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14-September-2008 18:38:45 - Clostridial necrotizing enteritis Food Safety Image:Food Safety 1.svg Terms Foodborne illness HACCP Critical Control Point Critical factors FAT TOM pH Water activity Wa Pathogens Clostridium botulinum · E. Coli · Hepatitis A Clostridial necrotizing enteritis Classification and external resources ICD-10 A05.22.3 ICD-9 005.2 May 2008 Clostridial necrotizing enteritis CNE -- also called enteritis necroticans and pigbel -- is an often fatal type of food poisoning caused by a β-toxin of Clostridium perfringens, Type C. It occurs in some developing countries, but was also documented in Germany following World War II. The toxin is normally inactivated by certain proteolytic enzymes and by normal cooking, but when these protections are impeded, the disease emerges. Contents 1 Etiology 2 Clinical aspects 3 Other Clostridial toxemias 4 References Etiology All the factors collectively causing CNE are generally only present in the hinterlands of New Guinea and parts of Africa, Latin America, and Asia. These factors include protein deprivation causing inadequate synthesis of trypsin protease an enzyme, to which the toxin is very sensitive, poor food hygiene, episodic meat feasting, staple diets containing trypsin inhibitors sweet potatoes, and infection by Ascaris parasites which secrete a trypsin inhibitor. In New Guinea origin of the term pigbel, the disease is usually spread through contaminated meat especially pork and perhaps by peanuts. CNE was also diagnosed in post WWII Germany, where it was known as Darmbrand or fire bowels. Clinical aspects CNE is a necrotizing inflammation the small bowel especially the jejunum but also the ileum. Clinical results may vary from mild diarrhea to a life-threatening sequence of severe abdominal pain, vomiting, bloody stool, ulceration of the small intestine with leakage perforation into the peritoneal cavity and possible death within a single day due to peritonitis. Treatment involves suppressing the toxin-producing organisms with antibiotics such as penicillin G or metronidazole. About half of seriously ill patients require surgery for perforation, persistent intestinal obstruction, or failure to respond to the antibiotics. An investigational toxoid vaccine has been used successfully in some developing countries but is not available outside of research. Other Clostridial toxemias Leukemia patients, cancer chemotherapy recipients and others suffering from suppressed white blood cells neutropenia can be afflicted by a similar syndrome, neutropenic enterocolitis, in which the cecum is targeted by Clostridium septicum in much the same way. In neonatal intensive care units, the syndrome of neonatal necrotizing enterocolitis may be caused in a similar way by C. perfringens, C. butyricum, and C. difficile, but this has not been proved. References Cooke RA. Pig Bel. Perspectives in Pediatric Pathology. 1979;5:137-52. PMID: 575409 Murrell TG, Roth L, Egerton J, Samels J, Walker PD. Pig-bel: enteritis necroticans. A study in diagnosis and management. Lancet. 1966 Jan 29;17431:217-22. PMID: 4159182 Murrell TG, Egerton JR, Rampling A, Samels J, Walker PD. The ecology and epidemiology of the pig-bel syndrome in man in New Guinea. Journal of Hygiene, London. 1966 Sep;643:375-96. PMID: 4288244 Nuland, Sherwin B., The Beast in the Belly, Discover, Vol. 16 No. 02 February 1995. v d e Infectious diseases - Bacterial diseases primarily A00-A79, 001-041,080-109 G+ Firmicutes Clostridium Pseudomembranous colitis - Botulism - Tetanus - Gas gangrene Bacilli class Coccus Strep-: Alpha pneumoniae, mutans, viridans - Beta A pyogenes Scarlet fever, Erysipelas, Rheumatic fever, Streptococcal pharyngitis, B agalactiae - D Entero- Staphylo- - Toxic shock syndrome Bacillus shape Bacillus Anthrax - Listeria Listeriosis Actinobacteria Actinomycetales Actinomycosis/Actinomycetoma Whipple's disease - Corynebacterium Diphtheria, Erythrasma - Nocardia Nocardiosis, Maduromycosis Mycobacterium M. tuberculosis Tuberculosis: Ghon focus/Ghon's complex - Pott disease - brain Meningitis, Rich focus - cutaneous Scrofula, Bazin disease, Lupus vulgaris, Prosector's wart - Miliary M. leprae Leprosy Nontuberculous: Mycobacterium avium Lady Windermere syndrome - Mycobacterium ulcerans Buruli ulcer G- Spirochetal Treponema: Syphilis Bejel - Yaws - Pinta Borrelia: Relapsing fever - Lyme disease Erythema chronicum migrans, Neuroborreliosis other/multiple/unknown: Noma - Trench mouth - Rat-bite fever Sodoku - Leptospirosis Intracellular Mycoplasmatales Mycoplasma pneumonia - Ureaplasma infection Chlamydiae Chlamydophila Psittacosis - Chlamydia Chlamydia, Lymphogranuloma venereum, Trachoma Proteobacteria primarily rods, except Neisseria =cocci α/ Intra- Rickettsiales/ Rickettsioses/ Anaplasmataceae Typhus Murine typhus, Epidemic typhus spotted fever Rocky Mountain spotted fever, Boutonneuse fever, Rickettsialpox Ehrlichiosis Human granulocytic ehrlichiosis, Human monocytic ehrlichiosis OTHER: Coxiella Q fever - Bartonella Trench fever - Orientia Scrub typhus Rhizobiales Brucellosis - Cat scratch fever - Bartonellosis Bacillary angiomatosis β Neisseriaceae: Meningococcus Meningococcal disease, Waterhouse-Friderichsen syndrome - Gonorrhea Burkholderiales: Glanders - Melioidosis - Pertussis γ Enterobacteriaceae: Salmonella Typhoid fever, Paratyphoid fever, Salmonellosis - Yersinia pestis Plague/Bubonic plague - Klebsiella Rhinoscleroma, Donovanosis - Shigella Shigellosis - Escherichia coli/O157:H7 - Proteus Pasteurellaceae: Pasteurella Pasteurellosis - Haemophilus Brazilian purpuric fever, Chancroid - Actinobacillus Actinobacillosis other: Francisella Tularemia - Vibrio Cholera - Legionella Legionellosis - Pseudomonas - Serratia ε Campylobacteriosis - Helicobacter Bacteroidetes Bacteroides Other Gardnerella v d e Digestive system - Digestive disease - Gastroenterology primarily K20-K93, 530-579 Upper GI tract Esophagus Esophagitis Candidal - Boerhaave syndrome - UES Zenker's diverticulum - LES Barrett's esophagus, Mallory-Weiss syndrome - Esophageal motility disorder Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD - Esophageal stricture - Megaesophagus Stomach Gastritis Atrophic, Ménétrier's disease, Gastroenteritis - Peptic gastric ulcer/Dieulafoy's lesion - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy - Gastric antral vascular ectasia - Gastric dumping syndrome - Gastric volvulus Intestinal/ enteropathy Small intestine/ duodenum/jejunum/ileum Enteritis Duodenitis, Jejunitis, Ileitis Peptic duodenal ulcer Malabsorption: Coeliac - Tropical sprue - Blind loop syndrome - Whipple's - Short bowel syndrome - Steatorrhea Large intestine appendix/colon Appendicitis - Colitis Pseudomembranous, Ulcerative, Ischemic Functional colonic disease IBS, Intestinal pseudoobstruction/Ogilvie syndrome Megacolon/Toxic megacolon - Diverticulitis/Diverticulosis Large and/or small Enterocolitis Necrotizing - IBD Crohn's disease vascular: Abdominal angina - Mesenteric ischemia - Angiodysplasia Bowel obstruction: Ileus - Intussusception - Volvulus - Fecal impaction Constipation - Diarrhea Rectum/anus Proctitis Radiation proctitis - Proctalgia fugax - Rectal prolapse - Anal fissure/Anal fistula - Anal abscess Accessory Liver Hepatitis Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis - Cirrhosis PBC - Fatty liver NASH - vascular Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver - Alcoholic liver disease - Liver failure Hepatic encephalopathy, Acute liver failure - Liver abscess - Hepatorenal syndrome - Peliosis hepatis Gallbladder Cholecystitis - Gallstones/Cholecystolithiasis - Cholesterolosis - Rokitansky-Aschoff sinuses - Postcholecystectomy syndrome Bile duct/ other biliary tree Cholangitis PSC, Ascending - Cholestasis/Mirizzi's syndrome - Biliary fistula - Haemobilia - Gallstones/Cholelithiasis common bile duct Choledocholithiasis, Biliary dyskinesia Pancreatic Pancreatitis Acute, Chronic, Herary - Pancreatic pseudocyst - Exocrine pancreatic insufficiency - Pancreatic fistula Hernia Diaphragmatic: Congenital diaphragmatic - Hiatus Abdominal hernia: Inguinal Indirect, Direct - Umbilical - Incisional - Femoral Obturator hernia - Spigelian hernia Peritoneal Peritonitis Spontaneous bacterial peritonitis - Hemoperitoneum - Pneumoperitoneum GI bleeding Upper Hematemesis, Melena - Lower Hematochezia See also congenital, neoplasia Retrieved from http://en..org/wiki/Clostridial_necrotizing_enteritis Categories: Food safety | Foodborne illnesses | Infectious diseases | NutritionHidden category: Articles needing additional references from May 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 9 September 2008, at 17:56
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