ALT : <10
Alk Phos : 20
Amylase : 29Blood investigations
Aetiology of colitis:
- Ulcerative colitis
- Crohn’s disease
- Indeterminate colitis
-Enterotoxigenic E. coli
C. perfringens produces at least 17 types of exotoxins (Type A, Type B, Type C etc)
250,000 cases of mild, self limiting gastroenteritis in the US caused by C perfringens Type A
‘Pigbel’ disease – necrotising enteritis associated with C perfringens Type C in severely protein deprived population in the Pacific – often fatal
Sobel J et al. Necrotizing enterocolitis associated with clostridium perfringens type A in previously healthy north american adults. J Am Coll Surg. 2005 Jul;201(1):48-56.
Bos J et al. Fatal necrotizing colitis following a foodborne outbreak of enterotoxigenic Clostridium perfringens type A infection.Clin Infect Dis. 2005 May 15;40(10):e78-83. Epub 2005 Apr 14.
Disease process: 1. Ingestion of food containing preformed toxins, 2. overgrowth of C. perfringens post antibiotic therapy1 or sporadically leading to disease in susceptible hosts
Diagnosis: C. perfringens growth in culture and isolation of toxin
Treatment: Metronidazole +/- clindamycin
1. Borriello SP, Larson HE, Welch AR, Barclay F, Enterotoxigenic Clostridium perfringens: a possible cause of antibiotic associated diarrhoea. Lancet 1984;1:305-7
Siggers RH et al. Early administration of probiotics alters bacterial colonization and limits diet-induced gut dysfunction and severity of necrotizing enterocolitis in preterm pigs. J Nutr. 2008 Aug;138(8):1437-44.
Remember the aetiology of colitis
Differential diagnosis of lower abdominal pain & distension
Treatment for C. perfringens colitis