INTRODUCTION: The binary toxin genes cdt and cdtB have been detected in approximately 5% of Clostridium difficile strains. Severe C. difficile disease (CDD) may be associated with strains that carry the binary toxin genes. METHODS: From April 2001 through March 2002, 8 severe and 41 nonsevere cases of nosocomial CDD were studied. Severe cases of CDD were defined by the presence of >or=2 of the following criteria: (1) abdominal pain, (2) a white blood cell count of >20,000 or <1500 cells/mm(3), and (3) ileus or bowel wall thickening with ascites. Underlying disease was assessed by 2 methods: a modified Horn score and the presence of comorbid conditions. The presence of cdtA, cdtB, and the toxin A and toxin B genes was determined, and molecular subtyping was performed. RESULTS: All strains were positive for the toxin A and B genes, and 65.3% of the strains carried the cdtA and cdtB genes. Strains that carried the binary toxin genes accounted for 87.5% of the cases of severe CDD and 61.0% of the nonsevere cases (P=.23). Severity of CDD was not associated with either severe underlying disease or comorbid conditions. The strains that caused severe CDD belonged to 4 protein profile groups and >or=3 restriction endonuclease analysis (REA) groups. All (i.e., 5 of 5) strains in REA group BI, compared with none (i.e., 0 of 7) of the strains in REA group J carried the binary toxin genes (P=.001). Strains that belonged to REA groups BK and BR also carried the binary toxin genes. CONCLUSIONS: The binary toxin genes were present in nearly two-thirds of the C. difficile strains, and they were correlated with the REA group. Severity of CDD was not closely associated with a specific clone or underlying disease, but it may be associated with the presence of the binary toxin genes. Larger studies are needed to discern whether a true association exists and whether the binary toxin alters the pathogenicity of the C. difficile strain.
INTRODUCTION: The binary toxin genes cdt and cdtB have been detected in approximately 5% of Clostridium difficile strains. Severe C. difficile disease (CDD) may be associated with strains that carry the binary toxin genes. METHODS: From April 2001 through March 2002, 8 severe and 41 nonsevere cases of nosocomial CDD were studied. Severe cases of CDD were defined by the presence of >or=2 of the following criteria: (1) abdominal pain, (2) a white blood cell count of >20,000 or <1500 cells/mm(3), and (3) ileus or bowel wall thickening with ascites. Underlying disease was assessed by 2 methods: a modified Horn score and the presence of comorbid conditions. The presence of cdtA, cdtB, and the toxin A and toxin B genes was determined, and molecular subtyping was performed. RESULTS: All strains were positive for the toxin A and B genes, and 65.3% of the strains carried the cdtA and cdtB genes. Strains that carried the binary toxin genes accounted for 87.5% of the cases of severe CDD and 61.0% of the nonsevere cases (P=.23). Severity of CDD was not associated with either severe underlying disease or comorbid conditions. The strains that caused severe CDD belonged to 4 protein profile groups and >or=3 restriction endonuclease analysis (REA) groups. All (i.e., 5 of 5) strains in REA group BI, compared with none (i.e., 0 of 7) of the strains in REA group J carried the binary toxin genes (P=.001). Strains that belonged to REA groups BK and BR also carried the binary toxin genes. CONCLUSIONS: The binary toxin genes were present in nearly two-thirds of the C. difficile strains, and they were correlated with the REA group. Severity of CDD was not closely associated with a specific clone or underlying disease, but it may be associated with the presence of the binary toxin genes. Larger studies are needed to discern whether a true association exists and whether the binary toxin alters the pathogenicity of the C. difficile strain.
Authors: J H Boone; M Goodykoontz; S J Rhodes; K Price; J Smith; K N Gearhart; R J Carman; T M Kerkering; T D Wilkins; D M Lyerly Journal: Eur J Clin Microbiol Infect Dis Date: 2011-12-14 Impact factor: 3.267
Authors: Irfan A Dhalla; Muhammad M Mamdani; Andrew E Simor; Alex Kopp; Paula A Rochon; David N Juurlink Journal: Antimicrob Agents Chemother Date: 2006-09 Impact factor: 5.191
Authors: I C Cavalcante; M V Castro; A R F Barreto; G W Sullivan; M Vale; P R C Almeida; J Linden; J M Rieger; F Q Cunha; R L Guerrant; R A Ribeiro; G A C Brito Journal: Infect Immun Date: 2006-05 Impact factor: 3.441
Authors: Rana E El Feghaly; Jennifer L Stauber; Elena Deych; Carlos Gonzalez; Phillip I Tarr; David B Haslam Journal: Clin Infect Dis Date: 2013-03-13 Impact factor: 9.079
Authors: Raina Shivashankar; Sahil Khanna; Patricia P Kammer; W Scott Harmsen; Alan R Zinsmeister; Larry M Baddour; Darrell S Pardi Journal: Clin Gastroenterol Hepatol Date: 2013-05-20 Impact factor: 11.382
Authors: Erik R Dubberke; Anne M Butler; Kimberly A Reske; Denis Agniel; Margaret A Olsen; Gina D'Angelo; L Clifford McDonald; Victoria J Fraser Journal: Emerg Infect Dis Date: 2008-07 Impact factor: 6.883
Authors: Richard A Stabler; Miao He; Lisa Dawson; Melissa Martin; Esmeralda Valiente; Craig Corton; Trevor D Lawley; Mohammed Sebaihia; Michael A Quail; Graham Rose; Dale N Gerding; Maryse Gibert; Michel R Popoff; Julian Parkhill; Gordon Dougan; Brendan W Wren Journal: Genome Biol Date: 2009-09-25 Impact factor: 13.583