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inflammation of the intestine (especially the small intestine); usually characterized by diarrhea

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腸炎

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/01/26 22:30:21」(JST)

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Clostridial necrotizing enteritis (CNE), also called enteritis necroticans and pigbel, is an often fatal type of food poisoning caused by a β-toxin of Clostridium perfringens,^[1] Type C. It occurs in some developing countries, but was also documented in Germany following World War II. The toxin is normally inactivated by certain proteolytic enzymes and by normal cooking, but when these protections are impeded, the disease emerges.

Etiology

All the factors collectively causing CNE are generally only present in the hinterlands of New Guinea and parts of Africa, Latin America, and Asia. These factors include protein deprivation (causing inadequate synthesis of trypsin protease (an enzyme), to which the toxin is very sensitive), poor food hygiene, episodic meat feasting, staple diets containing trypsin inhibitors (sweet potatoes), and infection by Ascaris parasites which secrete a trypsin inhibitor. In New Guinea (origin of the term "pigbel"), the disease is usually spread through contaminated meat (especially pork) and perhaps by peanuts. (CNE was also diagnosed in post World War II Germany, where it was known as Darmbrand or "fire bowels").

Clinical aspects

CNE is a necrotizing inflammation of the small bowel (especially the jejunum but also the ileum). Clinical results may vary from mild diarrhea to a life-threatening sequence of severe abdominal pain, vomiting, bloody stool, ulceration of the small intestine with leakage (perforation) into the peritoneal cavity and possible death within a single day due to peritonitis. Many patients exhibit meteorism. Treatment involves suppressing the toxin-producing organisms with antibiotics such as penicillin G or metronidazole. About half of seriously ill patients require surgery for perforation, persistent intestinal obstruction, or failure to respond to the antibiotics. An investigational toxoid vaccine has been used successfully in some developing countries but is not available outside of research.

Other clostridial toxemias

Leukemia patients, cancer chemotherapy recipients and others suffering from suppressed white blood cells (neutropenia) can be afflicted by a similar syndrome, neutropenic enterocolitis, in which the cecum is targeted by Clostridium septicum in much the same way.
In neonatal intensive-care units, the syndrome of neonatal necrotizing enterocolitis may be caused in a similar way by C. perfringens, C. butyricum, and C. difficile, but this has not been proved.

References

^ "Clostridial Necrotizing Enteritis: Anaerobic Bacteria: Merck Manual Professional". Retrieved 2008-12-19.

Cooke RA (1979). "Pig Bel". Perspect Pediatr Pathol. 5: 137–52. PMID 575409.
Murrell TG, Roth L, Egerton J, Samels J, Walker PD (January 1966). "Pig-bel: enteritis necroticans. A study in diagnosis and management". Lancet. 1 (7431): 217–22. doi:10.1016/s0140-6736(66)90048-1. PMID 4159182.
Murrell TG, Egerton JR, Rampling A, Samels J, Walker PD (September 1966). "The ecology and epidemiology of the pig-bel syndrome in man in New Guinea". J Hyg (Lond). 64 (3): 375–96. doi:10.1017/S0022172400040663. PMC 2134745. PMID 4288244.
Nuland, Sherwin B., “The Beast in the Belly”, Discover, Vol. 16 No. 02 (February 1995).

UpToDate Contents

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1. 先進国の小児における急性ウイルス性胃腸炎：臨床的特徴および診断 acute viral gastroenteritis in children in resource rich countries clinical features and diagnosis
2. 先進国に居住する小児の下痢へのアプローチ approach to diarrhea in children in resource rich countries
3. 先進国の小児における急性ウイルス性胃腸炎：マネージメントおよび予防 acute viral gastroenteritis in children in resource rich countries management and prevention
4. 成人における急性ウイルス性胃腸炎 acute viral gastroenteritis in adults
5. Causes of acute infectious diarrhea and other foodborne illnesses in resource-rich settings

English Journal

The CpAL quorum sensing system regulates production of hemolysins CPA and PFO to build Clostridium perfringens biofilms.

Vidal JE1, Shak JR2, Canizalez-Roman A3.
Infection and immunity.Infect Immun.2015 Jun;83(6):2430-42. doi: 10.1128/IAI.00240-15. Epub 2015 Mar 30.
PMID 25824838

Contributions of NanI sialidase to Caco-2 cell adherence by Clostridium perfringens type A and C strains causing human intestinal disease.

Li J1, McClane BA2.
Infection and immunity.Infect Immun.2014 Nov;82(11):4620-30. doi: 10.1128/IAI.02322-14. Epub 2014 Aug 18.
PMID 25135687

Crystal structure of the phosphate-binding protein (PBP-1) of an ABC-type phosphate transporter from Clostridium perfringens.

Gonzalez D1, Richez M1, Bergonzi C2, Chabriere E1, Elias M3.
Scientific reports.Sci Rep.2014 Oct 16;4:6636. doi: 10.1038/srep06636.
PMID 25338617

Japanese Journal

Enteritis necroticans 'pigbel' in a Japanese diabetic adult

MATSUDA Tomomichi,OKADA Yuji,INAGI Eiji,TANABE Yasushi,SHIMIZU Yozo,NAGASHIMA Kazuo,SAKURAI Jun,NAGAHAMA Masahiro,TANAKA Shinya
Pathology international 57(9), 622-626, 2007-09-01
NAID 10027375194

Enteritis necroticans caused by Clostridium perfringens type A

IWANAKA T.
J Pediatr 144, 410, 2004
NAID 30017436852

Enteritis necroticansの1例

村川知弘,登政和,田中信孝,古屋隆俊,水田耕一,大江健二
日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 58(11), 2571-2573, 1997-11-25
… perfringens type Cに起因するenteritis necroticans (Pig-bel/Darmbrand)はパプア・ニューギニアなど発展途上国では生命を脅かす疾患として知られているが,先進国では報告例を散見するのみである.われわれは,特発性回腸穿孔と考えて腸切除し,腹腔内容の培養による菌の同定および病理組織標本よりenteritis necroticansの診断に至った1例を経験した.本邦に於いては希有 …
NAID 10009383337

Related Pictures

★リンクテーブル★

リンク元	「壊死性腸炎」「壊孔性腸炎」

「壊死性腸炎」

Clostridial necrotizing enteritis
Classification and external resources
Specialty	Infectious disease, Gastroenterology
ICD-10	A05.2
ICD-9-CM	005.2
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