Published Date: 2006-10-29 00:00:00
Subject: PRO/EDR> Clostridium difficile - Canada (QC)
Archive Number: 20061029.3100
CLOSTRIDIUM DIFFICILE - CANADA (QUEBEC)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri, 27 Oct 2006
From: Pablo Nart <email@example.com>
Source: CTV.ca [edited]
Doctors are investigating whether a more virulent strain of the _C.
difficile_ bacterium is to blame for an outbreak at a Quebec hospital
that killed 9 people.
Health officials have identified a total of 22 cases at
Honore-Mercier Hospital in St-Hyacinthe, about 60 kilometres
southeast of Montreal, since late July 2006. Most of the 9 patients
who died were elderly and suffered from other ailments, CTV
Montreal's Cindy Sherwin reported, adding that the youngest of the
group was believed to be 59.
Another 13 patients who have fallen ill are now isolated in
single-patient rooms at the hospital, where strict infection control
measures are being applied, CTV Montreal reporter Cindy Sherwin said.
While doctors are not certain what caused the outbreak of
_Clostridium difficile_, they have expressed fears it could be a new
and more powerful strain. But Dr. Jocelyne Sauve, director of public
health for the Monteregie area, said the strain could be the same one
that struck Quebec hospitals a couple of years ago and is making a
renewed appearance. Lab results expected next week should confirm
which _C. difficile_ strain it is.
Health officials believe the outbreak may have invaded the hospital
when an already-infected patient was admitted.
A strain of _C. difficile_ is blamed for roughly 2000 deaths in
Quebec between 2003 and 2004.
_C. difficile_ expert Dr. Andre Dascal, with McGill University's
Department of Microbiology and Immunology, said the reappearance of
_C. difficile_ is not unusual. But reports of _C. difficile_
infections outside hospitals in people not commonly thought to be at
risk had him concerned.
"That ... is of major importance because if it's in the community
already then this notion that just managing it in the hospital may
not be enough," he told CP.
[The ribotype 027 strain, which has caused more severe disease in
North America and Europe (as discussed in the 'see also's below), may
be the culprit here. 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 strain. - Mod.LL]