Don Vinh's hypothesis is interesting. However, the toxins of Clostridium perfringens essentially result in severe necrotizing enteritis, sparing the large bowel, in contrast to the hypervirulent C. difficile, which causes severe colitis,1 with little involvement of the small bowel. Nevertheless, the mechanism postulated deserves further investigation.
Jacques Pépin Department of Microbiology and Infectious Diseases University of Sherbrooke Sherbrooke, Que.
Reference
- 1.Pépin J, Valiquette L, Alary ME, Villemure P, Pelletier A, Forget K, et al. Clostridium difficile- associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171(5):466-72. [DOI] [PMC free article] [PubMed]