Published Date: 2007-04-10 13:00:02
Subject: PRO/EDR> Clostridium difficile, ribotype 027 - UK (England)
Archive Number: 20070410.1203
CLOSTRIDIUM DIFFICILE, RIBOTYPE 027 - UK (ENGLAND)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 10 Apr 2007
From: ProMED-mail <firstname.lastname@example.org>
Source: Great Yarmouth Mercury [edited]
A Gorleston hospital has reported a further death linked to
_Clostridium difficile_ and a rise in the number of infected patients
being treated in isolation. It brings the number of deaths at the
James Paget University Hospital (JPH) linked to the bug to 18 since
the start of December 2006 -- a further 5 people have had to undergo
major bowel surgery.
During the past week, the number of patients known to be currently
infected with _C. difficile_, which can cause severe diarrhea, has
risen from 11 to 14. A hospital spokesman said last night, 9 Apr
2007, that the figures were accurate for Fri 6 Apr 2007, and that a
fresh statement on _C. difficile_ would be released today (10 Apr 2007).
Staff began to focus on the _C. difficile_ problem in December 2006,
when they detected a rise in cases and that patients were
experiencing worse symptoms than the normal diarrhea. Subsequent
tests on bacteria cultures showed that the hospital was contending
with the dangerous 027 strain of the bug, only identified 4 years ago
in North America.
Since February 2007, the hospital has invested an extra 400 000
pounds (USD 786 000) in an intensive cleaning program with bleach,
known to kill the bug, and additional cleaners have been taken on.
The deaths of 8 people at the Queen Elizabeth Hospital in King's Lynn
were also linked to the bug recently.
[Control of this potentially lethal process, which occurs mostly in
health care facilities involves strict infection control procedures
primarily related to hand washing and the more rational use of antimicrobials.
The hypervirulent strain referred to in the posting, ribotype 027, is
a toxinotype III organism, which is a hyperproducer of toxin(s), and
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 strain.
TcdC is part of the pathogenicity locus (PaLoc) of _C. difficile_.
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. perfringens_ although is not clear if the binary toxin has a role
King's Lynn, Great Yarmouth, and Gorleston are towns in Norfolk
County, England, located in the southeast part of the island. The
location of the county can be found at
<http://en.wikipedia.org/wiki/Norfolk>. - Mod.LL]