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J Med Microbiol 53 (2004), 887-894; DOI: 10.1099/jmm.0.45610-0
© 2004 Society for General Microbiology
ISSN 0022-2615

Distribution of Clostridium difficile variant toxinotypes and strains with binary toxin genes among clinical isolates in an American hospital

Barbara Geric1, Maja Rupnik1, Dale N. Gerding2,3, Miklavz Grabnar1 and Stuart Johnson2,3

1Department of Biology, University of Ljubljana, Vecna pot 111, 1000 Ljubljana, Slovenia 2Hines VA Hospital, Hospital/151 Fifth Avenue & Roosevelt Road, Hines, IL 60141, USA 3Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA

Correspondence Stuart Johnson sjohnson{at}lumc.edu

Received January 21, 2004
Accepted May 21, 2004

Genetic variants of Clostridium difficile have been reported with increasing frequency, but their true incidence is unknown. C. difficile strains have been classified into variant toxinotypes according to variations in the pathogenicity locus encoding the major virulence factors, toxins A and B. Some strains produce an additional toxin, binary toxin CDT. This survey of clinical isolates (153) from patients in a single hospital set out to ascertain the distribution of variant toxinotypes and strains possessing binary toxin genes. A PCR-RFLP-based method of toxinotyping identified 123 (80.4 %) isolates as toxinotype 0, 13 (8.5 %) strains as non-toxigenic and 17 (11.1 %) as belonging to variant toxinotypes. Binary toxin genes were amplified by PCR in nine strains (5.8 %), all of which were variant toxinotypes. Toxin variants of C. difficile are pathogenic and commonly isolated and need to be considered when evaluating new diagnostic testing strategies for C. difficile disease.

Abbreviations: CDAD, C. difficile-associated diarrhoea; PaLoc, pathogenicity locus; PMC, pseudomembranous colitis; TcdA, toxin A; TcdB, toxin B.




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