Prevalence and pathogenicity of binary toxin-positive Clostridium difficile strains that do not produce toxins A and B

New Microbes and New Infections
Catherine EckertF Barbut

Abstract

Clostridium difficile causes antibiotic-associated diarrhoea and pseudomembranous colitis. The main virulence factors of C. difficile are the toxins A (TcdA) and B (TcdB). A third toxin, called binary toxin (CDT), can be detected in 17% to 23% of strains, but its role in human disease has not been clearly defined. We report six independent cases of patients with diarrhoea suspected of having C. difficile infection due to strains from toxinotype XI/PCR ribotype 033 or 033-like, an unusual toxinotype/PCR ribotype positive for CDT but negative for TcdA and TcdB. Four patients were considered truly infected by clinicians and were specifically treated with oral metronidazole. One of the cases was identified during a prevalence study of A(-)B(-)CDT(+) strains. In this study, we screened a French collection of 220 nontoxigenic strains and found only one (0.5%) toxinotype XI/PCR ribotype 033 or 033-like strain. The description of such strains raises the question of the role of binary toxin as a virulence factor and could have implications for laboratory diagnostics that currently rarely include testing for binary toxin.

References

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Citations

Nov 10, 2015·Microbial Pathogenesis·C RodriguezG Daube
May 10, 2016·Nature Reviews. Disease Primers·Wiep Klaas SmitsEd J Kuijper
Apr 25, 2016·Anaerobe·Séverine Péchiné, Anne Collignon
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Jan 4, 2020·Proceedings of the National Academy of Sciences of the United States of America·Xingjian XuDavid J Weber
Jul 20, 2019·Anaerobe·T W BilverstoneS A Kuehne
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May 28, 2019·Microbiology Spectrum·S MiletoD Lyras
Nov 19, 2021·Journal of the Pediatric Infectious Diseases Society·Sicilia Perumalsamy, Thomas V Riley

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Methods Mentioned

BETA
PCR
nucleic acid amplifications

Software Mentioned

PaLoc

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