KIDS HEALTH -- Clostridium  -- Gas Gangrene -- FOOD POISONING

The Clostridium group of bacteria are commonly found in soil everywhere in the world, and some species even live
harmlessly in our intestines. When Clostridium bacteria cause human illness, it is usually because they produce a
chemical that is toxic (poisonous) to our human bodies. Illnesses caused by the Clostridium group of bacteria include
gas gangrene, Clostridium food poisoning, and pseudomembranous colitis.

Gas Gangrene
Gas gangrene is a serious wound infection that can follow a "dirty" wound (car accident, crush injury, farm accident,
factory injury). Clostridium bacteria from the intestines or the soil contaminate the wound and produce toxins that
destroy skin and muscles nearby. As the bacteria grow in the wound, they also manufacture "gas" as a by-product, and
this gas can often be seen by doctors when they look at X-rays or scans of the wound area. Although at least seven
different types of Clostridium bacteria may cause gas gangrene, about 80% of cases are due to Clostridium perfringens.

Signs and Symptoms
Gas gangrene is a severe but rare infection of the skin and muscles that can occur when a wound or injury is
contaminated by Clostridium bacteria found in soil. The first symptom of gas gangrene is sudden, severe pain in the
wound, with swelling that stretches the skin "tight" nearby. The skin in the area of the wound may be pale, bronze, or
deep red, and it is tender to the touch. Large, bloody blisters may form in the area, and the wound itself may have a
sweet smell and may leak a brown, bloody, or amber-colored fluid. As this serious infection continues, symptoms appear
that involve the entire body, including fever, sweating, rapid pulse, and a sudden drop in blood pressure. Untreated gas
gangrene may lead to severe kidney and blood problems, kidney failure, coma, and death.

You can prevent gas gangrene by checking with your doctor whenever your child has a large contaminated wound. This
is especially important if the wound is clearly "dirty" or deep and there is a lot of damage to nearby skin.

The incubation period for gas gangrene is usually 1 to 4 days after the "dirty" wound.

The duration of gas gangrene varies from patient to patient. It can be cured with antibiotics, combined with surgery to
remove dead tissue around the wound.

Gas gangrene is not contagious from person to person, but caregivers need to use standard precautions (like gloves
and hand washing) when they care for contaminated wounds.

Home Treatment
Gas gangrene is usually treated in a hospital, with antibiotics and surgical removal of dead tissue around the wound.

Professional Treatment
Doctors can often make the diagnosis of gas gangrene by looking at the infected wound, noting its sweet odor, and
evaluating the extent of injury.

When to Call Your Child's Doctor
Call your doctor immediately if your child has a serious "dirty" wound or crush injury.

Clostridium Food Poisoning
Clostridium food poisoning also is usually caused by Clostridium perfringens. The bacteria may contaminate gravies or
cooked meats 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 cells along the inside lining of the intestines.
Symptoms of food poisoning usually begin within 6 to 24 hours of eating the contaminated food.

Signs and Symptoms
Clostridium bacteria can contaminate food and produce a toxin (poison) that causes a mild form of food poisoning.
Symptoms begin 6 to 24 hours after eating the contaminated food. They include diarrhea, cramps, fever, nausea, and
sometimes vomiting.

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 long periods.

The incubation period is 6 to 24 hours after eating contaminated food.

Clostridium food poisoning is usually a mild illness. Symptoms last for about 24 hours and then stop. There is usually no
need for antibiotics.

Clostridium food poisoning is not contagious from person to person, but everyone who eats the same contaminated food
is at risk for food poisoning.

Home Treatment
If your child has Clostridium food poisoning, symptoms will probably pass in a day or two. Until then, make sure the child
drinks plenty of fluids to replace body water lost to diarrhea. Check with your doctor before giving your child any
store-bought medicine for diarrhea.

Professional Treatment
Since Clostridium food poisoning is a mild illness that only lasts a day or two, doctors usually do not treat it with

When to Call Your Child's Doctor
Call your doctor whenever your child has any of the following symptoms: abdominal pain, cramps, diarrhea, nausea,
vomiting, or fever. Tell your doctor if other family members have similar symptoms, especially if they have all eaten the
same foods within the past few hours.

Pseudomembranous colitis
Pseudomembranous colitis is caused by Clostridium difficile, bacteria that usually live harmlessly in the intestines of
about 50% to 70% of newborns, 20% to 50% of infants, and 3% of adults. In normal daily life, C. difficile compete with
other intestinal bacteria for a place in the intestines' balanced environment. But when someone takes antibiotics that kill
the competing neighbor bacteria, C. difficile can grow out of control and produce two toxins that cause intestinal illness.

Signs and Symptoms
Pseudomembranous colitis happens when the antibiotics used to treat childhood illnesses also kill "friendly" bacteria that
normally live in the intestines. This allows Clostridium bacteria to grow in the intestines without competition, causing a
wide range of symptoms. Symptoms usually begin after a child has been taking antibiotics for 4 to 8 days, but may even
start after the antibiotic treatment is finished. In mild cases of pseudomembranous colitis, a child has abdominal cramps
with a little watery-brown diarrhea that is not bloody. In severe cases, a child can have bloody diarrhea, fever, and a
swollen or enlarged abdomen that is tender to the touch.

You may be able to help prevent severe pseudomembranous colitis by calling your doctor immediately if your child
develops diarrhea while taking antibiotics. In general, antibiotics should be used only when there is reason to believe
that an infection is caused by bacteria.

Symptoms of pseudomembranous colitis usually begin after a child has been taking antibiotics for 4 to 8 days, but they
may start as late as 5 to 21 days after a child has finished taking antibiotics.

First, the antibiotic that caused the pseudomembranous colitis must be stopped. Once this is done, symptoms of mild
pseudomembranous colitis often improve within 2 days and are usually gone within 7 to 10 days. However, severe cases
of pseudomembranous colitis may need to be treated with certain specific antibiotics that kill C. difficile.

Pseudomembranous colitis is usually not contagious from person to person among healthy children. However, it can
spread among persons who are already hospitalized for other illnesses. Hospitals usually try to isolate patients with this
illness and use disinfectants and gloves when caring for them.

Home Treatment
If your doctor suspects that your child has pseudomembranous colitis, he or she will probably tell you to stop giving your
child the antibiotics that caused the illness. A severely ill child will be treated in a hospital. If a child is only mildly ill, he
will need to rest in bed at home. Your doctor may modify your child's diet until diarrhea passes. This may mean switching
your child to a liquid diet, then a soft diet, then a regular diet over a period of days as your child's diarrhea improves.

Professional Treatment
Doctors can make the diagnosis of pseudomembranous colitis by obtaining stool samples from the child. These samples
will be checked in a laboratory to see if they contain bacterial toxins. Your doctor may also need to examine the inside of
your child's intestines using a colonoscope.

When to Call Your Child's Doctor
Call your doctor immediately if your child develops bloody diarrhea, or has any blood at all in his stool. Also, call your
doctor if your child has been taking antibiotics and suddenly develops cramps and diarrhea.

Reviewed by: Lori Patterson, MD
Date reviewed: July 2004
Originally reviewed by: Joel Klein, MD