Clostridial Infections

       Gas Gangrene

          Gas gangrene is an infection of the muscles and the skins that
          occurs when a wound or injury is contaminated by the CLOSTRIDIUM
          PERFRINGENS bacteria. Gas gangrene is typically seen in gun shot
          injuries. It usually appears 1-4 days after the wound.

          Other penetrating injuries also have a potential of causing gas
          gangrene.

          The patient would present with:

             * generally history of a penetrating wound
             * severe pain in the wound
             * swelling in the affected area
             * the skin in the area of the wound may be pale, bronze or deep
               red.
             * blood blisters may form in the visinity
             * blood may be oozing out from the wound
             * a crepitus may be felt in the wound
             * As the infection progresses certain other features may be
               evident:
                  - high grade fever
                  - sweating
                  - rapid pulse
                  - a sudden drop in blood pressure

          Untreated gas gangrene can lead to kidney failure, coma, and death.

       CLOSTRIDIUM Food Poisoning

          Food poisoning by clostridia is caused by the CLOSTRIDIUM
          BOUTILINUM, CLOSTRIDIUM PERFRINGENS. It can contaminate food and
          produce a toxin that causes a mild form of food poisoning.
          Symptoms begin 7 to 15 hours after eating the contaminated food.
          The bacteria may contaminate gravies or cooked meats it may be
          present in canned food items that have been kept too long at room
          temperature before they are eaten. At room temperature, the
          bacteria grow in the contaminated food and produce a toxin that
          can kill the intestinal mucosal cells.

          The patient would present with:

             * diarrhoea
             * fever
             * nausea and vomiting
             * cramps

          You can prevent CLOSTRIDIUM food poisoning by promptly
          refrigerating foods, especially gravies and meats, after cooking
          them. Avoid foods that have been stored at room temperature for l
          long periods.

          Infant botulism, when it occurs, is seen in children under six
          months of age. The children may come to medical attention because
          of constipation, poor sucking ability, a weak cry and a progressive
          muscle weakness.

          Infant botulism is caused by CLOSTRIDIUM bacteria that harbour the
          soil and dust. These bacteria may also contaminate foods,
          especially honey. CLOSTRIDIUM bacteria produce a toxin called the
          botulinum toxin, which blocks the neuronal transmission to the
          muscles thus affecting the entire body.

       Pseudomembranous Colitis                                                                        Pseudomembranous Colitis

          Pseudomembranous colitis is a condition which occurs when broad
          spectrum antibiotics are used e.g. vancomycin.

          Pseudomembranous colitis is caused by CLOSTRIDIUM DIFFICILE a
          bacteria that is a usual commensal of the intestinal tract.
          Normally the bacteria  CLOSTRIDIUM DIFFICILE compete with other
          intestinal bacteria for a place in the intestines, a balanced
          environment with the other bacteria is eventually created. But when
          antibiotics are injested that kill the competing bacteria,
          CLOSTRIDIUM DIFFICILE can grow out of control and produce two toxins
          that cause the pseudomembranous colitis.

          NOTE: The antibiotic treatment allows preferential growth of the
          CLOSTRIDIUM bacteria as competition from the other organisms is
          reduced.

          The presentation is generally seen afer 4-8 days of the injestion
          of the antibiotic, although the symptoms may appear even before
          this time.

          The patient would present as:

             * a colitis
             * abdominal cramps
             * fever
             * diarrhoea
             * abdominal distention
             * tender abdomen