Novel Molecular Type of<i>Clostridium difficile</i>in Neonatal Pigs, Western Australia

Squire, Michele M.; Carter, Glen P.; Mackin, Kate E.; Chakravorty, Anjana; Norén, Torbjörn; Elliott, Briony; Lyras, Dena; Riley, Thomas V.

doi:10.3201/eid1905.121062

Cited by 39 publications

(45 citation statements)

References 15 publications

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“…It is worth noting that toxin A þ BÀ isolates of C. difficile have not been described in nature. Toxin AÀ toxin Bþ strains have been widely reported in human cases [138] but also in animals suffering from diarrhoea [139]. A previous study reported that toxin AÀ toxin Bþ strains caused the same spectrum of disease that is associated with toxin Aþ toxin Bþ strains, ranging from asymptomatic colonisation to fulminant colitis, with outbreaks in hospitals and other healthcare settings worldwide [135].…”

Section: Difficile Characteristics and Its Toxinsmentioning

confidence: 99%

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Rodríguez

Broeck

Taminiau

et al. 2016

Microbial Pathogenesis

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a b s t r a c tRecognised as the leading cause of nosocomial antibiotic-associated diarrhoea, the incidence of Clostridium difficile infection (CDI) remains high despite efforts to improve prevention and reduce the spread of the bacterium in healthcare settings. In the last decade, many studies have focused on the epidemiology and rapid diagnosis of CDI. In addition, different typing methods have been developed for epidemiological studies. This review explores the history of C. difficile and the current scope of the infection. The variety of available laboratory tests for CDI diagnosis and strain typing methods are also examined.

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Section: Difficile Characteristics and Its Toxinsmentioning

confidence: 99%

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Rodríguez

Broeck

Taminiau

et al. 2016

Microbial Pathogenesis

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“…Up until recently, all known A Ϫ B ϩ toxinotypes had at least a part of the tcdA gene present and the entire or deleted version of tcdC (7). An Australian group described the first A Ϫ B ϩ variants (toxinotypes XXX and XXXI) lacking the complete tcdA gene and two accessory genes (tcdE and tcdC); however, each of these were binary toxin positive (A Ϫ B ϩ CDT ϩ ) (13,14). In addition to lacking tcdA and tcdC, toxinotype XXXII also has no binary toxin CDT genes (A Ϫ B ϩ CDT Ϫ ).…”

mentioning

confidence: 99%

A New Type of Toxin A-Negative, Toxin B-Positive Clostridium difficile Strain Lacking a Complete tcdA Gene

et al. 2015

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Clostridium difficile is the main cause of community and nosocomial diarrhea associated with antibiotic treatment and has major health care and economic impacts (1-3).Three toxins, toxin A (TcdA, enterotoxin), toxin B (TcdB, cytotoxin), and binary toxin CDT (Clostridium difficile transferase), are produced by C. difficile. CDT is present in only a subset of strains, and its role in pathogenesis is increasingly recognized but still unclear (4). Toxins A and B are the main virulence factors causing damage to the intestinal epithelium and producing diarrhea and inflammation. They are also a main target for enzymebased or molecular diagnostic tests (5, 6). Genes encoding TcdA and TcdB are located on the chromosome and together with three additional genes (tcdR, tcdE, and tcdC) form a 19.6-kb pathogenicity locus (PaLoc). The genes for CDT toxin are located elsewhere on the chromosome (CdtLoc).C. difficile strains can be differentiated based on different patterns of toxin production. Strains which do not produce any of the toxins are nontoxinogenic and do not cause disease. The majority of toxigenic strains are TcdA and TcdB positive (A ϩ B ϩ ), but some strains produce only TcdB (A Ϫ B ϩ ). Toxigenic strains can be further differentiated into toxinotypes based on changes (deletions, insertions, single nucleotide polymorphisms [SNPs]) in the PaLoc. By 2008, 24 different toxinotypes had been published (7), and currently, 31 toxinotypes, designated by roman numbers from I to XXXI, are differentiated (see http://www.mf.uni-mb.si /tox/). Here, we describe a case history and the isolation and characterization of a new A Ϫ B ϩ variant of C. difficile. Case Report. A 68-year-old Spanish male followed as an outpatient at the Gregorio Marań on University Hospital of Madrid because of ischemic cardiomyopathy, angina, and chronic pancreatitis was admitted to the emergency department in October 2011 with a 21-day history of diarrhea. The patient did not have fever, and his general condition was good, but he reported a recent weight loss of 5 kg. Stool microbiological studies were requested at the emergency department for enteropathogens, antigens of rotavirus and adenovirus, intestinal parasites, and C. difficile culture and toxin detection. A direct cytotoxicity assay was performed by centrifuging stool specimen dilutions (1/40) made with phosphate-buffered saline and filtering 500 l of supernatant onto monolayers of human MRC-5 fibroblasts. A test result was considered negative only after 48 h of incubation at 37°C. The specificity of the cytopathic effect was confirmed using a neutralizing high-titer C. difficile antitoxin (TechLab) following the manufacturer's instructions.The rapid detection of glutamate dehydrogenase (GDH) and toxins A and B (C. diff Quik Chek Complete; Techlab, Blacksburg, VA) was also performed on stool specimens showing positive results for GDH but negative results for toxins A and B. Following international recommendations (5, 6), the GeneXpert C. difficile assay (Cepheid, Sunnyvale, CA, USA) was then p...

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“…This was supported by Couturier et al, who reported detection of the tcdA target sequence in A Ϫ B ϩ strains belonging to toxinotypes VIII and X using the illumigene C. difficile assay (13), and in the present study for RT017 (toxinotype VIII) strains which have a truncated tcdA gene retaining only the A1 fragment of the gene (4). Other A Ϫ B ϩ ribotypes tested (RT237, RT280, and RT281) that were known to contain a truncated tcdA region (14,15) were not detected by the illumigene C. difficile assay. Therefore, in addition to PaLoc-negative C. difficile, the target region of the illumigene C. difficile assay is not conserved in the PaLocs of RT033, RT237, RT280, and RT281 strains.…”

mentioning

confidence: 97%

“…As a common ribotype in veal calves and piglets in some parts of the world, the presence of RT033 isolates should be a concern for the veterinary industry (6,16). While the role of C. difficile in idiopathic diarrhea in calves is still unclear, C. difficile is the most frequent cause of piglet neonatal diarrhea in the United States (15). The RT033 strain has also been isolated from symptomatic human patients, suggesting possible zoonotic transmission (12).…”

mentioning

confidence: 99%

Evaluation of the Cepheid Xpert C. difficile/ Epi and Meridian Bioscience illumi gene C. difficile Assays for Detecting Clostridium difficile Ribotype 033 Strains

et al. 2015

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bClostridium difficile PCR ribotype 033 (RT033) is found in the gastrointestinal tracts of production animals and, occasionally, humans. The illumigene C. difficile assay (Meridian Bioscience, Inc.) failed to detect any of 52 C. difficile RT033 isolates, while all strains signaled positive for the binary toxin genes but were reported as negative for C. difficile by the Xpert C. difficile/Epi assay (Cepheid).

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Novel Molecular Type ofClostridium difficilein Neonatal Pigs, Western Australia

Cited by 39 publications

References 15 publications

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

A New Type of Toxin A-Negative, Toxin B-Positive Clostridium difficile Strain Lacking a Complete tcdA Gene

Evaluation of the Cepheid Xpert C. difficile/ Epi and Meridian Bioscience illumi gene C. difficile Assays for Detecting Clostridium difficile Ribotype 033 Strains

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