Toxin-Producing Clostridium difficile Strains as Long-Term Gut Colonizers in Healthy Infants

Adlerberth, Ingegerd; Huang, Haihui; Lindberg, Erika; Åberg, Nils; Hesselmar, Bill; Saalman, Robert; Nord, Carl Erik; Wold, Agnes E.; Weintraub, Andrej

doi:10.1128/jcm.01701-13

Cited by 53 publications

(63 citation statements)

References 41 publications

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“…Figure 3 summarizes the longitudinal changes of C. difficile bacteria in the 18 toxigenic C. difficile-positive infants. In agreement with findings of previous studies (12,23), specific single strains of the same genotype were retained over time in each of the 11 infants who yielded toxigenic C. difficile isolates on at least two occasions. These results suggested that C. difficile in a majority of infants was not transient, but rather was a colonizer, in their intestines.…”

Section: Table 4 Isolation and Characterization Of Toxigenic Clostridsupporting

confidence: 80%

“…It is probable that PR 014 is the most common strain type, not only in healthy infants but also in adult CDI patients, in Belgium, and this may support the recently proposed hypothesis that asymptomatic infants are a reservoir of pathogenic strains and contribute to the mediation of CDI in adults (12,14,23). The results of a literature search support the associations of specific PRs between infants and adult patients in other countries, namely, PR 014 in France (12,38) and PR 001 in Sweden (23,39).…”

Section: Fig 3 Longitudinal Changes In Bacterial Counts and Genotypessupporting

confidence: 60%

“…The results of a literature search support the associations of specific PRs between infants and adult patients in other countries, namely, PR 014 in France (12,38) and PR 001 in Sweden (23,39). The possibility of direct transmission of specific strains from asymptomatic babies to their mothers, who then suffer recurrent CDI, has been reported (14), although this form of transmission remains speculative.…”

Section: Fig 3 Longitudinal Changes In Bacterial Counts and Genotypesmentioning

confidence: 58%

“…Previous studies were limited to reports of the bacterium's prevalence at a single time point or in relatively small numbers of infants (22,23). We examined both the carriage rates and bacterial counts for total and toxigenic C. difficile strains in 111 infants over time, from immediately after birth until 180 days of age.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study showed that ST33 was the most frequently identified strain type of toxigenic C. difficile in French infants (13). Many PCR ribotyping-based studies have revealed that PR 014 is the most frequent strain type of toxigenic C. difficile in French infants (12,13) and the second most frequent one after PR 001 in Swedish infants (23). PR 014 strains are also frequently isolated from adult CDI patients (36).…”

Section: Table 4 Isolation and Characterization Of Toxigenic Clostridmentioning

confidence: 99%

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Longitudinal Investigation of Carriage Rates, Counts, and Genotypes of Toxigenic Clostridium difficile in Early Infancy

Kubota

Makino

Gawad³

et al. 2016

Appl Environ Microbiol

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Asymptomatic infant carriers of toxigenic Clostridium difficile are suggested to play a role in the transmission of C. difficile infection (CDI) in adults. However, the mode of C. difficile carriage in infants remains to be fully elucidated. We investigated longitudinal changes in carriage rates, counts, and strain types of toxigenic C. difficile in infants. Stools collected from 111 healthy infants in Belgium periodically from birth until the age of 6 months were examined by quantitative PCR targeting 16S rRNA and toxin genes. Toxigenic C. difficile was detected in 18 of 111 infants (16%) in the period up to the age of 6 months. The carriage rate of toxigenic C. difficile remained below 5% until the age of 3 months. The carriage rate increased to 13% 1 week after weaning (average age, 143 days) and reached 16% at the age of 6 months. Counts of toxigenic C. difficile bacteria ranged from 10 4 to 10 8 cells/g of stool. Notably, two infants retained >10 8 cells/g of stool for at least several weeks. Average counts in the 18 infants hovered around 10 7 cells/g of stool from the age of 3 days until the age of 6 months, showing no age-related trend. Genotyping of toxigenic C. difficile isolates from the 18 infants revealed that 11 infants each retained a particular monophyletic strain for at least a month. The genotype most frequently identified was the same as that frequently identified in symptomatic adult CDI patients. Thus, toxigenic C. difficile strains-potential causes of CDI in adults-colonized the infants' intestines. IMPORTANCEOur study provides longitudinal data on counts and strain types of toxigenic C. difficile in infants. We found that considerable numbers of toxigenic C. difficile bacteria colonized the infants' intestines. The results of strain typing suggest that toxigenic C. difficile carried by healthy infants could be potentially pathogenic to adults. These results and findings are informative not only for ecological studies but also for efforts to prevent or control the spread of CDI in adults. Toxigenic Clostridium difficile is the main cause of health careassociated gastrointestinal infections. In general, C. difficile is not a normal inhabitant of the adult gastrointestinal tract, because its colonization is considered to be prevented by the presence of commensal microbiota (1-3). Colonization of the intestines by toxigenic C. difficile is the first crucial step in the development of C. difficile infection (CDI). Accumulating evidence suggests that disruption of the microbiota and frequent exposure to toxigenic C. difficile could increase the risk of CDI (4-6). Whereas asymptomatic carriage of toxigenic C. difficile is rare in adults, occurring in Ͻ5% of adults (7,8), it is very common in infants (9, 10), probably due to the immaturity of the microbiota composition. Regardless of the high prevalence, a great majority of infants rarely show CDI-related abdominal symptoms. The presumed reason for this is that infants are not susceptible to C. difficile toxins owing to the poor developmen...

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Section: Table 4 Isolation and Characterization Of Toxigenic Clostridsupporting

confidence: 80%

Section: Fig 3 Longitudinal Changes In Bacterial Counts and Genotypessupporting

confidence: 60%

Section: Fig 3 Longitudinal Changes In Bacterial Counts and Genotypesmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Table 4 Isolation and Characterization Of Toxigenic Clostridmentioning

confidence: 99%

See 3 more Smart Citations

Longitudinal Investigation of Carriage Rates, Counts, and Genotypes of Toxigenic Clostridium difficile in Early Infancy

Kubota

Makino

Gawad³

et al. 2016

Appl Environ Microbiol

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Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

et al. 2021

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IMPORTANCE Detection of Clostridioides difficile has frequently been described in asymptomatic infants and children, but accurate estimates across the age spectrum are unavailable. OBJECTIVE To assess the prevalence of C difficile detection among asymptomatic children across the age spectrum. DATA SOURCES This systematic review and meta-analysis included a search of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Scopus, and Web of Science for articles published from January 1, 1990, to December 31, 2020. Search terms included Clostridium difficile, Peptoclostridium difficile, Clostridioides difficile, CDF OR CDI OR c diff OR c difficile, Clostridium infections OR cd positive diarrhea OR cd positive diarrhea OR Clostridium difficile OR Peptoclostridium difficile OR pseudomembranous colitis OR pseudomembranous enterocolitis, enterocolitis, and pseudomembranous. These were combined with the following terms: bacterial colonization and colonization OR colonized OR colonizing OR epidemiology OR prevalence OR seroprevalence. STUDY SELECTION Studies were screened independently by 2 authors. Studies were included if they reported testing for C difficile among asymptomatic children (ie, children without diarrhea) younger than 18 years.DATA EXTRACTION AND SYNTHESIS Data were extracted independently and in duplicate by 2 reviewers. Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe primary outcome was prevalence of C difficile detection among asymptomatic children. Secondary outcomes included prevalence of toxigenic vs nontoxigenic strains of C difficile and prevalence of C difficile detection stratified by geographic region, income status, testing method, and year of testing. RESULTS A total of 95 studies with 19 186 participants were included. Rates of detection of toxigenic or nontoxigenic C difficile were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) and decreased to 12% (95% CI, 7%-18%) among children aged 5 to 18 years. The prevalence of toxigenic C difficile colonization was lower, peaking at 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and decreasing to 6% (95% CI, 2%-11%) among children older than 5 years. Although prevalence differed by geographic region (ie, North and South America vs Europe: β, −0.151, P = .001; North and South America vs Western Pacific: β, 0.136, P = .007), there was no difference by testing method (ie, culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, −0.178, P = .051), income class (low-middle income vs high income: β, −0.144, P = .23; upper-middle vs high income: β, −0.020,

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Molecular epidemiology of norovirus in children and the elderly in Atlanta, Georgia, United States

Wahl

Sederdahl

et al. 2015

Journal of Medical Virology

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Noroviruses are an important cause of gastroenteritis, which can be severe at the extremes of ages. Data documenting the endemic burden of norovirus among children and elderly adults are lacking. Stool specimens submitted for clinical testing were collected from elderly (≥ 65 years) adults and children (<18 years) with acute vomiting and/or diarrhea seeking care at several metropolitan Atlanta adult and pediatric hospitals from January 2013-June 2013. Specimens were tested for norovirus with real-time RT-PCR and sequenced if norovirus was detected. Corresponding clinical and demographic data were abstracted from retrospective chart review. Norovirus was detected in 11% (11/104) of elderly specimens and 11% (67/628) of pediatric, with GII.4 Sydney_2012 detected in 64% (7/11) of elderly norovirus-positive and 11% (8/67) of pediatric specimens, P < 0.001. In comparison to hospitalized children, hospitalized elderly with norovirus were more commonly admitted to the intensive care unit (ICU) (36% vs. 7%, P = 0.02). Norovirus in the elderly can be associated with severe illness requiring ICU admissions. The pediatric group demonstrated greater variability in genotype distribution. Ongoing surveillance of norovirus genotypes is crucial for norovirus vaccine development in understanding circulating and emerging genotypes.

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Toxin-Producing Clostridium difficile Strains as Long-Term Gut Colonizers in Healthy Infants

Cited by 53 publications

References 41 publications

Longitudinal Investigation of Carriage Rates, Counts, and Genotypes of Toxigenic Clostridium difficile in Early Infancy

Longitudinal Investigation of Carriage Rates, Counts, and Genotypes of Toxigenic Clostridium difficile in Early Infancy

Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

Molecular epidemiology of norovirus in children and the elderly in Atlanta, Georgia, United States

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