Clostridium perfringens (food poisoning)

Last edited 02/2020 and last reviewed 07/2021

Clostridium perfingens multiplies within the gut with release of endotoxin during sporulation. The toxin increases capillary permeability resulting in ileal fluid accumulation. It accounts for about 20% of bacterial diarrhoea.

Clinically, there is abdominal pain and diarrhoea, rarely, vomiting, with onset of symptoms between 8-18 hours (range 6-24 hours) after incubation, and usually lasting for one day (symptoms resolve within 24 hours for most cases).

Spores are ubiquitous - in animal and human gut, and the soil. Those contaminating meat and poultry can survive cooking, germinate and multiply to large numbers - as oxygen has been driven off by boiling - if food is allowed to cool slowly or stand at room temperature.

Cause: Clostridium perfringens enterotoxin

Reservoir:

• Ubiquitous in soil and gastrointestinal tract of mammals and birds; frequently present in raw meat
• Enterotoxin is produced only by some strains and thus C. perfringens can live in the human intestine without producing symptoms of disease. Only strains able to produce enterotoxin cause gastrointestinal illness

Epidemiology:

• Reported cases in the UK are higher in autumn and winter months
• There are estimated to be >100,000 UK cases per year, but these are greatly under-reported and under-detected
• C. perfringens food poisoning outbreaks are particularly associated with institutional catering where food is inadequately refrigerated before serving allowing the bacterium to grow
• Enterotoxigenic strains can also cause non-foodborne infections or antibiotic associated diarrhoeal illness and outbreaks

Transmission:

• food poisoning occurs via ingestion of high numbers of C. perfringens vegetative cells in contaminated foods, especially meat and meat products. The organism can grow at temperatures of 15-50 degrees C and heat-resistant spores survive normal cooking temperatures
• inadequate storage and insufficient reheating of contaminated food allows growth of the organism to high numbers. C. perfringens vegetative cells are ingested with the food and then sporulate and release toxin in the small intestine

Incubation Period: 8-18 hours (range 6-24 hours)

Infectivity:

• not applicable as no risk of person-to-person spread

Treatment is symptomatic. Prevention is by ensuring prompt consumption or refrigeration of foods.

Notes:

• the elderly, very young and those with underlying medical conditions may experience more severe disease
• testing for this enterotoxin is not routinely undertaken, and a specific request will need to be made to the reference laboratory to have this performed
• the ability of C. perfringens isolates to encode enterotoxin genes which can be determined by PCR and is performed by the PHE Reference Laboratory at Colindale

Reference:

• PHE (2019). Recommendations for the Public Health Management of Gastrointestinal Infections