Bacteremia with a large clostridial toxin-negative, binary toxin-positive strain of Clostridium difficile

Elliott, Briony; Reed, Robert P.; Chang, Barbara J.; Riley, Thomas V.

doi:10.1016/j.anaerobe.2009.08.006

Cited by 35 publications

(26 citation statements)

References 25 publications

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“…In nontoxigenic strains, a short, 115-bp sequence is typically found in the insertion site instead of the PaLoc (9). Recently, 75-bp and 7.2-kb sequences at the PaLoc insertion site have also been described (10,11). Horizontal gene transfer of the PaLoc has been previously shown (12), but the type of the mobile element or transfer mechanism has not been reported so far.…”

Section: Paloc-a Toxin a And B Coding Regionmentioning

confidence: 99%

An Update on Clostridium difficile Toxinotyping

Rupnik

Janežič

2016

J Clin Microbiol

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cToxinotyping is a PCR-restriction fragment length polymorphism (RFLP)-based method for differentiation of Clostridium difficile strains according to the changes in the pathogenicity locus (PaLoc), a region coding for toxins A and B. Toxinotypes are a heterogenous group of strains that are important in the development of molecular diagnostic tests and vaccines and are a good basis for C. difficile phylogenetic studies. Here we describe an overview of the 34 currently known toxinotypes (I to XXXIV) and some changes in nomenclature.

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Section: Paloc-a Toxin a And B Coding Regionmentioning

confidence: 99%

An Update on Clostridium difficile Toxinotyping

Rupnik

Janežič

2016

J Clin Microbiol

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“…However, recent MLST and WGS studies have shown that clade 5 is more heterogeneous than first thought, including not only RT078 but also numerous RTs (RT033, RT045, RT066, RT126, RT127, RT237, RT280, RT281, and RT288) from a diverse collection of clinical, animal, and food sources worldwide (46,102,103). Some clade 5 strains show an atypical arrangement of the PaLoc, specifically the genes for LCTs A and B. RT237, which has been recovered from pigs and humans in Australia, is positive for toxin B but negative for toxin A (A Ϫ B ϩ ) while also possessing binary toxin (CDT ϩ ) (104). In RT033 and RT288, CDT is present; however, the entire tcdB gene and the majority of tcdA are absent (41, 105).…”

Section: Phylogenetics and Molecular Epidemiologymentioning

confidence: 99%

Diversity and Evolution in the Genome of Clostridium difficile

et al. 2015

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SUMMARY Clostridium difficile infection (CDI) is the leading cause of antimicrobial and health care-associated diarrhea in humans, presenting a significant burden to global health care systems. In the last 2 decades, PCR- and sequence-based techniques, particularly whole-genome sequencing (WGS), have significantly furthered our knowledge of the genetic diversity, evolution, epidemiology, and pathogenicity of this once enigmatic pathogen. C. difficile is taxonomically distinct from many other well-known clostridia, with a diverse population structure comprising hundreds of strain types spread across at least 6 phylogenetic clades. The C. difficile species is defined by a large diverse pangenome with extreme levels of evolutionary plasticity that has been shaped over long time periods by gene flux and recombination, often between divergent lineages. These evolutionary events are in response to environmental and anthropogenic activities and have led to the rapid emergence and worldwide dissemination of virulent clonal lineages. Moreover, genome analysis of large clinically relevant data sets has improved our understanding of CDI outbreaks, transmission, and recurrence. The epidemiology of CDI has changed dramatically over the last 15 years, and CDI may have a foodborne or zoonotic etiology. The WGS era promises to continue to redefine our view of this significant pathogen.

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“…For example, with the emergence of toxin A-negative strains associated with severe clinical disease, assays that rely solely on detection of toxin A are generally no longer used (36,84,191) (Table 6). It has also been reported that assay performance might vary depending upon the strain type (118).…”

Section: Evolving Epidemiology Clinical Implications Of Strain Typingmentioning

confidence: 99%

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

2013

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SUMMARY Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile . This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.

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Bacteremia with a large clostridial toxin-negative, binary toxin-positive strain of Clostridium difficile

Cited by 35 publications

References 25 publications

An Update on Clostridium difficile Toxinotyping

An Update on Clostridium difficile Toxinotyping

Diversity and Evolution in the Genome of Clostridium difficile

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

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