Skip to main content
Log in

Heterogeneity ofClostridium difficile isolates from infants

  • Infectious Diseases
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

In order to improve our understanding of the role ofClostridium difficile in infants we characterised the strains isolated from this population. The production of toxin A and toxin B was studied. The toxin A, playing a major role in the disease, was searched for in faecal samples. The serogroup of the isolates was determined because some serogroups have been shown to be more pathogenic than others. Over a 9-month period, 102 faecal samples from 102 hospitalised infants (0–12 months) were analysed and 26% of the children were colonised withC. difficile. Fifteen isolates secreted neither toxin A nor B (62.5%). Nine isolates were toxigenic and secreted both toxins (37.5%). Of the eight toxigenic strains tested, six were from serogroup H and two serogroup K. Of the 13 nontoxigenic strains tested, 8 belonged to serogroup D, 2 to serogroup X, and 1 each to serogroup A, serogroup B and serogroup C. Three infants out of 102 studied had toxin A in their faeces. In summary, the infants can be colonised by (1) nontoxigenic strains, most of them from nonpathogenic serogroup D, without toxin A in the faeces; (2) toxigenic strains of virulent serogroups H and K, with or without toxin A in the faeces. Although some infants had diarrhoea, none needed a specific treatment forC. difficile. No specificC. difficile pathology could be retained and different mechanisms are advanced to explain this absence of pathogenicity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

PAD:

post-antibiotic diarrhoea

PMC:

pseudomembranous colitis

References

  1. Borriello SP, Ketley JM, Mitchell TJ, Barclay FE, Welch AR, Price AB, Stephen J (1987)Clostridium difficile a spectrum of virulence and analysis of putative virulence determinants in the hamster model of antibiotic associated colitis. J Med Microbiol 24:53–64

    Google Scholar 

  2. Borriello SP, Davies HA, Kamiya S, Reed PJ, Seddon S (1990) Virulence factors ofClostridium difficile. Rev Infect Dis 12:S185-S191

    Google Scholar 

  3. Collignon A, Cotte-Lafitte AM, Quero AM, Torlotin JC (1986)Clostridium difficile et sa cytotoxine dans les selles de jeunes enfants hospitalisés. Influence du traitement antibiotique. Pathol Biol 34:977–982

    Google Scholar 

  4. Collignon A, Chaumard C, Torlotin JC (1987) Immplantation deClostridium difficile chez les nourrissons en cours d'antibiothérapie. Pathol Biol 35:590–594

    Google Scholar 

  5. Collignon A, Chaumard C, Vallet-Collomb I, Delepine N (1988)Clostridium difficile chez des enfants et adolescents sous chimiothérapie anticancéreuse et antiinfectieuse. Pathol Biol 36:754–758

    Google Scholar 

  6. Corthier G, Dubos F, Raibaud P (1985) Modulation of cytotoxin production byClostridium difficile in the intestinal tracts of gnotobiotic mice inoculated with various human intestinal bacteria. Appl Environ Microbiol 49:250–252

    Google Scholar 

  7. Corthier G, Muller MC (1988) Emergence in gnotobiotic mice of non toxigenic clones ofClostridium difficile from a toxigenic one. Infect Immun 56:1500–1504

    Google Scholar 

  8. Corthier G, Muller MC, Elmer GW, Lucas F, Dubos-Ramare F (1989) Interrelationships between digestive proteolytic activities and production and quantitation of toxins in pseudomembranous colitis induced byClostridium difficile in gnotobiotic mice. Infect Immun 57:3922–3927

    Google Scholar 

  9. Cortier G, Muller MC, Wilkins TD, Lyerly D, L'Haridon R (1991) Protection against experimental pseudomembranous colitis in gnotobiotic mice by use of monoclonal antibodies againstClostridium difficile toxin A. Infect Immun 59:1192–1195

    Google Scholar 

  10. Donta ST, Myers MG (1982)Clostridium difficile in asymptomatic neonates. J Pediatr 100:431–434

    Google Scholar 

  11. Delmée M, Avesani V (1990) Virulence of ten serogroups ofClostridium difficile in hamsters. J Med Microbiol 33:85–90

    Google Scholar 

  12. Delmée M, Homel M, Wauters G (1985) Serogrouping ofClostridium difficile strains by slide agglutination. J Clin Microbiol 21:323–327

    Google Scholar 

  13. Delmée M, Verellen G, Avesani V, Francois G (1988)Clostridium difficile in neonates: serogrouping and epidemiology. Eur J Pediatr 147:36–40

    Google Scholar 

  14. Depitre C, L'Haridon R, Andremont A, Collignon A, Corthier G (1990) Improvement ofClostridium difficile enterotoxin detection in human faecal samples by the use of monoclonal antibodies. XV International Congress on Microbial Ecology and Disease Ioannina, Greece

  15. Eriksson S, Aronsson B (1989) Medical implications of nosocomial infection withClostridium difficile. Scand J Infect Dis 21:733–734

    Google Scholar 

  16. George RH (1986) The carrier state. J Antimicrob Chemother 18:45–58

    Google Scholar 

  17. Krivan HC, Clark GF, Smith DF, Wilkins TD (1986) Cell surface binding site forClostridium difficile enterotoxin: evidence for a glycoconjugate contraining the sequence Galα-3Galβ1-4GFlcNAc. Infect Immun 53:573–581

    Google Scholar 

  18. Libby JM, Donta ST, Wilkins TD (1983) Clostridium difficile toxin A in infants. J Infect Dis 148:606

    Google Scholar 

  19. Lyerly D, Krivan HC, Wilkins TD (1988)Clostridium difficile: its disease and toxins. Clin Micobiol Rev 1:1–18

    Google Scholar 

  20. MacFarland LV, Mulligan ME, Kwok RR, Stamm WE (1989) Nosocomial acquisition ofClostridium difficile infection. N Engl J Med 320:204–210

    Google Scholar 

  21. Mahe S, Corthier G, Dubos F (1987) Effect of various diets on toxin production by two strains ofClostridium difficile in gnotobiotic mice. Infect Immun 55:1801–1805

    Google Scholar 

  22. Marler LM, Siders JA, Wotlers LC, Pettigrew Y, Skitt BL, Allen SD (1992) Comparison of five procedures for isolation ofClostridium difficile from stools. J Clin Microbiol 30:514–516

    Google Scholar 

  23. Toma S, Lesiak G, Magus M, Lo H, Delmée M (1988) Serotyping ofClostridium difficile. J Clin Microbiol 26:426–428

    Google Scholar 

  24. Torres JF, Cedillo R, Sánchez J, Dillman C, Giono S, Muñoz O (1984) Prevalence ofClostridium difficile and its cytotoxin in infants in Mexico. J Clin Microbiol 20:274–275

    Google Scholar 

  25. Tullus K, Aronsson B, Marcus S, Möllby R (1989) Intestinal colonization withClostridium difficile in infants up to 18 months of age. Eur J Clin Microbiol Infect Dis 8:390–393

    Google Scholar 

  26. Tvede M, Schiøtz PO, Krasilnikoff PA (1990) Incidence ofClostridium difficile in hospitalized children. A prospective study. Acta Pediatr Scand 79:292–299

    Google Scholar 

  27. Vernet A, Corthier G, Dubos-Ramaré F, Parodi AL (1989) Relationship between levels ofClostridium difficile toxin A and toxin B and cecal lesions in gnotobiotic mice. Infect Immun 57:2123–2127

    Google Scholar 

  28. Wilson KH, Sheagren JN (1983) Antagonism of toxigenic Clostridium difficile by non toxigenicC. difficile. J Infect Dis 147:733–736

    Google Scholar 

  29. Zwiener RJ, Belknap WM, Quan R (1989) Severe psydomembranous enterocolitis in a child: case report and literature review.Pediatr Infect Dis J 8:876–882

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Collignon, A., Ticchi, L., Depitre, C. et al. Heterogeneity ofClostridium difficile isolates from infants. Eur J Pediatr 152, 319–322 (1993). https://doi.org/10.1007/BF01956743

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01956743

Key words

Navigation