Clostridium difficile infection in the community: a zoonotic disease?

Abstract

Clin Microbiol Infect 2012; 18: 635–645 Abstract Clostridium difficile infections (CDIs) are traditionally seen in elderly and hospitalized patients who have used antibiotic therapy. In the community, CDIs requiring a visit to a general practitioner are increasingly occurring among young and relatively healthy individuals without known predisposing factors. C. difficile is also found as a commensal or pathogen in the intestinal tracts of most mammals, and various birds and reptiles. In the environment, including soil and water, C. difficile may be ubiquitous; however, this is based on limited evidence. Food products such as (processed) meat, fish and vegetables can also contain C. difficile, but studies conducted in Europe report lower prevalence rates than in North America. Absolute counts of toxigenic C. difficile in the environment and food are low, however the exact infectious dose is unknown. To date, direct transmission of C. difficile from animals, food or the environment to humans has not been proven, although similar PCR ribotypes are found. We therefore believe that the overall epidemiology of human CDI is not driven by amplification in animals or other sources. As no outbreaks of CDI have been reported among humans in the community, host factors that increase vulnerability to CDI might be of more importance than increased exposure to C. difficile. Conversely, emerging C. difficile ribotype 078 is found in high numbers in piglets, calves, and their immediate environment. Although there is no direct evidence proving transmission to humans, circumstantial evidence points towards a zoonotic potential of this type. In future emerging PCR ribotypes, zoonotic potential needs to be considered.

Clostridium difficile infection: Evolution, phylogeny and molecular epidemiology

“…transmission (Hensgens et al, 2012;Lund and Peck, 2015). Detection of C. difficile in meat is rare (Knight et al, 2016b;Lund and Peck, 2015), however, and it may simply be that the rise of this strain is due to amplification in production herds and contamination of the environment (Casey et al, 2015).…”

Clostridium difficile Infection

“…For these reasons, the model is suitable to study colonization, transmission and persistence phenotypes 38,148,149 . A piglet model is of particular interest to study C. difficile strains that are problematic in both animal and human populations 13,35,150 . In vitro gut models have been developed to study interactions of C. difficile with therapeutics in the context of a complex microbiome 13,151,152 .…”

“…Given the multiple comorbidities (such as respiratory disease and renal failure) typically present in patients with CDI, mortality is often related to one or more of these conditions. C. difficile is a human pathogen but can also infect and cause disease in animals that can enter the food chain; however, the relevance of foodborne transmission in human disease is unclear 13 . Since the beginning of 2000, C. difficile has been reported as a major cause of neonatal enteritis in piglets.…”

Investigation of Clostridium difficile interspecies relatedness using multilocus sequence typing, multilocus variable-number tandem-repeat analysis and antimicrobial susceptibility testing

“…Several outbreaks have been reported in recent years, particularly in hospitals, making C. difficile a primarily nosocomial pathogen in humans (Jones et al, 2013). However, the increasing number of C. difficile infections (CDI) acquired in the community (Hensgens et al, 2012) and the large number of reports describing food (Rodriguez-Palacios et al, 2013), animal (Susick et al, 2012) and environmental (Zidaric et al, 2010;Hargreaves et al, 2013) reservoirs of the bacterium suggest possible transmission outside healthcare settings. For this reason, several studies have considered food and animals as potential sources for human community-acquired CDI (Rodriguez-Palacios et al, 2013).…”