C. perfringens Type C (an
anaerobic gram-positive bacillus)
also produces
beta-enterotoxin, which causes a necrotizing enteritis known as "pig
bel".
Pig Bel.Perspect
Pediatr Pathol.
1979;5:137-52
This necrotizing enteritis is seen in
malnourished persons who have sudden dietary overindulgence, as was
seen, for example, in impoverished children immediately after World
War II.
Necrotizing enteritis is endemic in the
highlands of New Guinea, especially in children who have participated
in pig feasts. Most adults have circulating antibodies and do
not develop pig bel. Spit roasting of pig carcasses eaten at the
feasts encourages the growth of C. perfringens. The normal diet of the
children is vegetarian, more than 90% of calories being derived from
sweet potatoes. The combination of inadequate protein consumption and
the presence of a trypsin inhibitor in sweet potatoes renders the
children deficient in intestinal proteases, to which beta-enterotoxin
is very sensitive.
Usual incubation period is 48 hours
after ingestion of contaminated meat.
The presenting symptoms include severe
abdominal pain and distention, vomiting, and passage of bloody or
black stool.
Patients with fulminating pig bel may
die within 24 hours of onset.
Other patients have mild pig bel that
resembles gastroenteritis.
Half of the patients require surgery.
Pathological features:
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Necrotizing enteritis is a segmental
disease that may be restricted to a few centimeters or may involve the
entire small intestine.
Green, necrotic pseudomembranes are
seen in segmental areas of necrosis and peritonitis.
More advanced lesions may perforate the
bowel wall.
Histologic sections reveal infarction
of the mucosa, with edema, hemorrhage, and suppurative infiltrate that
extends transmurally.
The pseudomembrane is composed of necrotic
epithelium containing gram-positive bacilli.
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