Published Date: 2005-06-06 23:50:00
Subject: PRO/EDR> Clostridium difficile, increased virulence - UK (England)
Archive Number: 20050606.1572
CLOSTRIDIUM DIFFICILE, INCREASED VIRULENCE - UK (ENGLAND)
A ProMED-mail post
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International Society for Infectious Diseases
Date: Mon 6 Jun 2005
From: ProMED-mail <firstname.lastname@example.org>
Source: The Guardian [edited]
12 dead as virulent strain hits Stoke Mandeville Hospital
A new strain of a hospital-acquired infection has claimed 12 lives at
the specialist Stoke Mandeville Hospital in Buckinghamshire, and
infected more than 300, the Department of Health confirmed last
night, 5 Jun 2005.
The outbreak of the bug, _Clostridium difficile_, dates from 2003. It
causes diarrhea in patients and has been added to the department's
mandatory surveillance system, which also scrutinizes the development
of the so-called hospital "superbug" MRSA [methicillin-resistant
_Staphylococcus aureus_ - Mod.LL].
A health department spokeswoman stressed the infection is not the
same as MRSA and is not considered a "superbug." However, she said
the NHS has been supplying specific advice to hospitals on how to
deal with the bug since 1994. The victims of the outbreak at the
world famous spinal injuries hospital at Stoke Mandeville have been
affected by a new strain of the bacteria which 1st appeared there in
2003. The news comes amid rising concern over the growth in
hospital-acquired infections and the possibility of a government
crackdown on the hygiene of interaction between patients, clinical
staff and visitors.
"_Clostridium difficile_ causes a hospital-acquired diarrhea that we
have known about for some time. It is not a new phenomenon," a health
department spokeswoman said. "There is a particular new strain which
has affected patients at Stoke Mandeville which is still very rare in
the UK as a whole. We are continually updating our guidance on this
to the NHS. I would like to stress that most people who do contract
_Clostridium difficile_ do make a full recovery."
The Health Protection Agency has issued guidelines which include
staff using disposable gloves at all times when in contact with
patients. But incidences of _Clostridium difficile_ have risen
quickly in England, Wales and Northern Ireland from 10 000 a year in
1995 to more than 40 000 in 2004.
[Byline: Rob Booth]
[The report does not state over what period of time the cases
occurred. It is possible that the organism present there is the
so-called toxinotype III strain, which is thought to be of increased
virulence and has been described this year (2005) in North America.
The toxinotype III strain produces 16 times more toxin A and 20 times
more toxin B in vitro compared with 13 variations of the toxinotype 0
strain commonly found.
Genetic analysis of the type III strain revealed deletion of the tcdC
gene, believed to be a negative regulator [depressor] of toxin production that
is normally expressed during the log phase of replication [when bacterial
multiplication increases exponentially]. Toxin production during the log phase
rather than the stationary phase was consistent with this finding. - Mod.LL]