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Publication #FSHN035

Preventing Foodborne Illness Associated with Clostridium perfringens1

Keith R. Schneider, Renée Goodrich-Schneider, Michael A. Hubbard, and Susanna Richardson2

This is one in a series of fact sheets discussing common foodborne pathogens of interest to food handlers, processors, and retailers.

What causes a Clostridium perfringens foodborne illness?

The bacteria Clostridium perfringens is one of the leading causes of foodborne gastroenteritis in the United States. According to the Centers for Disease Control and Prevention (CDC) estimates, as many as one million individuals are affected by C. perfringens each year (Grass et al. 2013; Scallan et al. 2011) although only a fraction of these are actually recorded. The number of C. perfringens foodborne illnesses is likely underreported due to the mildness of symptoms, brief illness duration, and lack of routine testing by public health officials. The average cost per case (cost-of-illness model includes estimates for medical costs, productivity losses, and illness-related death) of C. perfringens is $539 (Scharff et al. 2009) with a 13-year total (1998–2010) of just over $8 million dollars (Grass et al. 2013).

Outbreaks associated with Clostridium perfringens

While outbreaks of C. perfringens are common, they do not become major headlines, as the typical symptoms of the illness are mild and deaths are extremely rare. Most of the symptoms only last about 24 hours, so identifying an outbreak in that limited amount of time is difficult (Murray et al. 2007). Table 1 outlines several of the outbreaks that were identified by the CDC in 2011 (the most recent data available).

What type of bacterium is Clostridium perfringens?

Clostridium perfringens is an anaerobic Gram-positive bacterial pathogen that has the capability of forming endospores. These tough, dormant spores allow for the protection of the bacteria during times of environmental stress for example lack of water, high temperature, etc. (Cornell 2014). This sporulation allows C. perfringens to survive the cooking process if the food is not heated above 140°F. While the endospores are not detrimental to humans, these spores can change into potentially harmful vegetative cells if exposed to low cooking temperatures and then allowed to remain at temperatures between 54°F and 140°F for several hours. The range of 109°F–117°F is particularly conducive to this occurrence (CDC 2013). These vegetative cells can produce a toxin that will cause gastrointestinal illnesses in humans (Grass et al. 2013).

Clostridium perfringens is found not only in soil and sediment, but is present as a part of the normal intestinal flora of animals and humans. Thus, the organism can be found in sewage and in areas prone to animal and sewage contamination. Clostridium perfringens spores have also been isolated from raw and cooked foods (Grass et al. 2013).

Figure 1. 

Photomicrographic view of a Gram-stained culture speciminen, revealing the presence of numerous Clostridium perfringens Gram-positive bacteria.


Credit:

CDC (1979) [PHIL #14346]


[Click thumbnail to enlarge.]

How is Clostridium perfringens spread?

Clostridium perfringens thrives in high-protein foods of animal origin, such as meat and meat products, meat dishes, stews, soups, gravies, and milk (see outbreak data in Table 1). Occasionally, poultry products, pork, lamb, fish, shrimp, crab, legumes (beans), potato salad, and macaroni and cheese may contain C. perfringens. These protein-containing foods, when kept at improper storage temperatures, between 54°F and 140°F, provide the greatest risk of infection and disease from C. perfringens, since spores present after cooking can germinate and potentially grow to high, dangerous numbers. The danger zone exists between 109°F and 117°F (CDC 2013). Foods need to be cooled rapidly through this zone on their way to 41°F. The 2009 Food Code recommends that food should not be in this zone for more than two hours (FDA 2009). In the majority of illnesses involving these foods, keeping food in the danger zone too long was identified as the cause of the C. perfringens food poisoning.

Symptoms of Clostridium perfringens illness

Gastroenteritis, which is the inflammation of the stomach and/or intestines, can occur 6–24 hours after consuming food contaminated with large numbers of the vegetative form of C. perfringens (CDC 2013). Symptoms include severe abdominal cramps and pain, diarrhea, and flatulence (CDC 2013). Because most symptoms usually last approximately 24 hours, many infected individuals believe that they had a case of the “24-hour flu” (Birkhead et al. 1988). Occasionally, less severe symptoms may continue for 1–2 weeks (CDC 2013). These longer episodes are usually associated with the extremely young or the elderly. In severe cases, dehydration and other complications can result in death of the infected individual.

The gastrointestinal symptoms, typically without fever, precede confirmation by toxin or organism detection in fecal (stool) samples of affected individuals (CDC 2013). The illness can also be confirmed by the detection of C. perfringens in the suspected food that was consumed (Birkhead et al. 1988; Dailey et al. 2012).

Which populations are at high risk for Clostridium perfringens foodborne illness?

Hospitals, nursing homes, prisons, and school cafeterias are locations that pose the highest risk of a C. perfringens outbreak (CDC 2013). In these settings, foods are cooked but may not be kept at safe, adequate temperatures prior to serving. Although C. perfringens may be present in small numbers in raw foods, improper storage and handling of these foods could allow the pathogen to grow to high, harmful numbers (CDC 2013; FDA 2009). The age group with the highest number of illnesses due to C. perfringens is those between the ages of 20–49, with men being more likely to become ill than women (Grass et al. 2013).

How can Clostridium perfringens foodborne illness be controlled and prevented?

Since Clostridium perfringens can grow rapidly at elevated temperatures and forms heat-resistant spores, preventing growth is paramount. Foods should be cooked to an internal temperature of 165°F or higher to inactivate the pathogen's vegetative cells. Additionally, the cooked food must be chilled rapidly to 41°F or less, or kept at hot holding temperatures of 140°F or higher to prevent any activation and growth of C. perfringens spores.

Large portions of meat, broth, gravies, and other foods commonly associated with C. perfringens must meet specific guidelines noted in the 2009 FDA Food Code. These guidelines specify that potentially hazardous food shall be cooled within two hours from 140°F to 70°F, and within six hours from the initial 140°F to 41°F. Large containers of food may take an extended period of time to cool to 41°F and therefore should be separated into smaller portions. Additionally, storage containers should be stacked to encourage good airflow both above and below to facilitate rapid cooling. Leftover foods should be reheated to 165°F or greater, which should inactivate any vegetative cells that have germinated during cooling, as well as other foodborne pathogens which may have cross-contaminated the food (CDC 2013; FDA 2009).

Best Ways to Avoid Illness

The best way to prevent foodborne illness associated with C. perfringens is to observe a few proper control measures in food preparation, storage, and temperature controls. These include measures such as the rapid, uniform cooling of cooked foods; making sure cooked foods remain hot after they’re cooked; and when reheating cooled or chilled foods making sure foods reach a minimum internal temperature of at least 165ºF.

References

Centers for Disease Control and Prevention [CDC]. 2013. Food Safety: Clostridium perfringens. Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases. http://www.cdc.gov/foodsafety/clostridium-perfingens.html (Last Accessed: 29 January 2014).

Birkhead, G., R. L. Vogt, E. M. Heun, J. T. Snyder, and B. A. McClane. 1988. Characterization of an Outbreak of Clostridium perfringens Food Poisoning by Quantitative Fecal Culture and Fecal Enterotoxin Measurement. Journal of Clinical Microbiology. 26(3):471-474.

Cornell University. 2014. Department of Microbiology-Bacterial Endospores. http://micro.cornell.edu/cals/micro/research/labs/angert-lab/bacterialendo.cfm (Last Accessed: 29 January 2014).

Dailey, N. J., N. Lee, A. T. Feischauer, Z. S. Moore, E. Alfano-Sobsey, F. Breedlove, A. Pierce, A. Ledford, S. Greene, G. A. Gómez, D. F. Talkington, M. J. Sotir, A. J. Hall and D. Sweat. 2012. Clostridium perfringens Infections Initially Attributed to Norovirus, North Carolina, 2010. Clinical Infectious Diseases. 55(4):568-570.

Grass, J. E., L. H. Gould, and B. E. Mahon. 2013. Epidemiology of Foodborne Disease Outbreaks Caused by Clostridium perfringens, United States, 1998-2010. Foodborne Pathogens and Disease. 10(2):131-135.

Food and Drug Administration [FDA]. 2009. "FDA 2009 Food Code – Table of Contents." http://www.fda.gov/Food/FoodSafety/RetailFoodProtection/FoodCode/FoodCode2009/default.htm (Last Accessed: 29 January 2014)

Murray, P. R., E. J. Baron, J. H. Jorgensen, M. L. Landry, and M. A. Pfaller, eds. 2007. Manual of Clinical Microbiology (9th ed.). Washington DC: ASM Press.

Scallan, E., R. M. Hoekstra, F. J. Angulo, R. V. Tauxe, M-A. Widdowson, S. L. Roy, J. L. Jones, and P. M. Griffin. 2011. Foodborne Illness Acquired in the United States—Major Pathogens. Emerging Infectious Diseases. 17(1):7-15.

Scharff R., J. McDowell, and L. Medeiros. 2009. Economic cost of foodborne illness in Ohio. Journal of Food Protection. 72(1):128-136.

Resources

Schmidt, R.H., R.M. Goodrich, D.L. Archer, and K.R. Schneider. FSHN033/FS099: General Overview of the Causative Agents of Foodborne Illness. http://edis.ifas.ufl.edu/fs099 (Last Accessed: 29 January 2014).

Tables

Table 1. 

Outbreaks of Clostridium perfringens in 2011

Year

Month

State

Genus Species

Status

Location of Consumption

Total Ill

Total Hospitalized

Total Deaths

Food Vehicle

Contaminated Ingredient

2011

February

Illinois

Clostridium perfringens

Confirmed

School

30

0

0

chicken, BBQ

chicken

2011

March

Minnesota

Clostridium perfringens

Confirmed

Prison, jail

32

0

0

potato, scalloped

 

2011

April

Idaho

Clostridium perfringens

Confirmed

Restaurant—Sit-down dining

23

0

0

enchilada, chicken

chicken

2011

March

Florida

Clostridium perfringens

Suspected

Restaurant—"Fast-food" (drive- up service or pay at counter)

4

0

0

   

2011

May

Kansas

Clostridium perfringens

Suspected

Prison, jail

115

0

0

Chili Macaroni

turkey

2011

May

Wisconsin

Clostridium perfringens

Suspected

Private home

12

0

0

beef, roast with gravy

 

2011

June

Louisiana

Clostridium perfringens

Confirmed

 

30

0

0

   

2011

March

Colorado

Clostridium perfringens

Confirmed

Caterer

27

0

0

beef, brisket; potato, mashed

beef, brisket; gravy, beef; potatoes

2011

June

Connecticut

Clostridium perfringens

Confirmed

Restaurant—Sit-down dining

4

0

0

chicken, stew

 

2011

March

California

Clostridium perfringens

Suspected

Private home

19

0

0

refried beans, unspecified

 

2011

August

Minnesota

Clostridium perfringens

Confirmed

Workplace, not cafeteria

5

0

0

   

2011

November

Ohio

Clostridium perfringens

Confirmed

Private home

101

0

0

turkey, roasted

turkey

2011

October

Colorado

Clostridium perfringens

Suspected

 

40

1

0

rice

rice

2011

December

New York

Clostridium perfringens

Suspected

Restaurant—Sit-down dining

17

0

0

steak, prime rib

beef

2011

November

Arizona

Clostridium perfringens

Suspected

Other

45

0

0

mashed potato/gravy; stuffing/gravy

 

2011

December

Iowa

Clostridium perfringens

Confirmed

 

21

0

0

   

2011

December

Nevada

Clostridium perfringens

Confirmed

Workplace, not cafeteria

21

0

0

ham

ham

2011

December

Ohio

Clostridium perfringens

Confirmed

Workplace, not cafeteria

10

0

0

turkey, roasted

turkey

2011

November

North Dakota

Clostridium perfringens

Confirmed

Prison, jail

88

0

0

   

2011

November

North Dakota

Clostridium perfringens

Suspected

Banquet facility

23

0

0

   

*Data from the Centers for Disease Control and Prevention’s Foodborne Outbreak Online Database (Food) (http://wwwn.cdc.gov/foodborneoutbreaks/)

Footnotes

1.

This document is FSHN035, one of a series of the Food Science and Human Nutrition Department, Florida Cooperative Extension Service, IFAS, University of Florida. Original publication date April 2003. Revised January 2014. Visit the EDIS Website at http://edis.ifas.ufl.edu.

2.

Keith R. Schneider, professor; Renée Goodrich-Schneider, associate professor; Michael A. Hubbard, graduated student; and Susanna Richardson, technician; Food Science and Human Nutrition Department, UF/IFAS Extension, Gainesville, FL 32611.


The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county's UF/IFAS Extension office.

U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.