Journal article
A series of three cases of severe Clostridium difficile infection in Australia associated with a binary toxin producing clade 2 ribotype 251 strain
Anaerobe, Vol.55, pp.117-123
2018
Abstract
Three patients with severe Clostridium difficile infection (CDI) caused by an unusual strain of C. difficile, PCR ribotype (RT) 251, were identified in New South Wales, Australia. All cases presented with severe diarrhoea, two had multiple recurrences and one died following a colectomy. C. difficile RT251 strains were isolated by toxigenic culture. Genetic characterisation was performed using techniques including toxin gene profiling, PCR ribotyping, whole genome sequencing (WGS), in-silico multi-locus-sequence-typing (MLST) and core-genome single nucleotide variant (SNV) analyses. Antimicrobial susceptibility was determined using an agar incorporation method. In vitro toxin production was confirmed by Vero cell cytotoxicity assay and pathogenicity was assessed in a murine model of CDI. All RT251 isolates contained toxin A (tcdA), toxin B (tcdB) and binary toxin (cdtA and cdtB) genes. Core-genome analyses revealed the RT251 strains were clonal, with 0–5 SNVs between isolates. WGS and MLST clustered RT251 in the same evolutionary clade (clade 2) as RT027. Despite comparatively lower levels of in vitro toxin production, in the murine model RT251 infection resembled RT027 infection. Mice showed marked weight loss, severe disease within 48 h post-infection and death. All isolates were susceptible to metronidazole and vancomycin. Our observations suggest C. difficile RT251 causes severe disease and emphasise the importance of ongoing surveillance for new and emerging strains of C. difficile with enhanced virulence.
Details
- Title
- A series of three cases of severe Clostridium difficile infection in Australia associated with a binary toxin producing clade 2 ribotype 251 strain
- Authors/Creators
- M.C. Wehrhahn (Author/Creator) - Douglass Hanly Moir PathologyC. Keighley (Author/Creator) - Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead, NSW, Australia.J. Kurtovic (Author/Creator) - Prince of Wales HospitalD.R. Knight (Author/Creator) - Murdoch UniversityS. Hong (Author/Creator) - Queen Elizabeth II Medical CentreM.L. Hutton (Author/Creator) - Monash UniversityD. Lyras (Author/Creator) - Monash UniversityQ. Wang (Author/Creator) - Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead, NSW, Australia.R. Leong (Author/Creator) - Macquarie UniversityT. Borody (Author/Creator) - Centre For Digestive DiseasesM. Edye (Author/Creator) - Blacktown & Mount Druitt HospitalT.V. Riley (Author/Creator) - The University of Western Australia
- Publication Details
- Anaerobe, Vol.55, pp.117-123
- Publisher
- Academic Press
- Identifiers
- 991005542913307891
- Copyright
- © 2018 Elsevier Ltd.
- Murdoch Affiliation
- School of Veterinary and Life Sciences
- Language
- English
- Resource Type
- Journal article
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- 1 Clinical & Life Sciences
- 1.120 Inflammatory Bowel Diseases & Infections
- 1.120.1133 Clostridium Infections
- Web Of Science research areas
- Microbiology
- ESI research areas
- Microbiology