Abstract
BackgroundClostridium difficile infections (CDI) in humans range from asymptomatic carriage to life-threatening intestinal disease. Findings on C. difficile in various animal species and an overlap in ribotypes (RTs) suggest potential zoonotic transmission. However, the impact of animals for human CDI remains unclear.MethodsIn a large-scale survey we collected 1,447 fecal samples to determine the occurrence of C. difficile in small companion animals (dogs and cats) and their owners and to assess potential epidemiological links within the community. The Germany-wide survey was conducted from July 2012-August 2013. PCR ribotyping, Multilocus VNTR Analysis (MLVA) and PCR detection of toxin genes were used to characterize isolated C. difficile strains. A database was defined and logistic regression used to identify putative factors associated with fecal shedding of C. difficile.ResultsIn total, 1,418 samples met the inclusion criteria. The isolation rates for small companion animals and their owners within the community were similarly low with 3.0% (25/840) and 2.9% (17/578), respectively. PCR ribotyping revealed eight and twelve different RTs in animals and humans, respectively, whereas three RTs were isolated in both, humans and animals. RT 014/0, a well-known human hospital-associated lineage, was predominantly detected in animal samples. Moreover, the potentially highly pathogenic RTs 027 and 078 were isolated from dogs. Even though, C. difficile did not occur simultaneously in animals and humans sharing the same household. The results of the epidemiological analysis of factors associated with fecal shedding of C. difficile support the hypothesis of a zoonotic potential.ConclusionsMolecular characterization and epidemiological analysis revealed that the zoonotic risk for C. difficile associated with dogs and cats within the community is low but cannot be excluded.
Highlights
Clostridium difficile is the major cause of antibiotic and hospital-associated diarrhea in humans
The isolation rates for small companion animals and their owners within the community were low with 3.0% (25/840) and 2.9% (17/578), respectively
Molecular characterization and epidemiological analysis revealed that the zoonotic risk for C. difficile associated with dogs and cats within the community is low but cannot be excluded
Summary
Clostridium difficile is the major cause of antibiotic and hospital-associated diarrhea in humans. With regard to communityacquired CDI, the overlap of C. difficile strains isolated from humans and animals has increasingly urged one to explore the significance of C. difficile isolation in various animal species and its potential for zoonotic transmission [3, 4]. RT 014/0 has been reported to be the most common cause of (CDI-) diarrhea in humans in Europe [5, 6]. Identical RT 078 strains shared by farmers and their pigs have been identified [14]. These findings have triggered concerns about the zoonotic transmission of this important pathogen. Findings on C. difficile in various animal species and an overlap in ribotypes (RTs) suggest potential zoonotic transmission. The impact of animals for human CDI remains unclear
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