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J Med Microbiol 54 (2005), 181-185; DOI: 10.1099/jmm.0.45804-0
© 2005 Society for General Microbiology
ISSN 0022-2615

Clinical features of Clostridium difficile-associated diarrhoea due to binary toxin (actin-specific ADP-ribosyltransferase)-producing strains

Frédéric Barbut1,8, Dominique Decré1,8, Valérie Lalande1,8, Béatrice Burghoffer8, Latifa Noussair2, Anne Gigandon3, Florence Espinasse4, Laurent Raskine5, Jérome Robert6, Alain Mangeol7, Catherine Branger2 and Jean-Claude Petit1,8

1Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France

Correspondence Frédéric Barbut frederic.barbut{at}sat.ap-hop-paris.fr

Received June 30, 2004
Accepted September 30, 2004

Toxins A and B are known to be the primary virulence factors of Clostridium difficile. Other potential virulence factors have been identified such as binary toxin (actin-specific ADP-ribosyltransferase toxin, or CDT). A retrospective case–control study was performed in order to identify clinical features and risk factors of C. difficile-associated diarrhoea due to binary toxin-producing strains. Each case (a patient with diarrhoea due to binary toxin-producing strain) was compared with two controls (patients with diarrhoea due to a C. difficile strain that did not produce binary toxin) matched for ward and date of hospitalization. cdtA and cdtB genes were screened by PCR. Production of CDT was studied by Western blotting using an antiserum against Ia and Ib from the Clostridium perfringens iota toxin, and the activity of the binary toxin was assessed using an ADP-ribosyltransferase assay. Twenty-six cases (14 males and 12 females) were identified in 1999 and 2000. Cases and controls did not differ significantly for sex, age, previous administration of antibiotics or frequency of endoscopic examination. Diarrhoea was community-acquired more often in cases than in controls (65.4 vs 35.7 %, P = 0.017) and more often represented the cause of hospitalization (61.5 vs 26.2 %, P = 0.003). Moreover, diarrhoea in cases was more frequently associated with abdominal pain (63.6 vs 39.4 %, P = 0.07) and with liquid stools (76.9 vs 59.5 %, P = 0.14) than in controls. These results suggest that there could be a correlation between the production of binary toxin and the severity of diarrhoea.

This paper was presented at the First International Clostridium difficile Symposium, Kranjska Gora, Slovenia, 5–7 May 2004.

Abbreviations: AAD, antibiotic-associated diarrhoea; CDAD, C. difficile-associated diarrhoea; PMC, pseudomembranous colitis.




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