Published Date: 2005-10-21 23:50:00
Subject: PRO/EDR> Clostridium difficile, ribotype 027 - Belgium
Archive Number: 20051021.3071

CLOSTRIDIUM DIFFICILE, RIBOTYPE 027 - BELGIUM
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Date: Thu, 20 Oct 2005
From: ProMED-mail <promed@promedmail.org>
Source: Eurosurveillance [edited]
<http://www.eurosurveillance.org/ew/2005/051020.asp#4>

Outbreaks of diarrhea due to _Clostridium
difficile_ ribotype 027, toxinotype III have
been reported in North America, United Kingdom,
and the Netherlands (1-4), and this toxinotype
has also been isolated from patients in
Belgium. Recently, it has been suggested that
the severity of the disease is associated with
hyperproduction of toxins A and B by this new variant strain (5).
By 19 Sep 2005, 4 patients in the Jan Yperman
hospital in Leper, southwest Belgium, had been
infected. There was one death due to
complications of _C. difficile_-associated
diarrhea and an underlying condition. All
patients were female, aged over 70 and had spent
longer than 2 weeks in hospital. 2 patients were
treated with quinolones, a 3rd patient with a
beta-lactam antibiotic and the 4th patient, who
had a milder form, received no antibiotics at
all. In the Jan Yperman hospital, the incidence
of _C. difficile_-associated diarrhea increased
from 10 per 10 000 admissions in Jan - Aug 2005
to 33 per 10 000 patient admissions in Sep 2005.
The strain was characterised as PCR ribotype 027
and toxinotype III at the reference laboratory at
Leiden University Medical Center. It also
contained the binary toxin and had an 18-bp
deletion in a toxin regulator gene (tcdC). As
determined by E-tests, the isolates were
resistant to ciprofloxacin (MIC greater than 32
microg/mL) and susceptible to clindamycin (MIC =
2 microg/mL) and metronidazole (MIC = 0.19
microg/mL). These characteristics are similar to
those of the strain that has been isolated from
outbreaks in the USA, Canada, the UK and the Netherlands.
Contact tracing did not reveal the origin of this
strain. The hospital has taken additional
infection control measures and used the
guidelines recently published by Centre for
Infectious Disease Control at the National
Institute for Public Health and the Environment
(RIVM) in Bilthoven (<http://www.rivm.nl>).
Subsequently, the Health Inspectorate and the
Clostridium Reference Centre in Brussels, Belgium, were informed.
1. Eggertson L: C difficile: by the numbers. CMAJ. 2004; 171:1331-32.
2. Outbreak of Clostridium difficile in a
hospital in south east England. CDR weekly 2005;15(24): news.
(<http://www.hpa.org.uk/cdr/archives/archive05/News/news2405.htm>)
3. McDonald C: Clostridium difficile: responding
to a new threat from an old enemy. Infect Control Epidemiol. 2005; 26:672-75.
4. Kuijper EJ, Debast SB, van Kregten E, et al:.
Clostridium difficile ribotype 027, toxinotype
III in the Nederlands. Ned Tijdschr Geneeskd. 2005; 49:2087-89.
5. Warny M, Pepin J, Fang A, et al: Toxin
production by an emerging strain of Clostridium
difficile associated with outbreaks of severe
disease in North America and Europe. Lancet. 2005; 366:1079-84.
[Reported by: Rafael Joseph 1/, Danny Demeyer /1,
Dirk Vanrenterghem /1, Renate van den Berg /2, Ed
Kuijper (E.J.Kuijper@lumc.nl) /2, M. Delm�/3
1/Jan Yperman Ziekenhuis, Leper, Belgium
2/Department of Medical Microbiology, Reference
laboratory for Clostridum difficile, Leiden
University Medical Center, The Netherlands
3/Department of Medical Microbiology, Universite
Catholique de Louvain, Brussels, Belgium]
--
ProMED-mail
<promed@promedmail.org>
[This emerging strain of _C. difficile_ continues
to spread, now to Belgium. Reference 5 above,
from the 24 Sep 2005 issue of Lancet, reported
that the strain, also referred to as North
American PFGE type 1 or NAP1/027, produced 16
more toxin A and 23 times more toxin B than
control strains. These toxins appear to be the
major virulence factors in this disease with
toxin B apparently a factor of 10 more toxic in
colonic explants. Although the strain is
sensitive to metronidazole, clinical observations
suggest that both the metronidazole failure and
post-metronidazole relapse rates are higher with 027. - Mod.LL]
[Elsevier reference:
Warny M, Pepin J, Fang A, et al: Toxin
production by an emerging strain of Clostridium
difficile associated with outbreaks of severe
disease in North America and Europe. Lancet.
2005; 366:1079-84. <http://dx.doi.org/:10.1016/S0140-6736(05)67420-X>]

See Also

Clostridium difficile, increased virulence - Netherlands 20050706.1912
Clostridium difficile, increased virulence - UK (England) (05) 20050630.1843
Clostridium difficile, increased virulence - UK (England) 20050606.1572
Clostridium difficile, increased virulence, 2004 - USA, Canada 20050412.1055
2004
----
Clostridium difficile, increased virulence - USA 20041004.2735
Clostridium difficile, fatal - Canada (QC) 20040808.2191
....................mpp/ll/pg/mpp

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