Necrotizing enterocolitis of the neonate with Clostridium perfringens: diagnosis, clinical course, and role of alpha toxin

Abstract

The severity of the clinical course in necrotizing enterocolitis (NEC) associated with Clostridium perfringens (Cp) may support the hypothesis of a specific disease. We conducted a case control study of infants diagnosed with NEC, who underwent surgical treatment over a 7-year period. Patient histories examined characteristics of the infants, bacterial infection as well as NEC's severity, antibiotic treatment, and clinical course. Infants infected with NEC associated with Cp were compared with NEC patients without Cp. The alpha toxin from Cp type A was detected in most of the isolated strains. Cp was identified as a causative agent of NEC in nine cases. As compared with the control group (n = 32), the onset of disease was earlier in life, the clinical course more severe, and patients had a larger extent of gangrene. Portal venous gas was evident in 77% of all Cp cases, as compared to 25% in the control group. The mortality rate was 44% in the Cp group, and only 18.7% in the control group. Type A Clostridium perfringens was identified in six cases. In each isolate alpha toxin production was proven, but without any correlation to the severity of the clinical course, the extent of intestinal gangrene or mortality. In premature infants NEC in conjunction with Cp seems to be more severe than other NEC cases; it also entails higher mortality and morbidity. Alpha toxin concentrations do not correlate with the severity of the disease. Portal venous gas is highly suggestive for the diagnosis of Cp infection.

Acute necrotizing enterocolitis of preterm piglets is characterized by dysbiosis of ileal mucosa-associated bacteria

“…The presence of clostridia is frequently associated with acute outbreaks and more lethal courses of NEC in human infants. 14,18,19,21,27 This was also true of the present study in which all but one piglet with NEC had acute clinical disease and died or had to be euthanized prior to the 30 h endpoint of the study. TRFLP patterns from small intestinal mucosa consistent with Clostridium spp.…”

Increased prevalence of pathogenic bacteria in the gut microbiota of infants at risk of developing celiac disease: The PROFICEL study

“…37 This bacterial species has also been considered as a causal agent of necrotizing enterocolitis in infants. 38 Similarly, a higher prevalence of C. perfringens has been proposed to possibly increase the risk of suffering other chronic intestinal disorders. Altogether, this evidence could support the protective role attributed to breast-feeding in reducing the rate of infections and, in turn, has been related to a reduced risk of developing CD in some studies.…”

Investigation of the early intestinal microflora in premature infants with/without necrotizing enterocolitis using two different methods

“…Some studies have found an association between various bacterial species and NEC (15)(16)(17)(18)(19)(20), whereas others did not observe any association between NEC and any specific bacterial species (8,21).…”