Human Clostridium difficile infection caused by a livestock-associated PCR ribotype 237 strain in Western Australia.

Alan M. Mc Govern,Niki F. Foster,Lynette A. Pereira,Briony Elliott,Barbara J. Chang,Thomas V. Riley,Daniel R. Knight

doi:10.1099/jmmcr.0.005062

Abstract

Introduction:Clostridium difficile infection (CDI) is a significant gastrointestinal disease in the developed world and increasingly recognised as a zoonotic infection. In North America and Europe, the PCR ribotype (RT) 078 strain of C. difficile is commonly found in production animals and as a cause of disease in humans although proof of transmission from animals is lacking. This strain is absent in Australian livestock. We report a case of human CDI caused by a strain of C. difficile belonging to known Australian livestock-associated RT 237.Case presentation:A young male was admitted for multiple trauma following a motor vehicle accident and placed on piperacillin/tazobactam for pneumonia. After 4 days of treatment, he developed symptoms of CDI, which was confirmed in the laboratory. His symptoms resolved after 6 days of intravenous metronidazole. The strain of C. difficile isolated was identified as RT 237, an unusual RT previously found in with several Western Australia piggeries.Conclusion:This case of CDI caused by an unusual livestock-associated C. difficile RT 237 supports the hypothesis of zoonotic transmission. The case highlights the potential of livestock to act as reservoir for C. difficile and the need for continued surveillance of CDI in both human and animal populations.

Highlights

Clostridium difficile infection (CDI) is a significant gastrointestinal disease in the developed world and increasingly recognised as a zoonotic infection
While RT 078 has not been detected in Australian livestock, a variety of other RTs has been isolated from production animals, including cattle, pigs and sheep (Knight & Riley, 2013; Knight et al, 2015c; Knight et al, 2013; Moono et al, 2016; Squire et al, 2013)
In several piggeries in Western Australia (WA), an unusual RT of C. difficile (RT 237) is endemic

Summary

Introduction

Clostridium difficile is an anaerobic, spore-forming, Grampositive bacillus that acts as an opportunistic pathogen causing diarrhoea and sometimes life-threatening conditions such as toxic megacolon and pseudomembranous colitis. The patient was placed on 4.5 g intravenous (IV) piperacillin/tazobactam three times daily for 6 days to prophylax against infection complicating the pelvic and abdominal trauma. On the fourth day of admission, the patient developed a fever with a temperature of 38.4 C and associated tachycardia and tachypnoea He began to exhibit abdominal distension and frequent bowel motions with loose stools. At 10 days post-admission, he was noted to have pus discharging from the urethra and was recommenced on piperacillin/tazobactam 4.5 g IV three times daily for 5 days for treatment of presumed urinary tract infection. Ten days post-admission, the patient developed a deep infection complicating the pelvic plate. At this time, he was recommenced on piperacillin/tazobactam empirically. The antimicrobial susceptibility profile of WA 1016 matched those typical of animal RT 237 isolates (Knight & Riley, 2016)

Conclusion

Discussion