Scanning electronmicroscopy of the jejunum in enteritis necroticans

Intestinal tissue resected at laparotomy from patients in Papua New Guinea at various clinical stages of enteritis necroticans, locally known as pig-bel, has been examined under the scanning electronmicroscope. Evidence obtained from parallel studies of experimental infection in pigs is presented. Progressive destruction of the intestinal mucosa was seen during the course of the disease in man. Numerous filamentous rods morphologically consistent with the appearance of Clostridium perfringens type C, were seen to be attached the affected areas of gut and were associated with the necrotic tissue. The mechanism of pathogenicity includes a stage of attachment to the surfaces of jejunal villi, local multiplication, and the production of beta toxin which may be protected from tryptic digestion by the inadequacy of pancreatic protease production in susceptible subjects and by the ingestion of a trypsin inhibitor. The association of the condition with pork feasting is discussed.