1887

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Volume 13, Issue 3

SCANNING ELECTRONMICROSCOPY OF THE JEJUNUM IN ENTERITIS NECROTICANS Free

Abstract

An Epidemic form of enteritis necroticans, locally known as pig-bel, occurs in children in the highlands of Papua New Guinea (Murrell and Roth, 1963; Murrell , 1966). The disease is a serious public-health problem with an annual mortality of about 14 per 10,000 population (Murrell , 1966). It is now the commonest cause of death in Eastern Highland Hospitals among children over 1 year of age and it is estimated that approximately 750 children die from pig-bel each year. Evidence suggests that the condition is precipitated by the growth of strains of type C (Egerton and Walker, 1964) present in small numbers in the normal intestinal flora or ingested with contaminated meat during pig feasting, with subsequent production of β toxin leading to segmental paralysis, inflammation and necrosis of the small intestine. The normal low-protein diet, the staple sweet potato, a dietary change to meat particularly during pig feasting, and low levels of β antitoxin in those at risk are thought to be predisposing factors in the pathogenesis of this gangrenous enteritis (Lawrence and Walker, 1976). Only small amounts of pancreatic protease, particularly trypsin which is known to destroy β toxin, are produced by children on a low-protein diet; this, coupled with the presence of trypsin inhibitors in semi-cooked sweet potato, may be of particular importance (Lawrence, 1974, 1975).

Pig-bel may present in several ways. In the acute toxic form, with toxaemia and shock, abdominal symptoms may be prominent; in the acute surgical form there is obstruction of the small bowel and severe pain, and surgery is life-saving; and in the subacute surgical form there is a degree of small-bowel obstruction with subsequent malabsorption resulting from scarring and fibrosis. The most common form is mild and there is usually complete recovery.

How the toxin penetrates the jejunal mucosa is not clearly understood. According to Lawrence (1974), the clinical course of pig-bel reflects the amount of damage done by large amounts of toxin produced in a short period after the meat meal that invariably precedes the disease. This process is localised in time, the damage done to the gut by absorption of toxin early in the

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© 1980 The Pathological Society of Great Britain and Ireland
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1980-08-01
2024-05-02
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References

  1. Arbuckle J. B. R. 1972; The attachment of Clostridium welchii (Cl. perfringens) type C to intestinal villi of pigs. J. Path 106:65
     [Google Scholar]
  2. Banwell J. C., Hutt M. S., Tunnicliffe R. 1964; Observations on jejunal biopsy in ugandan africans. E. Afr. Med. J 41:46
     [Google Scholar]
  3. Bergeland M. E. 1972; Pathogenesis and immunity of clostridium perfringens type c enteritis in swine. J. Am. Vet. Med. Ass 160:568
     [Google Scholar]
  4. Bhat P., Shantakumari S., Rajan D., Mathan V. I., Kapadia C. R., Swarnabai C., Baker S. J. 1972; Bacterial flora of the gastrointestinal tract in southern indian control subjects and patients with tropical sprue. Gastroenterology 62:11
     [Google Scholar]
  5. Egerton J. R., Walker P. D. 1964; The isolation of clostridium perfringens type c from necrotic enteritis of man in papua new guinea. J. Path. Bact 88:275
     [Google Scholar]
  6. Gyr K., Felsenfeld O., Wolf R. H. 1975; Intestinal absorption, exocrine pancreatic function and response to vibrio cholerae infection in protein deficient patas monkeys (erythrocebuspatas). Trans. R. Soc. Trop. Med. Hyg 69:247
     [Google Scholar]
  7. Knop J., Rowley D. 1975a; Antibacterial mechanisms in the intestine. Elimination of v. Cholerae from the gastrointestinal tract of adult mice. Aust. J. Exp. Biol. Med. Sci 53:137
     [Google Scholar]
  8. Knop J., Rowley D. 1975b; Antibacterial mechanisms in the intestine. Elimination of v. Cholerae from the intestines of infant mice and the role of antibody. Aust. J. Exp. Biol. Med. Sci 53:147
     [Google Scholar]
  9. Knop J., Rowley D. 1975c; Protection against cholera. A bactericidal mechanism on the mucosal surface of the small intestine of mice. Aust. J. Exp. Biol. Med. Sci 53:155
     [Google Scholar]
  10. Lawrence G. 1974; Further speculation on pig-bel. Proceedings of 10th annual symposium papua new guinea medical society port moresby, p 207
     [Google Scholar]
  11. Lawrence G. 1975; Recent advances in pig-bel. Proceedings 11 th Annual Symposium Papua New Guinea Medical Society Port Moresby, p 26
     [Google Scholar]
  12. Lawrence G., Walker P. D. 1976; Pathogenesis of enteritis necroticans in Papua New Guinea. Lancet 1:125
     [Google Scholar]
  13. Lawrence G., Shann F., Freestone D. S., Walker P. D. 1979; Prevention of necrotising enteritis in Papua New Guinea by active immunisation. Lancet 1:227
     [Google Scholar]
  14. Murrell T. G. C. 1966; Pig-bel—case report. Papua New Guinea med. J 9:68
     [Google Scholar]
  15. Murrell T. G. C. 1967; Pig-bel—epidemic and sporadic necrotizing enteritis in the highlands of New Guinea. Australas. Ann. Med 16:4
     [Google Scholar]
  16. Murrell T. G. C., Roth L. 1963; Necrotizing jejunitis: a newly discovered disease in the highlands of New Guinea. Med. J. Aust 1:61
     [Google Scholar]
  17. Murrell T. G. C., Roth L., Egerton J., Samels J., Walker P. D. 1966a; Pig-bel: enteritis necroticans. A study in diagnosis and management. Lancet 1:217
     [Google Scholar]
  18. Murrell T. G. C., Egerton J. R., Rampling A., Samels J., Walker P. D. 1966b; The ecology and epidemiology of the pig-bel syndrome in man in New Guinea. J. Hyg., Camb 64:375
     [Google Scholar]
  19. Nelson E. T., Clements J. D., Finkelstein R. A. 1976; Vibrio cholerae adherence and colonization in experimental cholera: electron microscopic studies. Infect. Immun 14:527
     [Google Scholar]
  20. Parnas J. 1976; Ober den EinfluO des Beta-Toxins von Clostridium perfringens (Typ C) auf die Motorik der Darmsegmente (in vitro). Zentbl. Bakt. ParasitKde I. Abt. Org 234:243
     [Google Scholar]
  21. Tomkins A. M., Wright S. G., Drasar B. S., James W. P. T. 1978; Bacterial colonization of jejunal mucosa in giardiasis. Trans. R. Soc. trop. Med. Hyg 72:33
     [Google Scholar]
  22. Walker P. D., Batty I., Thomson R. O. 1971; The localization of bacterial antigens by the use of the fluorescent and ferritin labelled antibody techniques. In Methods in microbiology edited by Norris J. R. Ribbons D. W. vol 5A: Academic Press; London & New York: p 219
     [Google Scholar]
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