Prevalence and characterization of Clostridium perfringens toxinotypes among patients with antibiotic-associated diarrhea in Iran

Abstract

Clostridium perfringens has emerged as an important cause of antibiotic-associated diarrhea (AAD), particularly in the hospital environment. Here we investigated the prevalence and molecular epidemiology of C. perfringens isolated from 2280 fecal samples from Iranian diarrheal patients suspected of having AAD. Overall, AAD was diagnosed in 13.3% (303/2280) of patients and associated with advanced age (>50 years, P = 0.001). A total of 106 C. perfringens isolates were cultured from AAD ( n = 68) and non-AAD ( n = 38) groups, with toxinotypes A and F comprising 84% and 16% of isolates, respectively. Notably, 41.2% of type F strains were also cpb2 -positive and enterotoxigenic cpe -positive strains were detected in 13.2% of the isolates from AAD patients. Genes associated with the VirR/VirS signal transduction ( virR , virS ) and accessory gene regulator ( agrB , agrD ) systems were detected in 56.6% and 67% of the isolates, respectively, and peptides of the quorum-sensing modulator, AgrD were highly conserved across all strains. The high prevalence of C. perfringens in Iranian AAD patients suggests that diagnostic laboratories in this region should consider screening for C. perfringens in cases of suspected AAD, especially if the specimen is negative for other pathogens and/or the patients are aged >50 years.

Prevalence and Genetic Diversity of Clostridium perfringens Isolates in Hospitalized Diarrheal Patients from Central China

“…2 CPE-positive C. perfringens subtypes are responsible for causing food poisoning (FP) and non-foodborne gastrointestinal (GI) diseases such as AAD and SD. [3][4][5] Type F represents the formerly called CPEpositive isolates of C. perfringens type A and produces CPA and CPE toxins. Recently, Azimirad et al reported that 13.3% of patients with AAD carried type F isolates, demonstrating the importance of type F in the development of AAD.…”

“…Recently, Azimirad et al reported that 13.3% of patients with AAD carried type F isolates, demonstrating the importance of type F in the development of AAD. 4 Additionally, type F was reported as an essential infection source for asymptomatic carriers and foodborne diseases. 6 Clostridium perfringens type C and type D also express CPE, 1 and type C can cause enteric diseases characterized by vomiting, diarrhea, and abdominal cramps.…”

Clostridium difficile infection in the pediatric patients of an oncological hospital: cultivation of anaerobic intestinal flora and treatment

“…В последние годы в мировой литературе описаны случаи диареи, этиологическим фактором которых выступают такие анаэробные микроорганизмы, как Bacteroides sp. [26], Clostridium perfringens [27], Clostridium butyricum [28]. Camorlinga et al [29] показали, что нетоксигенные штаммы C. difficile могут обладать цитотоксичностью.…”

Design of a chitosan-based nano vaccine against epsilon toxin of Clostridium perfringens type D and evaluation of its immunogenicity in BALB/c mice

“…C. perfringens is the most important cause of antibiotic-associated diarrhea, especially in the hospital environment. In a study on 2280 fecal samples from (> 50 years old) Iranian diarrhea patients suspected of having antibiotic-associated diarrhea, this pathogen was diagnosed in 13.3% of patients (303 out of 2280) ( 7 ). C. perfringens is divided into five categories (A-G) according to the type of toxins it produces: alpha (CPA), beta (CPB), epsilon (ETX), iota (ITX), and C. perfringens -enterotoxin (CPE) ( 2 ).…”