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This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical, however some people find that they add depth to the patient information leaflets. You may find the abbreviations record helpful.

Clostridial Infection

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Tetanus
Pseudomembranous Colitis
Gas Gangrene
Botulism

Clostridia are anaerobic, Gram-positive, spore-forming rods widely distributed in nature, particularly in soil. They form resistant spores under stress. These spores, which can survive brief heating to 100 °C, and the powerful exotoxins the active bacteria produce are central to the medical importance of the species.

Gas gangrene

Can be caused by various clostridia, e.g. Clostridium perfringens, Clostridium septicum, Clostridium novyi and Clostridium histolyticum. To see Gas Gangrene record, click here.

Septic abortion
Tetanus

Caused by Clostridium tetani. See Tetanus record.

Pseudomembranous colitis

Caused by Clostridium difficile. See Pseudomembranous Colitis record.

Botulism

Caused by neurotoxin of Clostridium botulinum. See Botulism record.

Botulism and bioterrorism

  • The most toxic substance known to man4; a lethal dose <1 mcg.
  • The Germans were developing the toxin in WWII as a cross-channel weapon, and the death of the head of the Gestapo in 1942 was attributed to a hand grenade contaminated with toxin, supplied to the Czech patriots by the British.
  • A deliberate release may involve airborne dissemination of toxin, or contamination of food or water supplies with toxin or bacteria.
  • Water treatment inactivates the toxin, the toxin cannot penetrate intact skin and it loses activity within a few days.
  • The most likely scenarios would therefore be:
    • A deliberate contamination of foodstuffs; large doses may lead directly to neurological symptoms without the gastrointestinal symptoms of nausea, vomiting, and diarrhoea followed by constipation.
    • Aerosol release; most effective in an enclosed environment. After inhalation, the onset of symptoms may be as rapid as <1 hour. However, in cases of accidental inhalation symptom onset can be 3-4 days.
Clostridium perfringens food poisoning

Fourth commonest form of food-borne illness, after Norwalk-like viruses, Campylobacter spp; and Salmonella spp.

  • Spores survive cooking, and germinate during slow cooling or unrefrigerated storage.5 They produce exotoxin, requiring a large infective dose.
  • Mostly associated with meat and poultry, usually occurring in schools, hospitals, factories and catering establishments.Typically, a meat dish is stewed or boiled and allowed to stand for 4-24 hours and then served without adequate reheating.
  • 6-12 hours later the patient suffers crampy abdominal pain followed by diarrhoea, which subsides 12-24 hours later.


Document references
  1. Vasquez DN, Estenssoro E, Canales HS, et al; Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest. 2007 Mar;131(3):718-24. [abstract]
  2. Guleria K, Bansal S, Agarwal N, et al; Women with septic abortion: who, how and why? A prospective study from tertiary care hospital in India. Indian J Public Health. 2006 Apr-Jun;50(2):95-6. [abstract]
  3. Osazuwa H, Aziken M; Septic abortion: a review of social and demographic characteristics. Arch Gynecol Obstet. 2007 Feb;275(2):117-9. Epub 2006 Sep 1. [abstract]
  4. Osborne SL, Latham CF, Wen PJ, et al; The janus faces of botulinum neurotoxin: Sensational medicine and deadly biological weapon. J Neurosci Res. 2007 May 1;85(6):1149-58. [abstract]
  5. de Jong AE, Rombouts FM, Beumer RR; Behavior of Clostridium perfringens at low temperatures. Int J Food Microbiol. 2004 Dec 1;97(1):71-80. [abstract]

Internet and further reading Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article and to Dr Hayley Willacy for earlier versions. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2009.
Document ID: 1970
Document Version: 21
Document Reference: bgp414
Last Updated: 19 Aug 2009
Planned Review: 19 Aug 2011

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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