Published Date: 2006-10-02 00:00:00
Subject: PRO/EDR> Clostridium difficile, ribotype 027 - UK (England)
Archive Number: 20061002.2825
CLOSTRIDIUM DIFFICILE, RIBOTYPE 027 � UK (ENGLAND)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sun 1 Oct 2006
From: ProMED-mail <email@example.com>
Source: Sunday Times [edited]
New concerns about a virulent infection emerged on the evening of 30 Sep
2006 after 3 hospitals in Leicester admitted that the infection had killed
at least 49 people and possibly as many as 78 in 2006.
The "hypervirulent" strain of the _Clostridium difficile_ bacterium emerged
at the Leicester Royal Infirmary, Leicester General hospital and Glenfield
hospital, which is in the constituency of Patricia Hewitt, the health
The Healthcare Commission launched an inquiry earlier in 2006 after an
outbreak of the bug killed at least 20 people at Maidstone hospital in
Kent. It was also responsible for the deaths of at least 33 patients at
Stoke Mandeville hospital in Aylesbury, Buckinghamshire, between Oct 2004
and Jun 2005.
Dr David Jenkins, director of prevention and control for University
Hospitals of Leicester NHS Trust, said the bug was not new but that the
latest strain was extremely virulent. "NHS trusts are not required to keep
information on those deaths where _C. difficile_ may have been a
contributing factor," he said. "However, we are analyzing this as part of
the battle against the new, hypervirulent strain."
He claimed that infection in at least 20 per cent of cases had occurred
outside hospitals, but the main cause is infection control issues,
overcrowding, and a shortage of beds. Earlier in 2006, the trust set up a
taskforce of consultants, doctors, nurses, and infection control
specialists to fight the new infection.
The Healthcare Commission announced an inquiry into an outbreak of _C.
difficile_ at Maidstone hospital in Kent that killed 6 patients and was a
factor in the deaths of 14 others between Apr and Jun 2006. A total of 136
patients were infected with the bug in 3 months. The inquiry into Maidstone
and Tunbridge Wells NHS Trust is 1 of only 2 that the commission has
announced. It will examine outbreaks of the infection and evaluate how well
the trust dealt with them. The investigation was sought by the South East
Coast Strategic Health Authority and the trust, whose 3 hospitals serve
Maidstone and Tunbridge Wells and surrounding areas including Tonbridge and
[byline: Chris Johnston]
[The hypervirulent strain referred to in the posting is a ribotype 027,
toxinotype III organism, which is a hyperproducer of toxin(s), and which
has been found in North America and Europe.
The strain has an 18-bp deletion in the _tcdC_ reading frame which is felt
to be a negative regulator of the production of toxins A and B and may be
responsible for the recognized enhanced toxin production of the epidemic
TcdC is part of the pathogenicity locus (PaLoc) of _C. difficile_ (3). This
19.6-kb locus also contains the genes for toxins A (_tcdA_) and B (_tcdB_)
and for TcdB, a positive regulator of the toxins as well as genetic
information for several insertion sequences.
The strain produces a binary toxin (CDT) similar to the iota toxin of _C.
perfringes_ although is not clear if the binary toxin has a role in
A map of England showing the location of Leicester in the East Midlands can
be found at