Clostridium perfringens foodborne illness is characterized by a sudden onset of watery diarrhea and moderate to severe, crampy, midepigastric pain. Vomiting and fever are uncommon. Symptoms usually resolve within 24 hours. The short incubation period, short duration, and absence of fever in most patients differentiates C perfringens foodborne disease from shigellosis and salmonellosis, and the infrequency of vomiting and longer incubation period contrast with the clinical features of foodborne disease associated with heavy metals, Staphylococcus aureus enterotoxins, and fish and shellfish toxins. Diarrheal illness caused by Bacillus cereus enterotoxin can be indistinguishable from that caused by C perfringens (see Appendix IX, Clinical Syndromes Associated With Foodborne Diseases). Enteritis necroticans (known locally as pigbel) is a cause of severe illness and death attributable to C perfringens food poisoning among children in Papua, New Guinea. Rare cases have been reported elsewhere.