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Description
The Clostridium group contains over 60 different species of Gram-positive bacteria, belonging to the phylum Firmicutes. They are obligate anaerobes capable of producing endospores. Individual cells are rod-shaped, which gives them their name, from the Greek Kloster or spindle. These characteristics traditionally defined in the genus, but they are not phylogenetically significant, and many species originally classified as Clostridium have been moved elsewhere.
Clostridium includes common free-living bacteria as well as important pathogens. There are four main species responsible for disease in humans:
C. botulinum, an organism producing a very deadly toxin in food that causes botulism.
C. difficile, which can overgrow other bacteria in the gut during antibiotic therapy, can cause pseudomembranous colitis. 
C. perfringens, causes a wide range of symptoms, from food poisoning to gas gangrene. Also responsible for enterotoxemia (also known as "overeating disease" or "pulpy kidney disease") in sheep and goats. Gas gangrene occurs as a result of infection with Clostridium bacteria that, under anaerobic (low oxygen) conditions, produce toxins that cause issue death and associated symptoms. Gas gangrene is rare with only 1,000 to 3,000 cases yearly in the U.S. 
C. tetani, the causative organism of tetanus (lockjaw).
Other important species include:
C. acetobutylicum, also known as the Weizmann organism, which was first used by Chaim Weizmann to produce acetone and biobutanol from starch in 1916 for the production of gunpowder and TNT. 
C. sordellii has been linked to the toxic shock syndrome deaths of more than a dozen women after childbirth. 
C. thermocellum can utilize lignocellulosic waste and generate ethanol, thus making it a possible candidate for use in ethanol production. It also has no oxygen requirement and is thermophilic, reducing cooling cost.
These 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.
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 health care providers 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.
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 seven to 15 hours of eating the contaminated food. C. botulinum is a very deadly bacteria that causes a disease known as botulism.
Pseudomembranous colitis is caused by Clostridium Difficile, bacteria that usually live harmlessly in the intestines of about 50-70% of newborns, 20-50% 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.
These two types of clostridium are quickly mentioned here in passing. They are important, but will not be discussed any further on this page other than the summaries below.
C. SORDELLII: Quick Overview
The Center for Disease Control and Prevention (CDC) recently reported that four women who had undergone abortions using Mifeprex (the trade name for the "abortion pill" RU-486) and misoprostol (an anti-ulcer drug that, when used in conjunction with Mifeprex, can end early pregnancies) died of a rare bacterial infection mostly associated with women who have just given birth. The four women, who ranged from 18 to 34 years of age, died of toxic shock syndrome after being infected with the bacteria Clostridium sordellii. Toxic shock syndrome is a medical emergency wherein the patient presents with shock symptoms and dysfunction of several organs as a result of bacterial infection. Though commonly associated with such symptoms as fever and skin rashes, none of the women who died of the C. sordellii-caused toxic shock syndrome presented with either, although they complained of abdominal cramping. All of the women were healthy, and died shortly after reporting their symptoms to the hospital following a rapid increase in infectious symptoms.
C. TETANI: Quick Overview
Tetanus is one of the oldest diseases known to afflict human beings. It is a disease that attacks the central nervous system, causing lockjaw and other symptoms. Tetanus is caused by infection of a wound by the bacterium Clostridium tetani. The bacteria Clostridium tetani are present in soil and in animal feces. The bacteria can produce spores, which are a special form of the bacteria that is resistant to heat and disinfectants. When spores enter the skin through a wound, they can germinate into the more active form of Clostridium tetani. The bacteria can then produce a substance that is very toxic (poisonous) to human beings. This toxin causes the symptoms of tetanus.
Tetanus is a rare disease in the United States (about 100 cases a year) because children are routinely vaccinated against it. But the disease is more common in places that do not have rigorous immunization policies. In the United States people who get tetanus tend to be older; many of them have not been adequately immunized. Without treatment, tetanus can be fatal. (Note: My great-aunt, Mary, died of tetanus back in the late 1960's after stepping on a nail out in the barn. This is one of the few vaccinations I recommend. It was a horrible way for her to die. - MoonDragon.org Midwife)
People get tetanus through an infected open wound. If a person steps on a rusty nail, for example, he or she could become ill from the spores of the tetanus bacteria. The bacteria produce a substance that is toxic to the central nervous system. Because the spores cannot germinate and the bacteria cannot live when there is a high level of oxygen, wounds that do not have a good blood supply or are not exposed to air are more likely to lead to tetanus. Once the bacteria have entered the body, it may take from 3 to 50 days (with an average of 5 to 10 days) for symptoms to appear.
Stiffness of the jaw (lockjaw) is the most common symptom of tetanus. A person with tetanus has difficulty opening his or her mouth. Other muscles become stiff (back, abdomen, face). If the muscles of the face stiffen, a person with tetanus looks as if he or she has a fixed smile that does not change. The patient may also have a fever, perspire heavily, have a rapid pulse, feel restless, and have muscle spasms. Noise and light may cause seizures in a person with tetanus. Infants with tetanus are unable to nurse because they lose their ability to suck.
There are no reliable tests for tetanus. The health care provider makes a diagnosis from the symptoms a person has and from a recent history of open wounds. It is, unfortunately, easier for a health care provider to diagnose tetanus in its later rather than its earlier stages. Some of the symptoms of tetanus could indicate a different disease.
THE DISCOVERY OF TETANUS The German physician Arthur Nicolaier discovered the tetanus bacillus in 1884. He was not able, however, to obtain a pure culture of the tetanus, which would have allowed him to study it more closely. Instead, he confirmed that the bacteria generated the tetanus toxin by injecting garden soil containing the bacteria into animals and observing the resultant symptoms of tetanus. Five years later, the Japanese bacteriologist Shibasaburo Kitasato cultivated the tetanus bacterium in pure culture and a year later developed an effective tetanus antitoxin. After World War I, English scientists developed an improved antitoxin that was put to use after World War II when the establishment of active immunization for all children became a standard practice.
When a health care provider does determine that tetanus is present, the patient should be given an injection of tetanus antitoxin. The antitoxin contains antibodies that attach to and neutralize the tetanus toxin. The person is also immunized for tetanus. After being treated with antitoxin, the infected areas are cleansed thoroughly. Then antibiotics are given to the patient to destroy bacteria in the wound. Other drugs are given to control the symptoms that are present. In some cases, a mechanical ventilator (breathing machine) is needed to help regulate the person's breathing. The patient is kept in a dark and quiet environment, since light and noise stimulate symptoms of the disease.
Tetanus can be prevented by vaccination. In combination with vaccines against diphtheria (a bacterial infection that causes sore throat and fever) and pertussis (whooping cough), a tetanus vaccination is given routinely to children in the United States. The vaccine will protect a person for 10 years, after which a booster shot is recommended. When a person has a serious wound to the skin and has not been immunized for over 10 years, tetanus antitoxin injections are administered as a precaution.
Resources: 1. Henderson, Alan D. "Neonatal Tetanus." Health Letter on the CDC, December 28, 1998, p. 10.
2. The U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, N.E., Atlanta, GA 30333. The United States government authority for information about infectious and other diseases, the CDC posts information about tetanus at its website. http://cdc.gov/nip/vaccine/nip-dtp.htm
MoonDragon's Health Information: Vaccinations - Pros & cons
Signs & Symptoms
Infections caused by the Clostridium group of bacteria include tetanus and infant botulism. Illnesses caused by Clostridium discussed here are gas gangrene, Clostridium food poisoning, and pseudomembranous colitis.
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. Gas gangrene occurs at the site of the trauma or a recent surgical wound. About a third of cases occur spontaneously. Patients who develop this disease spontaneously often have underlying blood vessel disease (atherosclerosis or hardening of the arteries), diabetes, or colon cancer.
The first symptom of gas gangrene is sudden, severe pain in the wound, with progressive swelling that stretches the skin "tight" nearby. The skin in the area of the wound may be initially pale, later dusky progressing to bronze, or deep, dark red or purple, and it is tender (moderate to severe pain) to the touch. Gas may be felt in the tissue as a crackly sensation when the swollen area is pressed with the fingers. The edges of the infected area expand so rapidly that changes are visible over a few minutes. The involved tissue is completely destroyed. Large, bloody blisters, vesicles formation, coalescent (combining into large blisters) may form in the area, and the wound itself may have a foul-smelling-sweet smell and may leak a brown, bloody, or amber-colored fluid (serosanguineous discharge) from the blisters.
Clostridium bacteria produce many different toxins, four of which (alpha, beta, epsilon, iota) can cause potentially fatal syndromes. In addition, they cause tissue death (necrosis), destruction of blood (hemolysis), local decrease in circulation (vasoconstriction), and leaking of the blood vessels (increased vascular permeability). These toxins are responsible for both the local tissue destruction and the systemic symptoms (symptoms that occur throughout the body). Systemic symptoms develop early in the infection. These consist of sweating, moderate to high fever, rapid pulse (tachycardia), and anxiety. If untreated, the individual develops a shock-like syndrome with decreased, sudden drop in blood pressure (hypotension), severe kidney failure, coma, and death. Symptoms usually begin suddenly and rapidly worsen.
Clostridium bacteria can contaminate food and produce a toxin (poison) that causes a mild form of food poisoning. Food that sets out such as a cafeteria, camps, school, or a buffet banquet may harbor bacteria. Packages of uncooked meat or poultry frequently contain Clostridium. Since Clostridium bacteria are found in soil, in stool, and in the intestines of healthy people and animals, Clostridium can also be transferred into food from the hands of those preparing it if they properly do not clean their hands before preparing food. The most commonly infected foods are meat, poultry, gravies, casseroles, stews, burritos, and other pre-cooked foods. Many people can get sick from the same source. Anyone can get it. Spores of Clostridium survive cooking. When the temperature drops back to less than about 140 degrees, the spores germinate and begin to multiply. Symptoms are caused by a toxin produced by the multiplying bacteria. The toxin can be destroyed by cooking. Symptoms begin seven to 15 hours after eating the contaminated food. The hallmark of Clostridium food poisoning is a sudden, watery diarrhea accompanied by abdominal pain or cramps that may range from mild to severe. Usually there is no fever (distinguishing it from Salmonella and others) and usually no vomiting (distinguishing it from Staph and others) however nausea and sometimes vomiting may occur. Illness is usually over within 24 hours of the onset of 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 four to eight 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.
Prevention
You can prevent gas gangrene by checking with your health care provider 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. Clean any skin injury thoroughly. Watch for signs of infection (such as redness, or swelling around a wound), and consult with your health care provider promptly if these occur.
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. Clostridium grows best between 45 and 140 degrees. Prepared foods should be kept cooler or warmer than this. Wash hands before preparing or serving foods. When handling raw meat or poultry, consider them contaminated. Wash your hands and any surfaces they have touched before proceeding. Be sure that the meat, poultry, and fish dishes are fully cooked and don't interrupt cooking to finish it later. Don't leave prepared foods unrefrigerated for more than 2 hours. When foods are taken from warming tables, they should be refrigerated immediately, not left at room temperature to cool. Prepared foods should be reheated to at least 165 degrees before serving.
You may be able to help prevent severe pseudomembranous colitis by calling your health care provider 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.
Incubation
The incubation period for gas gangrene is one to four days after the "dirty" wound.
The incubation period is seven to 15 hours after eating contaminated food.
Symptoms of pseudomembranous colitis usually begin after a child has been taking antibiotics for four to eight days, but they may start as late as five to 21 days after a child has finished taking antibiotics.
Duration
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.
Clostridium food poisoning is usually a mild illness. Symptoms last for about 24 hours and then stop. There is usually no need for antibiotics.
First, the antibiotic that caused the pseudomembranous colitis must be stopped. Once this is done, symptoms of mild pseudomembranous colitis often improve within two days and are usually gone within seven to ten days. However, severe cases of pseudomembranous colitis may need to be treated with certain specific antibiotics that kill C.Difficile.
Contagiousness
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.
Clostridium food poisoning is not contagious from person to person, but everyone who eats the same contaminated food is at risk for food poisoning. People who do not wash their hands properly can introduce into food, where it will germinate and multiply.
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 vinyl gloves when caring for them.
Home Treatment
Gas gangrene is usually treated in a hospital, with antibiotics and surgical removal of dead tissue around the wound.
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 health care provider before giving your child any store-bought medicine for diarrhea.
If your health care provider 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 health care provider 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
Health care providers can often make the diagnosis of gas gangrene by looking at the infected wound, noting its sweet odor, and evaluating the extent of injury.
Diagnosis: The person may be in shock, with general pallor, cold extremities, low blood pressure, and rapid heart rate. Air in the tissues (crepitus) may be felt. Infection involving the entire body (systemic toxicity or sepsis) may develop. Yellow skin color associated with the excessive breakdown of blood cells (jaundice) is possible.
- A gram stain of fluid from the infected area may shows Gram-positive rods (Clostridium species) or other bacterial types.
- A culture may grow the bacteria causing the infection.
- Blood cultures may grow the infecting bacteria.
- An anaerobic tissue and/or fluid culture may reveal Clostridium species.
- An x-ray, CT scan, or MRI of the area may show gas in the tissues.
Treatment: Prompt surgical removal of dead, damaged, and infected tissue (debridement) is necessary. Amputation of an arm or leg may be indicated to control the spread of infection. Antibiotics, preferably penicillin-type, should be given. Initially, this is given intravenously (through a vein). Analgesics may be required to control pain. Hyperbaric oxygen has been tried with varying degrees of success.
Prognosis: Gas gangrene is progressive and often lethal. Immediate medical attention is required.
Complications: Disfiguring or disabling permanent tissue damage, jaundice with liver damage, kidney failure, spread of infection through the body (sepsis), shock, stupor, delirium, coma, death.
Since Clostridium food poisoning is a mild illness that only lasts a day or two.
Diagnosis: Clostridium food poisoning is suspected by the history and physical exam. A diagnosis might be confirmed with stool studies. Keep in mind that clostridium are found in the stool of healthy people, so either large numbers (more than 1 million) organisms per gram of stool or evidence of the toxin are needed. Sometimes the diagnosis if made by finding Clostridium in the food.
Treatment: Usually health care providers do not treat it with antibiotics (antibiotics are not useful in Clostridium food poisoning) other than taking steps to prevent or treat dehydration.
Health care providers 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 health care provider may also need to examine the inside of your child's intestines using a colonoscope.
When To Call Your Health Care Provider
Call your health care provider immediately if your child has a serious "dirty" wound or crush injury. Any signs of infection at any time, including pain, swelling, redness, drainage of pus or blood, fever, or similar symptoms need to be reported immediately. Go to the emergency room or call the local emergency number (such as 911), if symptoms indicate gas gangrene. This is an emergency condition requiring immediate medical attention.
Call your health care provider whenever your child has any of the following symptoms: abdominal pain, cramps, diarrhea, nausea, vomiting, or fever. Tell your health care provider if other family members have similar symptoms, especially if they have all eaten the same foods within the past few hours.
Call your health care provider immediately if your child develops bloody diarrhea, or has any blood at all in his stool. Also, call your health care provider if your child has been taking antibiotics and suddenly develops cramps and diarrhea.
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