Felis ISSN 2398-2950

Clostridial enterotoxicosis

Contributor(s): Marge Chandler, Rance Sellon, James Simpson

Introduction

  • Although C. perfringens  Clostridium perfringens can be a normal commensual bacteria of the intestinal tract, they can under certain circumstances, become pathogenic and initiate chronic, acute or per acute (hemorrhagic) diarrhea. This is thought to depend on the biotype and ability of the organism to produce toxin.
  • Diarrhea due to C. perfringens is less common in cats than in dogs.
  • C difficile  Clostridium difficile has also been reported to cause large intestinal diarrhea in cats (C difficile associated disease or CDAD).

Pathogenesis

Etiology

  • There are 5 biotypes of C. perfringens (A to E) based on the presence of toxin genes - alpha, beta, iota, and epsilon.
  • All these biotypes can harbor the toxin gene CPE.
  • Most studies have shown that biotype A is most common with 15% being biotype A + CPE.
  • C difficile has 5 toxins, but not all the strains have the genes that encode for the toxin.

Predisposing factors

General

  • Infection may follow ingestion of food contaminated with enterotoxogenic C perfringens, or a change in the intestinal environment which results in C perfringens producing toxin. The latter might be due to antibiotic use, diet change, stress, viral infection or EPI Exocrine pancreatic insufficiency
  • Transmission from animal to animal can occur.
  • In humans, the risk for C difficile is increased by antibiotic use, enemas, nasogastric tubes and antacids.

Pathophysiology

  • C. perfringens and C difficile can be cultured in feces of cats with and without diarrhea as these organisms can exist as normal consitiuents of the indigenous intestinal flora. Not all strains of C perfringens or C difficile are toxigenic.
  • One study of 62 cats with diarrhea showed C perfringens enterotoxin (by ELISA) in 14% and C difficile toxin A in 5%, with 0% for both organisms in 51 healthy cats.
  • C difficile has been isolated from the feces of 2 to 30% of cats with normal feces.
  • The ability of C. perfringens to adhere to the intestine may be associated with changes in the intestinal environment, loss of brush border enzymes or lysosomes.
  • Presence of CPE genes is thought to be the deciding factor for inducing diarrhea. CPE is a small protein produced by the organism during sporulation and is released on lysis of the organism. CPE interacts with the tight junction proteins (occludins) altering tight junction structure and function. This leads to increased permeability and diarrhea. These changes appear to occur most often in the ileum or colon.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Weese J S, Weese H E, Bourdeau T L et al (2001) Suspected Clostridium difficile-associated diarrhea in two cats. JAVMA 218 (9), 1436-9 PubMed.
  • Marks S, Melli A, Kass P H et al (1999) Evaluation of methods to diagnose Clostrdium perfringens associated diarrhea in dogs. JAVMA 214 (3), 357-360 PubMed.
  • Turk J, Fales W, Miller M et al (1992) Enteric Clostridium perfringens infection associated with parvoviral enteritis in dogs 74 case (1987-1990). JAVMA 200 (7), 991-994 PubMed.

Other sources of information

  • Clooton J et al (2003) Prevalence and risk factors for clostridium difficile intestinal carriage in dogs and cats hospitalized in an intensive care unit. Proceedings, ACVIM Forum.
  • Tamms T (2001) Diarrhea cased by giardia and Clostridum perfringens enterotoxicosis. Atlantic Coast Veterinary Conference.


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