TAILIEUCHUNG - Chapter 135. Gas Gangrene and Other Clostridial Infections (Part 2)

Clinical Manifestations Intestinal Disorders Food Poisoning C. perfringens, primarily type A, is the second or third most common cause of food poisoning in the United States (Chap. 122). The responsible toxin is thought to be a cytotoxin produced by 75% of strains isolated from cases of foodborne disease. The cytotoxin binds to a receptor on the small-bowel brush border and induces a calcium ion–dependent alteration in permeability. The associated loss of ions alters intracellular metabolism, resulting in cell death. Outbreaks generally have resulted from problems in the cooling and storage of food cooked in bulk. The food sources primarily involved are. | Chapter 135. Gas Gangrene and Other Clostridial Infections Part 2 Clinical Manifestations Intestinal Disorders Food Poisoning C. perfringens primarily type A is the second or third most common cause of food poisoning in the United States Chap. 122 . The responsible toxin is thought to be a cytotoxin produced by 75 of strains isolated from cases of food-borne disease. The cytotoxin binds to a receptor on the small-bowel brush border and induces a calcium ion-dependent alteration in permeability. The associated loss of ions alters intracellular metabolism resulting in cell death. Outbreaks generally have resulted from problems in the cooling and storage of food cooked in bulk. The food sources primarily involved are meat meat products and poultry. Generally the implicated meats have been cooked allowed to cool and then recooked the following day often in a stew or hash. Strains of C. perfringens that contaminate meat manage to survive initial cooking. During reheating the organisms sporulate and germinate. The disease is associated with an attack rate that is often as high as 70 . Symptoms of food poisoning from type A strains develop 8-24 h after ingestion of foods heavily contaminated with the organism. The primary symptoms include epigastric pain nausea and watery diarrhea usually lasting 12-24 h. Fever and vomiting are uncommon. Molecular methods including ribotyping and pulsed-field gel electrophoresis have been used to detect fecal cytotoxin in outbreaks of food poisoning caused by C. perfringens. C. perfringens has also been implicated in a more severe form of diarrhea than that of classic food poisoning. This more severe disease tends to occur in the elderly and has been associated with antibiotic use in hospitalized populations. In this form of disease diarrhea is generally more profuse of longer duration and accompanied by abdominal pain. Blood and mucus have been detected in the feces of the affected patients. In one hospital-based study of a cluster of .

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