Advertisement

Current Microbiology

, Volume 33, Issue 4, pp 220–223 | Cite as

Relapses or reinfections: Analysis of a case of Clostridium difficile-associated colitis by two typing systems

  • Haru Kato
  • Naoki Kato
  • Kunitomo Watanabe
  • Kazue Ueno
  • Yoko Sakata
  • Kozo Fujita
Article

Abstract

Immunoblotting and pulsed-field gel electrophoresis of Clostridium difficile isolates were employed to differentiate reinfection by a newly acquired strain from relapse by an original strain in a 10-year-old patient with four episodes of C. difficile-associated colitis. Immunoblot typing demonstrated subserogroup K-1 of serogroup K for the first and second organisms, subserogroup A-1 of serogroup A for the third organism, and subserogroup G-4 of serogroup G for the fourth organism. PFGE analysis revealed consistent results with immunoblot analysis except that the strains from the fourth episode, whose DNA constantly degraded, were nontypable by this method. Five separate isolates of C. difficile from a specimen of each episode showed identical PFGE patterns, indicating that infections of multiple strains probably did not occur in this patient. These typing results suggested that the second episode after a 17-day course of vancomycin therapy represented a relapse by the strain causing the first episode, and that the third and fourth episodes after tapering vancomycin therapy were reinfections by other strains. Both immunoblot and PFGE typing systems are promising tools for analyzing recurrence of C. difficile infection.

Keywords

Vancomycin Norfloxacin Clostridium Difficile Restriction Endonuclease Analysis Vancomycin Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literature Cited

  1. 1.
    Allen SD, Baron EJ (1991) Clostridium. In: Balows A, Hausler WJ Jr, Herrmann KL, Isenberg HD, Shadomy HJ (eds) Manual of clinical microbiology, 5th ed. Washington, D.C.: American Society for Microbiology, pp 505–521Google Scholar
  2. 2.
    Bartlett JG (1992) Antibiotic-associated diarrhea. Clin Infect Dis 15: 573–581PubMedGoogle Scholar
  3. 3.
    Bordello SP, Wren BW, Hyde S, Seddon SV, Sibbons P, Krishna MM, Tabaqchali S, Manek S, Price AB (1992) Molecular, immunological, and biological characterization of a toxin A-negative, toxin B-positive strain of Clostridium difficile. Infect Immun 60: 4192–4199Google Scholar
  4. 4.
    Clabots CR, Johnson S, Bettin KM, Mathie PA, Mulligan ME, Shaberg DR, Peterson LR, Gerding DN (1993) Development of a rapid efficient restriction endonuclease analysis typing system for Clostridium difficile and correlation with other typing systems. J Clin Microbiol 31: 1870–1875PubMedGoogle Scholar
  5. 5.
    Delmee M, Homel M, Wauters G (1985) Serogrouping of Clostridium difficile strains by slide agglutination. J Clin Microbiol 21: 323–327PubMedGoogle Scholar
  6. 6.
    Delmee M, Laroche Y, Avesani V, Cornells G (1986) Comparison of serogrouping and polyacrylamide gel electrophoresis for typing Clostridium difficile. J Clin Microbiol 24: 991–994PubMedGoogle Scholar
  7. 7.
    Gorbach SL, Chang T-W, Goldin B (1987) Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet 1519Google Scholar
  8. 8.
    Johnson S, Adelmann A, Clabots CR, Peterson LR, Gerding DN (1989) Recurrences of Clostridium difficile diarrhea not caused by the original infecting organism. J Infect Dis 159: 340–343PubMedGoogle Scholar
  9. 9.
    Kato H, Cavallaro JJ, Kato N, Bartley SL, Killgore GE, Watanabe K, Ueno K (1993) Typing of Clostridium difficile by Western immunoblotting with 10 different antisera. J Clin Microbiol 31: 413–415PubMedGoogle Scholar
  10. 10.
    Kato H, Kato N, Watanabe K, Ueno K, Ushijima H, Hashira S, Abe T (1994) Application of typing by pulsed-field gel electrophoresis to the study of Clostridium difficile in a neonatal intensive care unit. J Clin Microbiol 32: 2067–2070PubMedGoogle Scholar
  11. 11.
    Kato N, Ou C-Y, Kato H, Bartley SL, Brown VK, Dowell VR Jr, Ueno K (1991) Identification of toxigenic Clostridium difficile by the polymerase chain reaction. J Clin Microbiol 29: 33–37PubMedGoogle Scholar
  12. 12.
    Kristjánsson M, Samore MH, Gerding DN, DeGirolami PC, Bettin KM, Karchmer AW, Arbeit RD (1994) Comparison of restriction endonuclease analysis, ribotyping, and pulsed-field gel electrophoresis for molecular differentiation of Clostridium difficile strains. J Clin Microbiol 32: 1963–1969PubMedGoogle Scholar
  13. 13.
    Kunimoto D, Thomson ABR (1986) Recurrent Clostridium difficile-associated colitis responding to cholestyramine. Digestion 33: 225–228PubMedCrossRefGoogle Scholar
  14. 14.
    Leung DYM, Kelly CP, Boguniewicz M, Pothoulakis C, LaMont JT, Flores A (1991) Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J Pediatr 118: 633–637PubMedCrossRefGoogle Scholar
  15. 15.
    O’Neill GL, Beaman MH, Riley TV (1991) Relapse versus reinfection with Clostridium difficile. Epidemiol Infect 107: 627–635PubMedCrossRefGoogle Scholar
  16. 16.
    Schwan A, Sjolin S, Trottestam U, Aronsson B (1984) Relapsing Clostridium difficile enterocolitis cured by rectal infusion of normal faeces. Scand J Infect Dis 16: 211–215PubMedCrossRefGoogle Scholar
  17. 17.
    Summanen P, Baron EJ, Citron DM, Strong C, Wexler HM, Finegold SM (eds) (1993) Wadsworth anaerobic bacteriology manual, 5th ed. Belmont, California: Star Publishing Co.Google Scholar
  18. 18.
    Surawicz CM, McFarland LV, Elmer G, Chinn J (1989) Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol 84: 1285–1287PubMedGoogle Scholar
  19. 19.
    Tedesco FJ, Gordon D, Fortson WC (1985) Approach to patients with multiple relapses of antibiotic-associated pseudomembranous colitis. Am J Gastroenterol 80: 867–868PubMedGoogle Scholar
  20. 20.
    Toma S, Lesiak G, Magus M, Lo H-L, Delmee M (1988) Serotyping of Clostridium difficile. J Clin Microbiol 26: 426–428PubMedGoogle Scholar
  21. 21.
    Wilcox MH, Spencer RC (1992) Clostridium difficile infection: responses, relapses and re-infections. J Hosp Infect 22: 85–92PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Haru Kato
    • 1
  • Naoki Kato
    • 1
  • Kunitomo Watanabe
    • 1
  • Kazue Ueno
    • 2
  • Yoko Sakata
    • 3
  • Kozo Fujita
    • 4
  1. 1.Institute of Anaerobic BacteriologyGifu University, School of MedicineGifuJapan
  2. 2.Gifu College of Medical TechnologySekiJapan
  3. 3.Department of PediatricsDouhoku Sanatorium HospitalAsahikawaJapan
  4. 4.Department of PediatricsAsahikawa Medical CollegeAsahikawaJapan

Personalised recommendations