**14.3** *Clostridium butyricum***-induced necrotizing enteritis**

*Clostridium butyricum* is a spore-forming, Gram-positive obligate anaerobic rod with a rugby ball-shaped configuration [156]. It frequently forms spores even in the *in vivo* state, a feature quite different from *C. perfringens*. A male patient aged 30's with severe uncontrolled diabetes mellitus suddenly suffered from mesenteric arterial thrombosis. The surgically resected small bowel accompanied pneumatosis cystoides intestinalis (gas formation in the intestinal wall). Computed tomography scan demonstrated gas embolism filling the portal vein branches in the liver. Microscopically, gas-filled spaces were formed in the submucosa of the small bowel. Spore-forming Gram-positive large rods were discerned in the necrotic gut wall (**Figure 56**). Capsule formation by the spore-forming rods was proven with colloidal iron stain. Microbial culture of the blood identified *C. butyricum*. In contrast to gas gangrene caused by *C. perfringens*, the prognosis of the patient with *C. butyricum*-induced gas gangrene is not so poor. In fact, this patient was alive for years after surgery [157].

Neonatal necrotizing enterocolitis occurs in premature babies. The most likely cause of the disease is infection of *C. butyricum* [158–160]. Symptoms caused by small bowel necrosis include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile. Poor blood flow results in ischemic necrosis of the bowel wall. Pneumatosis cystoides intestinalis and perforation with pneumoperitoneum and peritonitis are often associated. Surgery is required in those who have free air in the abdominal cavity. Breastfeeding may prevent the disease. Probiotic studies have reported that peroral administration of *C. butyricum* improves or even prevents clinical manifestation of pseudomembranous colitis due to *C. difficile* infection and hemorrhagic colitis caused by enterohemorrhagic *Escherichia coli* (O-157, H7)

infection [161, 162]. Neonatal intestinal mucormycosis, clinically resembling neonatal necrotizing enterocolitis, is fetal and challenging to make an appropriate diagnosis [163, 164]. Risk factors include premature birth, malnutrition, and asphyxia. The entry of the organism is thought to be the oropharynx or nares. **Figure 57** demonstrates the representative microscopic features of lethal ileal

C. butyricum*-induced gas gangrene (necrotizing enteritis) (H&E and Gram). The small bowel was surgically removed for mesenteric arterial thrombosis in a male patient aged 30's with severe diabetes mellitus. Gas-filled spaces are formed in the submucosa. Spore-forming, Gram-positive, rugby ball-shaped large rods are identified*

Anthrax is a zoonotic infection of a large-sized Gram-positive bacillus, *Bacillus*

*anthracis* [165–168]. Formation of spores and capsules is closely related to the pathogenicity of the microbe. Three clinical forms are known, involving the skin, lungs, and intestines. The latter two are often lethal. Skin anthrax, predominantly involving the arm, is an occupation-related infection of veterinarians and those who

*Neonatal intestinal mucormycosis (H&E, immunostain and Grocott). The premature baby was treated for neonatal necrotizing enterocolitis. Autopsy disclosed necrotic ileal wall with massive transmural infection of* Mucor *fungi. Vascular involvement (mycotic embolism) is evident by both immunostaining with a monoclonal antibody against* Rhizomucor *antigen and Grocott silver. Strong Grocott reactivity is noted in this case.*

mucormycosis seen in a premature baby.

**Figure 56.**

**Figure 57.**

**133**

*seen in the necrotic gut wall.*

*Pathology of Gangrene*

*DOI: http://dx.doi.org/10.5772/intechopen.93505*

**15. Anthrax and** *Bacillus cereus* **infection**

#### **Figure 55.**

*Lethal mucormycosis of rhinocerebral type in a poorly controlled diabetic male patient aged 60's (gross appearance). Angioinvasive mycosis resulted in hemorrhagic necrosis of the face and anteroinferior part of the brain. Infection had been extended from the paranasal cavity.*

#### **Figure 56.**

(rhinocerebral) mucormycosis, which is encountered as a complication of poorly controlled diabetes mellitus [154, 155]. Angioinvasive colonization of *Zygomycetes* aggressively progresses from the paranasal cavity to the overlying facial skin and to

*Clostridium butyricum* is a spore-forming, Gram-positive obligate anaerobic rod with a rugby ball-shaped configuration [156]. It frequently forms spores even in the *in vivo* state, a feature quite different from *C. perfringens*. A male patient aged 30's with severe uncontrolled diabetes mellitus suddenly suffered from mesenteric arterial thrombosis. The surgically resected small bowel accompanied pneumatosis cystoides intestinalis (gas formation in the intestinal wall). Computed tomography scan demonstrated gas embolism filling the portal vein branches in the liver. Microscopically, gas-filled spaces were formed in the submucosa of the small bowel. Spore-forming Gram-positive large rods were discerned in the necrotic gut wall (**Figure 56**). Capsule formation by the spore-forming rods was proven with colloidal iron stain. Microbial culture of the blood identified *C. butyricum*. In contrast to

gas gangrene caused by *C. perfringens*, the prognosis of the patient with *C. butyricum*-induced gas gangrene is not so poor. In fact, this patient was alive for

*Lethal mucormycosis of rhinocerebral type in a poorly controlled diabetic male patient aged 60's (gross appearance). Angioinvasive mycosis resulted in hemorrhagic necrosis of the face and anteroinferior part of the*

*brain. Infection had been extended from the paranasal cavity.*

Neonatal necrotizing enterocolitis occurs in premature babies. The most likely cause of the disease is infection of *C. butyricum* [158–160]. Symptoms caused by small bowel necrosis include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile. Poor blood flow results in ischemic necrosis of the bowel wall. Pneumatosis cystoides intestinalis and perforation with pneumoperitoneum and peritonitis are often associated. Surgery is required in those who have free air in the abdominal cavity. Breastfeeding may prevent the disease. Probiotic studies have reported that peroral administration of *C. butyricum* improves or even prevents clinical manifestation of pseudomembranous colitis due to *C. difficile* infection and hemorrhagic colitis caused by enterohemorrhagic *Escherichia coli* (O-157, H7)

years after surgery [157].

*Pathogenic Bacteria*

**Figure 55.**

**132**

the lower part of the frontal lobe of the brain (**Figure 55**).

**14.3** *Clostridium butyricum***-induced necrotizing enteritis**

C. butyricum*-induced gas gangrene (necrotizing enteritis) (H&E and Gram). The small bowel was surgically removed for mesenteric arterial thrombosis in a male patient aged 30's with severe diabetes mellitus. Gas-filled spaces are formed in the submucosa. Spore-forming, Gram-positive, rugby ball-shaped large rods are identified seen in the necrotic gut wall.*

infection [161, 162]. Neonatal intestinal mucormycosis, clinically resembling neonatal necrotizing enterocolitis, is fetal and challenging to make an appropriate diagnosis [163, 164]. Risk factors include premature birth, malnutrition, and asphyxia. The entry of the organism is thought to be the oropharynx or nares. **Figure 57** demonstrates the representative microscopic features of lethal ileal mucormycosis seen in a premature baby.
