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File: 970207_aadcn_014.txtCLOSTRIDIUM 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. 12 .
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