<i>Clostridium difficile</i>‐Associated Diseases: Comparison of Symptomatic Infection Versus Carriage on the Basis of Risk Factors, Toxin Production, and Genotyping Results

Cheng, Shu‐Hsing; Lu, Jang‐Jih; Young, Ton-Ho; Perng, Cherng‐Lih; Chi, Wei-Ming

doi:10.1086/516891

Cited by 26 publications

(15 citation statements)

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“…There was no association between the PCR ribotype of the infecting strain and the severity of disease. In accord with this result, others found no particular PCR ribotype predominant in cases of severe or relapsing CDAD (5,27,36,39), and the distributions of C. difficile immunoblot types were similar in symptomatic patients and in healthy carriers (24). However, Fawley et al (10) reported that a total of 17 strain types were isolated from both symptomatic patients and the hospital environment during a 4-year period, but only 4 of 17 types resulted in CDAD, suggesting a correlation between type and virulence.…”

Section: Discussionsupporting

confidence: 58%

“…A cohort study showed no difference in the distributions of C. difficile immunoblot types between asymptomatic carriers and CDAD patients, suggesting that patient factors or bacterial numbers contribute to disease more than the properties of specific C. difficile strain types (24). In addition, for a total of 62 C. difficile strains isolated from 17 patients with CDAD and 11 carriers and typed by PCR ribotyping and by use of randomly amplified polymorphic DNA, no significant correlation between genotype and disease severity was found (5). In the United Kingdom, PCR ribotype 001 was shown to dominate in hospital settings nationwide but not in community-acquired CDAD, suggesting that this PCR ribotype (or a subtype) has an increased attack rate or greater ability for nosocomial spread (35).…”

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confidence: 94%

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Correlation of Disease Severity with Fecal Toxin Levels in Patients with Clostridium difficile -Associated Diarrhea and Distribution of PCR Ribotypes and Toxin Yields In Vitro of Corresponding Isolates

Svenungsson²,

et al. 2006

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We investigated in vivo and in vitro yields of toxins A and B from and PCR ribotypes of Clostridium difficile isolates from 164 patients with differing severities of C. difficile-associated diarrhea (CDAD) (patients were grouped as follows: <3 loose stools per day, n ‫؍‬ 45; 3 to 10 per day, n ‫؍‬ 97; >10 per day, n ‫؍‬ 22). The median fecal toxin levels in each group were 0.5, 6.8, and 149 U/g feces (P < 0.001), respectively. Patients with severe diarrhea also had more-frequent occurrence of blood in stool and vomiting, but there was no association with fecal toxin levels per se. There was no correlation between fecal toxin level and toxin yield in vitro for the corresponding C. difficile isolate or between its PCR ribotype and disease severity. A broad range of toxin yields among isolates belonging to major PCR ribotypes indicated a presence of many subtypes. We hypothesize that bacterial and host factors that affect C. difficile toxin levels in feces are important determinants of symptoms in CDAD patients. An inverse correlation between toxin yield and spore count (r ‫؍‬ 0.66) in stationary-phase cultures supported the notion that toxin production and sporulation represent opposite alternative survival strategies for C. difficile cells facing nutrient shortage.Most strains of Clostridium difficile produce two toxins, A and B, that cause C. difficile-associated diarrhea (CDAD) with symptoms ranging from mild diarrhea to pseudomembranous colitis. CDAD is associated mainly with the use of antibiotics that reduce the protective microflora, which allows for overgrowth and toxin production by C. difficile (21), and chemostat and animal studies have verified that certain antibiotics induce C. difficile growth, toxin production, and toxin release (11,29,31). Furthermore, the age of the patient, underlying diseases, and levels of toxin-neutralizing antibodies are factors that affect attack rate, severity of disease, and the risk of relapse of CDAD (17,18,21,38). In addition, factors that differ between toxin-producing C. difficile strains, e.g., the amount of toxin produced, the serogroup, and the surface layer protein composition, may affect symptoms (12,14,20,25,32,33). For example, strains of C. difficile belonging to specific serogroups are highly virulent in animal models (3,8), but whether C. difficile strain types differ in terms of virulence in humans is less clear.The epidemiology and disease pattern of C. difficile strains have been studied by several methods, e.g., serotyping, toxinotyping, and PCR ribotyping (4). A cohort study showed no difference in the distributions of C. difficile immunoblot types between asymptomatic carriers and CDAD patients, suggesting that patient factors or bacterial numbers contribute to disease more than the properties of specific C. difficile strain types (24). In addition, for a total of 62 C. difficile strains isolated from 17 patients with CDAD and 11 carriers and typed by PCR ribotyping and by use of randomly amplified polymorphic DNA, no significant correlation between ge...

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Section: Discussionsupporting

confidence: 58%

mentioning

confidence: 94%

Correlation of Disease Severity with Fecal Toxin Levels in Patients with Clostridium difficile -Associated Diarrhea and Distribution of PCR Ribotypes and Toxin Yields In Vitro of Corresponding Isolates

Svenungsson²,

et al. 2006

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“…In studies of C. difficile strains in patients with CDAD when compared to asymptomatic carriers, no difference has been found between organisms in each group. These data suggest that the development of CDAD may, in many cases, be primarily related to host bacterial flora composition and immunity rather than specific C. difficile strain type [20,21]. A study of different strains in patients with mild, moderate, and severe CDAD also failed to show a correlation between strain type and severity of disease [22].…”

Section: Clostridium Difficile Infection and The Immune Responsementioning

confidence: 99%

Clostridium Difficile Infection in Non–HIV-Immunocompromised Patients and in HIV-Infected Patients

Raines

Lopez

2011

Curr Gastroenterol Rep

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Clostridium difficile infection is a common cause of morbidity in patients with HIV infection and in patients with non-HIV immune deficiency. The frequency of C. difficile--associated diarrhea (CDAD) seen in these two patient populations has been attributed to immune deficiency, as well as to increased exposure to hospital environments and antibiotic therapy, both of which are major risk factors for CDAD. This article reviews recent data useful in the evaluation, treatment, and prevention of C. difficile infection in these patient groups. Recent publications relating to C. difficile infection in specific immunocompromised conditions are also discussed.

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“…[24] In another study also no strain-specific difference for asymptomatic carrier versus patients with CDAD were seen and most strains from both the groups were toxigenic in vitro. [25] The antibody response before infection with C. difficile might also be very important in stopping the development of symptoms.…”

Section: Resultsmentioning

confidence: 99%

Effect of biotherapeutics on antitoxin IgG in experimentally induced Clostridium difficile infection

Kaur

Vaishnavi

Kochhar

et al. 2012

Indian Journal of Medical Microbiology

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Clostridium difficile‐Associated Diseases: Comparison of Symptomatic Infection Versus Carriage on the Basis of Risk Factors, Toxin Production, and Genotyping Results

Cited by 26 publications

References 0 publications

Correlation of Disease Severity with Fecal Toxin Levels in Patients with Clostridium difficile -Associated Diarrhea and Distribution of PCR Ribotypes and Toxin Yields In Vitro of Corresponding Isolates

Correlation of Disease Severity with Fecal Toxin Levels in Patients with Clostridium difficile -Associated Diarrhea and Distribution of PCR Ribotypes and Toxin Yields In Vitro of Corresponding Isolates

Clostridium Difficile Infection in Non–HIV-Immunocompromised Patients and in HIV-Infected Patients

Effect of biotherapeutics on antitoxin IgG in experimentally induced Clostridium difficile infection

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