1887

Abstract

Introduction:

is a significant gastrointestinal pathogen and a leading cause of life-threatening diarrhoea in the developed world. Antibiotic therapy and immunodeficiency are key risk factors for infection (CDI); consequently, oncology patients are at high risk.

Case presentation:

We present two cases of CDI in unrelated oncology patients from different Western Australian hospitals in 2012. The first, a 59-year-old male, presented with diarrhoea 3 weeks after admission to hospital for treatment of a grade IV glioblastoma. Symptoms commenced after receiving prophylactic perioperative cephazolin. The second case was a 2-year-old female who presented with several episodes of diarrhoea after extended hospitalization following treatment for a stage 4 neuroblastoma. The patient had been exposed to regimens of piperacillin/tazobactam and ciprofloxacin for febrile neutropaenia and intra-abdominal sepsis. In both cases, the diarrhoea resolved after commencement of oral metronidazole. Both patients had an uncommon strain of (PCR ribotype 126) detected in stool specimens, and both strains belonged to an unusual multilocus sequence type (ST), ST258. Comparison of the genomes of both strains by whole-genome sequencing showed them to be indistinguishable (no single-nucleotide variants). No epidemiological link between the patients was identified.

Conclusion:

These data suggest that both cases resulted from exposure to a common source, most likely food contaminated with livestock faeces. Moreover, this is the first report of ribotype 126 isolates belonging to a ST (ST258) other than ST11. Our cases highlight the need for continued molecular surveillance of , and the genetic analysis of emerging ribotypes.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.000043
2015-06-01
2019-11-18
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/2/3/jmmcr000043.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.000043&mimeType=html&fmt=ahah

References

  1. Barbut F , Decré D , Lalande V , Burghoffer B , Noussair L , Gigandon A , Espinasse F , Raskine L , Robert J , other authors . 2005; Clinical features of Clostridium difficile-associated diarrhoea due to binary toxin (actin-specific ADP-ribosyltransferase)-producing strains. J Med Microbiol 54: 181– 185 [CrossRef]
    [Google Scholar]
  2. Bauer M.P , Notermans D.W , van Benthem B.H , Brazier J.S , Wilcox M.H , Rupnik M , Monnet D.L , van Dissel J.T , Kuijper E.J , ECDIS Study Group . 2011; Clostridium difficile infection in Europe: a hospital-based survey. Lancet 377: 63– 73 [CrossRef]
    [Google Scholar]
  3. Boseiwaqa L.V , Foster N.F , Thean S.K , Squire M.M , Riley T.V , Carson K.C . 2013; Comparison of ChromID C. difficile agar and cycloserine-cefoxitin-fructose agar for the recovery of Clostridium difficile . Pathology 45: 495– 500 [CrossRef]
    [Google Scholar]
  4. Cairns M.D , Stabler R.A , Shetty N , Wren B.W . 2012; The continually evolving Clostridium difficile species. Future Microbiol 7: 945– 957 [CrossRef]
    [Google Scholar]
  5. Chopra T , Alangaden G.J , Chandrasekar P . 2010; Clostridium difficile infection in cancer patients and hematopoietic stem cell transplant recipients. Expert Rev Anti Infect Ther 8: 1113– 1119 [CrossRef]
    [Google Scholar]
  6. Curry S.R , Marsh J.W , Muto C.A , O'Leary M.M , Pasculle A.W , Harrison L.H . 2007; tcdC genotypes associated with severe TcdC truncation in an epidemic clone and other strains of Clostridium difficile . J Clin Microbiol 45: 215– 221 [CrossRef]
    [Google Scholar]
  7. Didelot X , Falush D . 2007; Inference of bacterial microevolution using multilocus sequence data. Genetics 175: 1251– 1266 [CrossRef]
    [Google Scholar]
  8. Didelot X , Eyre D.W , Cule M , Ip C.L , Ansari M.A , Griffiths D , Vaughan A , O'Connor L , Golubchik T , other authors . 2012; Microevolutionary analysis of Clostridium difficile genomes to investigate transmission. Genome Biol 13: R118 [CrossRef]
    [Google Scholar]
  9. Elliott B , Squire M.M , Thean S , Chang B.J , Brazier J.S , Rupnik M , Riley T.V . 2011; New types of toxin A-negative, toxin B-positive strains among clinical isolates of Clostridium difficile in Australia. J Med Microbiol 60: 1108– 1111 [CrossRef]
    [Google Scholar]
  10. Eyre D.W , Walker A.S . 2013; Clostridium difficile surveillance: harnessing new technologies to control transmission. Expert Rev Anti Infect Ther 11: 1193– 1205 [CrossRef]
    [Google Scholar]
  11. Eyre D.W , Cule M.L , Wilson D.J , Griffiths D , Vaughan A , O'Connor L , Ip C.L , Golubchik T , Batty E.M , other authors . 2013; Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 369: 1195– 1205 [CrossRef]
    [Google Scholar]
  12. Eyre D.W , Tracey L , Elliott B , Slimings C , Huntington P.G , Stuart R , Korman T , Kotsiou G , Griffiths D , other authors . 2015; Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia. Euro Surveill 20: pii = 21059
    [Google Scholar]
  13. Foster N.F , Collins D.A , Ditchburn S.L , Duncan C.N , van Schalkwyk J.W , Golledge C.L , Keed ABR , Riley T.V . 2014; Epidemiology of Clostridium difficile infection in two tertiary-care hospitals in Perth, Western Australia: a cross-sectional study. New Microbes New Infect 2: 64– 71 [CrossRef]
    [Google Scholar]
  14. Freeman J , Bauer M.P , Baines S.D , Corver J , Fawley W.N , Goorhuis B , Kuijper E.J , Wilcox M.H . 2010; The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev 23: 529– 549 [CrossRef]
    [Google Scholar]
  15. Goorhuis A , Bakker D , Corver J , Debast S.B , Harmanus C , Notermans D.W , Bergwerff A.A , Dekker F.W , Kuijper E.J . 2008; Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. Clin Infect Dis 47: 1162– 1170 [CrossRef]
    [Google Scholar]
  16. Griffiths D , Fawley W , Kachrimanidou M , Bowden R , Crook D.W , Fung R , Golubchik T , Harding R.M , Jeffery K.J , other authors . 2010; Multilocus sequence typing of Clostridium difficile . J Clin Microbiol 48: 770– 778 [CrossRef]
    [Google Scholar]
  17. Hart J , Putsathit P , Knight D.R , Sammels L , Riley T.V , Keil A . 2014; Clostridium difficile infection diagnosis in a paediatric population: comparison of methodologies. Eur J Clin Microbiol Infect Dis 33: 1555– 1564 [CrossRef]
    [Google Scholar]
  18. He M , Miyajima F , Roberts P , Ellison L , Pickard D.J , Martin M.J , Connor T.R , Harris S.R , Fairley D , other authors . 2013; Emergence and global spread of epidemic healthcare-associated Clostridium difficile . Nat Genet 45: 109– 113 [CrossRef]
    [Google Scholar]
  19. Heinlen L , Ballard J.D . 2010; Clostridium difficile infection. Am J Med Sci 340: 247– 252 [CrossRef]
    [Google Scholar]
  20. Hung Y.P , Lin H.J , Tsai B.Y , Liu H.C , Liu H.C , Lee J.C , Wu Y.H , Wilcox M.H , Fawley W.N , other authors . 2014; Clostridium difficile ribotype 126 in southern Taiwan: a cluster of three symptomatic cases. Anaerobe 30: 188– 192 [CrossRef]
    [Google Scholar]
  21. Jamal W , Rotimi V.O , Brazier J , Duerden B.I . 2010; Analysis of prevalence, risk factors and molecular epidemiology of Clostridium difficile infection in Kuwait over a 3-year period. Anaerobe 16: 560– 565 [CrossRef]
    [Google Scholar]
  22. Khanna S , Pardi D.S . 2014; Clostridium difficile infection: management strategies for a difficult disease. Therap Adv Gastroenterol 7: 72– 86 [CrossRef]
    [Google Scholar]
  23. Kim J , Shaklee J.F , Smathers S , Prasad P , Asti L , Zoltanski J , Dul M , Nerandzic M , Coffin S.E , other authors . 2012; Risk factors and outcomes associated with severe clostridium difficile infection in children. Pediatr Infect Dis J 31: 134– 138 [CrossRef]
    [Google Scholar]
  24. Knight D.R , Riley T.V . 2014; Prevalence, concentration and molecular epidemiology of Clostridium difficile on neonatal calf carcasses in Australia. . In Proceedings of the 39th Annual Scientific Meeting of the Australian Society for Microbiology, pp. xx Melbourne, Australia. Abstract A323
    [Google Scholar]
  25. Knight D.R , Thean S , Putsathit P , Fenwick S , Riley T.V . 2013; Cross-sectional study reveals high prevalence of Clostridium difficile non-PCR ribotype 078 strains in Australian veal calves at slaughter. Appl Environ Microbiol 79: 2630– 2635 [CrossRef]
    [Google Scholar]
  26. Knight D.R , Squire M.M , Riley T.V . 2014; Nationwide surveillance study of Clostridium difficile in Australian neonatal pigs shows high prevalence and heterogeneity of PCR ribotypes. Appl Environ Microbiol 81: 119– 123 [CrossRef]
    [Google Scholar]
  27. Leffler D.A , Lamont J.T . 2012; Editorial: not so nosocomial anymore: the growing threat of community-acquired Clostridium difficile . Am J Gastroenterol 107: 96– 98 [CrossRef]
    [Google Scholar]
  28. Lim S.K , Stuart R.L , Mackin K.E , Carter G.P , Kotsanas D , Francis M.J , Easton M , Dimovski K , Elliott B , other authors . 2014; Emergence of a ribotype 244 strain of Clostridium difficile associated with severe disease and related to the epidemic ribotype 027 strain. Clin Infect Dis 58: 1723– 1730 [CrossRef]
    [Google Scholar]
  29. Lipovsek S , Leitinger G , Rupnik M . 2013; Ultrastructure of Clostridium difficile colonies. Anaerobe 24: 66– 70 [CrossRef]
    [Google Scholar]
  30. Palmore T.N , Sohn S , Malak S.F , Eagan J , Sepkowitz K.A . 2005; Risk factors for acquisition of Clostridium difficile-associated diarrhea among outpatients at a cancer hospital. Infect Control Hosp Epidemiol 26: 680– 684 [CrossRef]
    [Google Scholar]
  31. Rupnik M . 2007; Is Clostridium difficile-associated infection a potentially zoonotic and foodborne disease?. Clin Microbiol Infect 13: 457– 459 [CrossRef]
    [Google Scholar]
  32. Schneeberg A , Neubauer H , Schmoock G , Baier S , Harlizius J , Nienhoff H , Brase K , Zimmermann S , Seyboldt C . 2013a; Clostridium difficile genotypes in piglet populations in Germany. J Clin Microbiol 51: 3796– 3803 [CrossRef]
    [Google Scholar]
  33. Schneeberg A , Neubauer H , Schmoock G , Grossmann E , Seyboldt C . 2013b; Presence of Clostridium difficile PCR ribotype clusters related to 033, 078 and 045 in diarrhoeic calves in Germany. J Med Microbiol 62: 1190– 1198 [CrossRef]
    [Google Scholar]
  34. Schneeberg A , Ehricht R , Slickers P , Baier V , Neubauer H , Zimmermann S , Rabold D , Lübke-Becker A , Seyboldt C . 2015; DNA microarray-based PCR ribotyping of Clostridium difficile . J Clin Microbiol 53: 433– 442 [CrossRef]
    [Google Scholar]
  35. Slimings C , Armstrong P , Beckingham W.D , Bull A.L , Hall L , Kennedy K.J , Marquess J , McCann R , Menzies A , other authors . 2014; Increasing incidence of Clostridium difficile infection, Australia, 2011–2012. Med J Aust 200: 272– 276 [CrossRef]
    [Google Scholar]
  36. Stabler R.A , Dawson L.F , Valiente E , Cairns M.D , Martin M.J , Donahue E.H , Riley T.V , Songer J.G , Kuijper E.J , other authors . 2012; Macro and micro diversity of Clostridium difficile isolates from diverse sources and geographical locations. PLoS One 7: e31559 [CrossRef]
    [Google Scholar]
  37. Stewart D.B , Berg A.S , Hegarty J.P . 2014; Single nucleotide polymorphisms of the tcdC gene and presence of the binary toxin gene predict recurrent episodes of Clostridium difficile infection. Ann Surg 260: 299– 304 [CrossRef]
    [Google Scholar]
  38. Walker A.S , Eyre D.W , Wyllie D.H , Dingle K.E , Griffiths D , Shine B , Oakley S , O'Connor L , Finney J , other authors . 2013; Relationship between bacterial strain type, host biomarkers, and mortality in Clostridium difficile infection. Clin Infect Dis 56: 1589– 1600 [CrossRef]
    [Google Scholar]
  39. Zerbino D.R , Birney E . 2008; Velvet: algorithms for de novo short read assembly using de Bruijn graphs. Genome Res 18: 821– 829 [CrossRef]
    [Google Scholar]
  40. Zidaric V , Pardon B , Dos Vultos T , Deprez P , Brouwer M.S , Roberts A.P , Henriques A.O , Rupnik M . 2012; Different antibiotic resistance and sporulation properties within multiclonal Clostridium difficile PCR ribotypes 078, 126, and 033 in a single calf farm. Appl Environ Microbiol 78: 8515– 8522 [CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.000043
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.000043
Loading

Data & Media loading...

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error