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Hussain H, Fadel A, Garcia E, Hernandez RJ, Saadoon ZF, Naseer L, Casmartino E, Hamad M, Schnepp T, Sarfraz R, Angly S, Jayakumar AR. Clostridial Myonecrosis: A Comprehensive Review of Toxin Pathophysiology and Management Strategies. Microorganisms 2024; 12:1464. [PMID: 39065232 PMCID: PMC11278868 DOI: 10.3390/microorganisms12071464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Clostridial myonecrosis, commonly known as gas gangrene (GG), is a rapidly progressing and potentially fatal bacterial infection that primarily affects muscle and soft tissue. In the United States, the incidence of GG is roughly 1000 cases per year, while, in developing countries, the incidence is higher. This condition is most often caused by Clostridium perfringens, a Gram-positive, spore-forming anaerobic bacterium widely distributed in the environment, although other Clostridium species have also been reported to cause GG. The CP genome contains over 200 transport-related genes, including ABC transporters, which facilitate the uptake of sugars, amino acids, nucleotides, and ions from the host environment. There are two main subtypes of GG: traumatic GG, resulting from injuries that introduce Clostridium spores into deep tissue, where anaerobic conditions allow for bacterial growth and toxin production, and spontaneous GG, which is rarer and often occurs in immunocompromised patients. Clostridium species produce various toxins (e.g., alpha, theta, beta) that induce specific downstream signaling changes in cellular pathways, causing apoptosis or severe, fatal immunological conditions. For example, the Clostridium perfringens alpha toxin (CPA) targets the host cell's plasma membrane, hydrolyzing sphingomyelin and phosphatidylcholine, which triggers necrosis and apoptosis. The clinical manifestations of clostridial myonecrosis vary. Some patients experience the sudden onset of severe pain, swelling, and muscle tenderness, with the infection progressing rapidly to widespread tissue necrosis, systemic toxicity, and, if untreated, death. Other patients present with discharge, pain, and features of cellulitis. The diagnosis of GG primarily involves clinical evaluation, imaging studies such as X-rays, computer tomography (CT) scans, and culture. The treatment of GG involves surgical exploration, broad-spectrum antibiotics, antitoxin, and hyperbaric oxygen therapy, which is considered an adjunctive treatment to inhibit anaerobic bacterial growth and enhance the antibiotic efficacy. Early recognition and prompt, comprehensive treatment are critical to improving the outcomes for patients affected by this severe and life-threatening condition.
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Affiliation(s)
- Hussain Hussain
- Department of Internal Medicine, Kendall Hospital-HCA Florida Healthcare, Miami, FL 33136, USA;
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Aya Fadel
- Department of Internal Medicine, Ocean University Medical Center—Hackensack Meridian Health, Brick, NJ 08724, USA;
| | - Efrain Garcia
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Robert J. Hernandez
- Department of Internal Medicine, Kendall Hospital-HCA Florida Healthcare, Miami, FL 33136, USA;
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Zahraa F. Saadoon
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Lamia Naseer
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Ekaterina Casmartino
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Mohammad Hamad
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Taylor Schnepp
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Rehan Sarfraz
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Sohair Angly
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA; (E.G.); (Z.F.S.); (L.N.); (E.C.); (M.H.); (T.S.); (R.S.); (S.A.)
| | - Arumugam R. Jayakumar
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Tian R, Xie F, Liu Y, Liu G, Li Q, Wang J, Zhang H, Dai L, Zhang W. Recombinase polymerase amplification combined with lateral flow biosensor for rapid visual detection of Clostridium perfringens in chicken meat and milk. Front Vet Sci 2024; 11:1395188. [PMID: 39011320 PMCID: PMC11246993 DOI: 10.3389/fvets.2024.1395188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024] Open
Abstract
Aims Clostridium perfringens is one of the major anaerobic pathogen causing food poisoning and animal enteritis. With the rise of antibiotic resistance and the restrictions of the use of antibiotic growth promoting agents (AGPs) in farming, Clostridium enteritis and food contamination have become more common. It is time-consuming and labor-intensive to confirm the detection by standard culture methods, and it is necessary to develop on-site rapid detection tools. In this study, a combination of recombinase polymerase amplification (RPA) and lateral flow biosensor (LFB) was used to visually detect C. perfringens in chicken meat and milk. Methods and results Two sets of primers were designed for the plc gene of C. perfringens, and the amplification efficiency and specificity of the primers. Selection of primers produces an amplified fragment on which the probe is designed. The probe was combined with the lateral flow biosensor (LFB). The reaction time and temperature of RPA-LFB assay were optimized, and the sensitivity of the assay was assessed. Several common foodborne pathogens were selected to test the specificity of the established method. Chicken and milk samples were artificially inoculated with different concentrations (1 × 102 CFU/mL to 1 × 106 CFU/mL) of C. perfringens, and the detection efficiency of RPA-LFB method and PCR method was compared. RPA-LFB can be completed in 20 min and the results can be read visually by the LFB test strips. The RPA-LFB has acceptable specificity and the lowest detection limit of 100 pg./μL for nucleic acid samples. It was able to stably detect C. perfringens contamination in chicken and milk at the lowest concentration of 1 × 104 CFU/mL and 1 × 103 CFU/mL, respectively. Conclusion In conclusion, RPA-LFB is specific and sensitive. It is a rapid, simple and easy-to-visualize method for the detection of C. perfringens in food and is suitable for use in field testing work.
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Affiliation(s)
- Rui Tian
- The Sanya Institute of Nanjing Agricultural University, Yabulun Industrial Park, Yazhou Bay Science and Technology City, Sanya, China
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Feng Xie
- The Sanya Institute of Nanjing Agricultural University, Yabulun Industrial Park, Yazhou Bay Science and Technology City, Sanya, China
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Yuqing Liu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan, China
| | - Guangjin Liu
- The Sanya Institute of Nanjing Agricultural University, Yabulun Industrial Park, Yazhou Bay Science and Technology City, Sanya, China
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Qingxia Li
- Hainan Animal Disease Prevention and Control Center, Haikou, China
| | - Jinxiu Wang
- Hainan Animal Disease Prevention and Control Center, Haikou, China
| | - Hongjian Zhang
- College of Agriculture and Animal Husbandry, Qinghai University, Xining, China
| | - Lei Dai
- Hainan Animal Disease Prevention and Control Center, Haikou, China
| | - Wei Zhang
- The Sanya Institute of Nanjing Agricultural University, Yabulun Industrial Park, Yazhou Bay Science and Technology City, Sanya, China
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
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Alimolaei M, Afzali S. Prevalence of Clostridium perfringens toxinotypes in antibiotic-associated diarrheal (AAD) patients in Iranian hospitals; can toxinotype D serve as a possible zoonotic agent for humans? Acta Trop 2023; 247:107002. [PMID: 37597720 DOI: 10.1016/j.actatropica.2023.107002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/18/2023] [Accepted: 08/17/2023] [Indexed: 08/21/2023]
Abstract
While Clostridium perfringens (C. perfringens) toxinotype F is known as the cause of 15% of antibiotic-associated diarrhea (AAD) and sporadic diarrhea (SD) cases, the association of the other C. perfringens toxinotypes with AAD/SD is not investigated. Therefore, the incidence of C. perfringens-associated diarrhea was investigated in hospitalized patients in six Iranian hospitals. A total of 151 stool specimens from AAD/SD patients were investigated for C. perfringens strains and the isolates were analyzed for the major (cpa, cpb, etx, and iap) and minor (cpe, cpb2, netb, PFO, and tpeL) toxin genes by PCR. C. perfringens isolation ratio was 28.5% (43 of 151 patients). C. perfringens isolation rates were not significant between different gender and age groups (p > 0.05), whereas it was significant between different wards and hospitals (p < 0.01). The cpa gene was detected in all C. perfringens isolates (n = 116). After that, the highest prevalence belonged to tpeL (87.1%), followed by pfo (84.5%), cpb2 (69.8%), cpe (55.2%), etx (12.9%), and netb (1.7%) genes. Based on these gene profiles, 35 (30.2%), 64 (55.2%), 15 (12.9%), and two (1.7%) isolates belonged to toxinotypes A, F, D, and G, respectively, and the other toxinotypes were not detected. This study persists in considering toxinotype F in Iranian AAD patients as it was the dominant C. perfringens toxinotype. Remarkably, the isolation of toxinotype D suggests it as a potential trigger in C. perfringens-associated AAD for the first time and highlights it as a possible zoonotic agent for humans.
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Affiliation(s)
- Mojtaba Alimolaei
- Research and Development Department, Kerman branch, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Kerman, Iran; Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
| | - Sadegh Afzali
- Research and Development Department, Kerman branch, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Kerman, Iran
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Garvey M. Foodborne Clostridioides Species: Pathogenicity, Virulence and Biocontrol Options. Microorganisms 2023; 11:2483. [PMID: 37894141 PMCID: PMC10609181 DOI: 10.3390/microorganisms11102483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Clostridioides species possess many virulence factors and alarming levels of muti-drug resistance which make them a significant risk to public health safety and a causative agent of livestock disease. Clostridioides result in serious systemic and gastrointestinal diseases such as myonecrosis, colitis, food poisoning and gastroenteritis. As foodborne pathogens, Clostridioides species are associated with significant incidences of morbidity and mortality where the application of broad-spectrum antibiotics predisposes patients to virulent Clostridioides colonisation. As part of the One Health approach, there is an urgent need to eliminate the use of antibiotics in food production to safeguard animals, humans and the environment. Alternative options are warranted to control foodborne pathogens at all stages of food production. Antimicrobial peptides and bacteriophages have demonstrated efficacy against Clostridioides species and may offer antimicrobial biocontrol options. The bacteriocin nisin, for example, has been implemented as a biopreservative for the control of Listeria, Staphylococcus and Clostridia species in food. Bacteriophage preparations have also gained recognition for the antibacterial action against highly virulent bacterial species including foodborne pathogens. Studies are warranted to mitigate the formulation and administration limitations associated with the application of such antimicrobials as biocontrol strategies. This review outlines foodborne Clostridioides species, their virulence factors, and potential biocontrol options for application in food production.
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Affiliation(s)
- Mary Garvey
- Department of Life Science, Atlantic Technological University, Ash Lane, F91 YW50 Sligo, Ireland;
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, F91 YW50 Sligo, Ireland
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Watier-Grillot S, Larréché S, Mazuet C, Baudouin F, Feraudet-Tarisse C, Holterbach L, Dia A, Tong C, Bourget L, Hery S, Pottier E, Bouilland O, Tanti M, Merens A, Simon S, Diancourt L, Chesnay A, Pommier de Santi V. From Foodborne Disease Outbreak (FBDO) to Investigation: The Plant Toxin Trap, Brittany, France, 2018. Toxins (Basel) 2023; 15:457. [PMID: 37505726 PMCID: PMC10467087 DOI: 10.3390/toxins15070457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
On 6 July 2018, the Center for Epidemiology and Public Health of the French Armed Forces was informed of an outbreak of acute gastroenteritis among customers of a dining facility at a military base in Brittany, France. A total of 200 patients were reported out of a population of 1700 (attack rate: 12%). The symptoms were mainly lower digestive tract disorders and occurred rapidly after lunch on 5 July (median incubation period: 3.3 h), suggesting a toxin-like pathogenic process. A case-control survey was carried out (92 cases and 113 controls). Statistical analysis pointed to the chili con carne served at lunch on 5 July as the very likely source of poisoning. Phytohaemagglutinin, a plant lectin, was found in the chili con carne at a concentration above the potentially toxic dose (400 HAU/gram). The raw kidney beans incorporated in the chili con carne presented a high haemagglutination activity (66,667 HAU/gram). They were undercooked, and the phytohaemagglutinin was not completely destroyed. FBDOs due to PHA are poorly documented. This study highlights the need to develop methods for routine testing of plant toxins in food matrices. Improved diagnostic capabilities would likely lead to better documentation, epidemiology, and prevention of food-borne illnesses caused by plant toxins.
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Affiliation(s)
- Stéphanie Watier-Grillot
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), 13014 Marseille, France; (L.H.); (A.D.); (C.T.); (M.T.); (V.P.d.S.)
| | - Sébastien Larréché
- Bégin Military Teaching Hospital, 94160 Saint-Mandé, France; (S.L.); (A.M.)
- Inserm, UMR-S1144, France & Paris Cité University, 75006 Paris, France
| | - Christelle Mazuet
- National Reference Centre for Anaerobic Bacteria and Botulism, Institut Pasteur, Paris Cité University, CEDEX 15, 75724 Paris, France; (C.M.); (L.D.)
| | | | - Cécile Feraudet-Tarisse
- Department of Medications and Healthcare Technologies (DMTS), Paris-Saclay University, CEA, INRAE, SPI, 91190 Gif-sur-Yvette, France; (C.F.-T.); (S.S.)
| | - Lise Holterbach
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), 13014 Marseille, France; (L.H.); (A.D.); (C.T.); (M.T.); (V.P.d.S.)
| | - Aïssata Dia
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), 13014 Marseille, France; (L.H.); (A.D.); (C.T.); (M.T.); (V.P.d.S.)
| | - Christelle Tong
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), 13014 Marseille, France; (L.H.); (A.D.); (C.T.); (M.T.); (V.P.d.S.)
| | - Laure Bourget
- Laboratory of the French Armed Forces Commissariat, 49130 Les Ponts-de-Cé, France; (L.B.); (A.C.)
| | - Sophie Hery
- Naval Group, Department of Occupational Health, 29200 Brest, France;
| | - Emmanuel Pottier
- Brest Arsenal Medical Center, 29200 Brest, France; (E.P.); (O.B.)
| | | | - Marc Tanti
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), 13014 Marseille, France; (L.H.); (A.D.); (C.T.); (M.T.); (V.P.d.S.)
| | - Audrey Merens
- Bégin Military Teaching Hospital, 94160 Saint-Mandé, France; (S.L.); (A.M.)
- Inserm, UMR-S1144, France & Paris Cité University, 75006 Paris, France
| | - Stéphanie Simon
- Department of Medications and Healthcare Technologies (DMTS), Paris-Saclay University, CEA, INRAE, SPI, 91190 Gif-sur-Yvette, France; (C.F.-T.); (S.S.)
| | - Laure Diancourt
- National Reference Centre for Anaerobic Bacteria and Botulism, Institut Pasteur, Paris Cité University, CEDEX 15, 75724 Paris, France; (C.M.); (L.D.)
| | - Aurélie Chesnay
- Laboratory of the French Armed Forces Commissariat, 49130 Les Ponts-de-Cé, France; (L.B.); (A.C.)
| | - Vincent Pommier de Santi
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), 13014 Marseille, France; (L.H.); (A.D.); (C.T.); (M.T.); (V.P.d.S.)
- Vectors–Tropical and Mediterranean Infections Joint Research Unit (VITROME), Aix-Marseille University, 13005 Marseille, France
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Ezan E, Simon S. Introduction to the Toxins Special Issue: "Antibodies for Toxins: From Detection to Therapeutics". Toxins (Basel) 2022; 14:toxins14050363. [PMID: 35622609 PMCID: PMC9146352 DOI: 10.3390/toxins14050363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
This Special Issue aims to provide an up-to-date investigation and reviews linked to antibody-based technologies for medical countermeasures and detection/diagnosis tools for toxins [...].
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