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Background Enteritis necroticans (pigbel), an often fatal illness characterized by hemorrhagic, inflammatory, or ischemic necrosis of the jejunum, occurs in developing countries but is rare in developed countries, where its occurrence is confined to adults with chronic illnesses. The causative organism of enteritis necroticans is Clostridium perfringens type C, an anaerobic gram-positive bacillus.
Methods In December 1998, enteritis necroticans developed in a 12-year-old boy with poorly controlled diabetes mellitus after he consumed pig intestines (chitterlings). He presented with hematemesis, abdominal distention, and severe diabetic ketoacidosis with hypotension. At laparotomy, extensive jejunal necrosis required bowel resection, jejunostomy, and ileostomy. Samples were obtained for histopathological examination. Polymerase-chain-reaction (PCR) assay was performed on paraffin-embedded bowel tissue with primers specific for the cpa and cpb genes, which code for the
Results Histologic examination of resected bowel tissue showed extensive mucosal necrosis, the formation of pseudomembrane, pneumatosis, and areas of epithelial regeneration that alternated with necrotic segments — findings consistent with a diagnosis of enteritis necroticans. Gram's staining showed large gram-positive bacilli whose features were consistent with those of clostridium species. Through PCR amplification, we detected products of the cpa and cpb genes, which indicated the presence of C. perfringens type C. Assay of ileal tissue obtained during surgery to restore the continuity of the patient's bowel was negative for C. perfringens.
Conclusions The preparation or consumption of chitterlings by diabetic patients and other chronically ill persons can result in potentially life-threatening infectious complications.
and ß toxins produced by C. perfringens.
Source Information
From the Divisions of Critical Care Medicine (T.M.P., J.D.F.) and Endocrinology (L.M.), Children's Healthcare of Atlanta at Egleston, Atlanta; the National Center for Infectious Diseases (C.M.B.-S.) and the Epidemiology Program Office (A.G.D.), Centers for Disease Control and Prevention, Atlanta; the Department of Veterinary Science and Microbiology, University of Arizona, Tucson (J.G.S., D.M.B.); and the Divisions of Pediatric Pathology (C.A.), Surgery (H.L.), and Infectious Diseases, Epidemiology, and Immunology (C.M.B.-S., C.A., S.R.N.), Emory University, Atlanta.
Address reprint requests to Dr. Petrillo at the Division of Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, 1405 Clifton Rd. NE, 3rd Fl. Annex, Atlanta, GA 30322, or at toni_petrillo{at}oz.ped.emory.edu.
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