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CLOSTRIDIUM PERFRINGENS

CLINICAL SYNDROME

Clostridium perfringens is a common anaerobic bacterium
associated with three distinct disease syndromes: (a) gas
gangrene or clostridial myonecrosis; (b) enteritis necroticans
(pig-bel); and (c) clostridial food poisoning. Each of these
syndromes has very specific requirements for delivery inocula
of C perfringens to specific sites to induce disease, and it is
difficult to envision a gernal scenario in which the spores or
vegetative organisms could be used as a biowarfare 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 best available speculation (based on virtually no
exploratory data with which to sharpen our conclusions) is that
the alpha toxin would be lethal by aerosol. This is a well
characterized, 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.

	Clinical Features. The clinical picture of aerosolized C
perfringens alpha toxin would be expected to be that of a
serious acute pulmonary insult. Absorbed toxin could produce
vascular leak, hemolysis, thrombocytopenia, liver damage, etc.
Other toxins could modify the event.

DIAGNOSIS

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

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

Specific Laboratory Diagnosis. Acute serum and tissue
samples should be collected and rapidly transported to a
reference laboratory. Specific immunoassays are available;
however, their utility in diagnosis of human disease is
unproven.

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