Clostridioides difficile: achados epidemiológicos em animais domésticos em um Hospital Veterinário Universitário em ­ Teresina, PI / Clostridioides difficile: epidemiological findings in domestic animals in a University Veterinary Hospital in Teresina, PI

O objetivo deste estudo foi analisar a prevalência de Clostridioides difficile e suas toxinas (A/B) nas fezes de animais domésticos de um Hospital Veterinário Universitário de Teresina - PI. A detecção de C. difficile e suas toxinas foi realizada por meio de um ensaio imunoenzimático, denominado C. Diff Quik Chek Complete® (TECHLAB), capaz de detectar antígeno Glutamato Desidrogenase (GDH) e as toxinas A/B produzidas pelo bacilo, realizado em amostras fecais de cães (C. lupus) e e gatos (Felis catus) coletadas entre agosto de 2019 a setembro de 2020. Um total de 54 amostras fecais foram analisadas, das quais 16 foram positivas para C. difficile (29,63%). 68,75% (11/16) pertenciam a caninos, enquanto 31,25% (5/16) a felinos. Amostras diarreicas e não diarreicas foram utilizadas para o estudo e uma maior prevalência do bacilo pôde ser identificada em amostras diarreicas (33%). Nenhuma das amostras apresentou toxinas do patógeno. Os achados deste estudo evidenciam que C.difficile está presente no estado do Piauí. Foi possível identificá-lo em todas as espécies e em amostras diarreicas ou não, demonstrando que essa infecção pode se manifestar de formasintomática e assintomática, levantando a possibilidade de infecção cruzada entre o animal e seu tutor.

The aim of this study was to analyze the prevalence of Clostridioides difficile and its toxins (A/B) in the feces of domestic animals at a University Veterinary Hospital in Teresina - PI. The detection of C. difficile and its toxins was performed by an immunogenic enzyme, called C. Diff Quik Chek Complete® (TECHLAB), capable of detecting antigen glutamate dehydrogenase (GDH) and A/B toxins produced by this bacillus, performed in fecal samples of dogs (C. lupus) and cats (Felis catus) collected between August 2019 and September 2020.:54 stools were analyzed, of which 16 were positive for C. difficile (29.63%). 68.75% (11/16) belonged to canines, while 3.25% (5/16) to felines. Diarrheal and non-diarrheal diseases are used for the study and a higher prevalence of bacillus can be identified in diarrheal diseases (33%). None of the samples present pathogen toxins. The results of this study show that C. difficile is present in the state of Piauí. It can be identified in all species and in diarrheal or non-diarrheic samples, demonstrating that this infection can be symptomatic and asymptomatic, giving the possibility of cross-infection between the animal and its owner.

Clostridioides (Clostridium) difficile-associated diarrhea in equine in Minas Gerais, Brazil: clinical and microbiological characterization of six cases / Diarreia por Clostridioides (Clostridium) difficile em equinos em Minas Gerais, Brasil: caracterização clínica e microbiológica de seis casos

Clostridioides (Clostridium) difficile is the main causative agent of antimicrobial-related diarrhea in humans and a major pathogen-associated enteric disorder in foals and adult horses. Moreover, studies have suggested that animals are a possible reservoir of toxigenic C. difficile strains for humans. Despite this known importance, the epidemiology of C. difficile infection (CDI) in equine is still largely unknown. Therefore, this study described six cases of equine CDI occurring in Minas Gerais, Brazil, including the characterization of the isolates. All but one equine included in this research developed CDI after antimicrobial therapy, three of which occurred during hospitalization. Coinfection with Salmonella Heidelberg and S. Infantis was detected in three cases, making the antimicrobial treatment challenging. All animals recovered after metronidazole administration. All C. difficile isolates were susceptible to metronidazole and vancomycin, while three were resistant to moxifloxacin and two were resistant to clindamycin. The isolates were classified as RT126 (n = 4), RT078 (n = 1), and RT014/020 (n = 1), all previously reported infecting humans and animals worldwide.

Clostridioides (Clostridium) difficile é o principal agente envolvido em diarreias associadas ao uso de antimicrobianos em seres humanos e um enteropatógeno de grande relevância em quadros de diarreia em potros e equinos adultos. Em adição, estudos tem sugerido que animais são possíveis reservatórios de estirpes toxigênicas de C. difficile para humanos. Apesar da importância na saúde animal e humana, a epidemiologia da infecção por C. difficile (ICD) é ainda pouco conhecida. Dessa forma, o presente estudo tem como objetivo caracterizar seis casos de diarreia por C. difficile ocorridos em Minas Gerais, Brasil. Com exceção de um animal, todos os equinos incluídos no presente estudo desenvolveram ICD após antibioticoterapia, três dos quais durante a hospitalização. Coinfecção por Salmonella Heidelberg e S. Infantis foi detectada em três casos, tornando o tratamento antimicrobiano desafiador. Todos os animais recuperaram após administração de metronidazol. Os isolados obtidos no presente estudo foram sensíveis a metronidazol e vancomicina, porém três estirpes foram resistentes a moxifloxacina e duas a clindamicina. Os isolados foram classificados como ribotipos 126 (n=4), 078 (n=1) e 014/020 (n=1), todos previamente relatados em seres humanos com ICD no Brasil e em outros países.

Clostridioides (Clostridium) difficile-associated diarrhea in equine in Minas Gerais, Brazil: clinical and microbiological characterization of six cases / Diarreia por Clostridioides (Clostridium) difficile em equinos em Minas Gerais, Brasil: caracterização clínica e microbiológica de seis casos

Clostridioides (Clostridium) difficile is the main causative agent of antimicrobial-related diarrhea in humans and a major pathogen-associated enteric disorder in foals and adult horses. Moreover, studies have suggested that animals are a possible reservoir of toxigenic C. difficile strains for humans. Despite this known importance, the epidemiology of C. difficile infection (CDI) in equine is still largely unknown. Therefore, this study described six cases of equine CDI occurring in Minas Gerais, Brazil, including the characterization of the isolates. All but one equine included in this research developed CDI after antimicrobial therapy, three of which occurred during hospitalization. Coinfection with Salmonella Heidelberg and S. Infantis was detected in three cases, making the antimicrobial treatment challenging. All animals recovered after metronidazole administration. All C. difficile isolates were susceptible to metronidazole and vancomycin, while three were resistant to moxifloxacin and two were resistant to clindamycin. The isolates were classified as RT126 (n = 4), RT078 (n = 1), and RT014/020 (n = 1), all previously reported infecting humans and animals worldwide.(AU)

Clostridioides (Clostridium) difficile é o principal agente envolvido em diarreias associadas ao uso de antimicrobianos em seres humanos e um enteropatógeno de grande relevância em quadros de diarreia em potros e equinos adultos. Em adição, estudos tem sugerido que animais são possíveis reservatórios de estirpes toxigênicas de C. difficile para humanos. Apesar da importância na saúde animal e humana, a epidemiologia da infecção por C. difficile (ICD) é ainda pouco conhecida. Dessa forma, o presente estudo tem como objetivo caracterizar seis casos de diarreia por C. difficile ocorridos em Minas Gerais, Brasil. Com exceção de um animal, todos os equinos incluídos no presente estudo desenvolveram ICD após antibioticoterapia, três dos quais durante a hospitalização. Coinfecção por Salmonella Heidelberg e S. Infantis foi detectada em três casos, tornando o tratamento antimicrobiano desafiador. Todos os animais recuperaram após administração de metronidazol. Os isolados obtidos no presente estudo foram sensíveis a metronidazol e vancomicina, porém três estirpes foram resistentes a moxifloxacina e duas a clindamicina. Os isolados foram classificados como ribotipos 126 (n=4), 078 (n=1) e 014/020 (n=1), todos previamente relatados em seres humanos com ICD no Brasil e em outros países.(AU)

Isolation of Clostridium perfringens and C. difficile in crab-eating fox ( Cerdocyon thous - Linnaeus 1776) from Northeastern Brazil / Isolamento de Clostridium perfringens e C. difficile em cachorro-do-mato (Cerdocyon thous - Linnaeus 1776) da região Nordeste do Brasil

The aim of the present study was to isolate Clostridium perfringens and C. difficile in crab-eating fox (Cerdocyon thous) from Northeastern Brazil. Stool samples of 18 captive crab-eating foxes from four states of Northeastern Brazil (Alagoas, Bahia, Paraíba e Pernambuco) were collected and subjected to C. perfringens and C. difficile isolation. Suggestive colonies of C. perfringens were then analyzed for genes encoding the major C. perfringens toxins (alpha, beta, epsilon and iota), beta-2 toxin (cpb2), enterotoxin (cpe), and NetB- (netB) and NetF- (netF) encoding genes. C. difficile strains were analyzed by multiplex-PCR for a housekeeping gene (tpi), toxins A (tcdA) and B (tcdB) and a binary toxin gene (cdtB). Unthawed aliquots of stool samples positive for toxigenic C. difficile were subjected to a commercial ELISA to evaluate the presence of A/B toxins. Clostridium perfringens (type A) was isolated from five (27%) samples, and only one sample was positive for beta-2 enconding gene (cpb2). Two (11%) stool samples were positive for C. difficile, but negative for A/B toxins. These two wild canids were also positive for C. perfringens type A. This is the first report of C. difficile in crab-eating fox.(AU)

O objetivo deste estudo foi isolar Clostridium perfringens e C. difficile em cachorro-do-mato (Cerdocyon thous) da região Nordeste do Brasil. Amostras de fezes de 18 cachorros-do-mato mantidos em cativeiro e oriundos de quatro estados da região Nordeste do Brasil (Alagoas, Bahia, Paraíba e Pernambuco) foram coletadas e submetidas a isolamento de C. perfringens e C. difficile. As colônias sugestivas de C. perfringens foram analisadas para os genes que codificam as principais toxinas de C. perfringens (alfa, beta, épsilon e iota), toxina beta-2 (cpb2), enterotoxina (cpe) e NetB- (netB) e NetF- (netF). As cepas de C. difficile foram analisadas por PCR-multiplex para o gene tpi, toxinas A (tcdA) e B (tcdB) e um gene de toxina binária (cdtB). Alíquotas de amostras de fezes positivas para C. difficile toxigênico foram submetidas a um ELISA comercial para avaliar a presença de toxinas A/B. Clostridium perfringens (tipo A) foi isolado de cinco (27%) amostras, e apenas uma amostra foi positiva para o gene da toxina beta-2 (cpb2). Duas (11%) amostras de fezes foram positivas para C. difficile, mas negativas para toxinas A/B. Estes dois canídeos silvestres também foram positivos para C. perfringens tipo A. Este é o primeiro relato de C. difficile em cachorro-do-mato.(AU)

Isolation of Clostridium perfringens and C. difficile in crab-eating fox ( Cerdocyon thous - Linnaeus 1776) from Northeastern Brazil / Isolamento de Clostridium perfringens e C. difficile em cachorro-do-mato (Cerdocyon thous - Linnaeus 1776) da região Nordeste do Brasil

The aim of the present study was to isolate Clostridium perfringens and C. difficile in crab-eating fox (Cerdocyon thous) from Northeastern Brazil. Stool samples of 18 captive crab-eating foxes from four states of Northeastern Brazil (Alagoas, Bahia, Paraíba e Pernambuco) were collected and subjected to C. perfringens and C. difficile isolation. Suggestive colonies of C. perfringens were then analyzed for genes encoding the major C. perfringens toxins (alpha, beta, epsilon and iota), beta-2 toxin (cpb2), enterotoxin (cpe), and NetB- (netB) and NetF- (netF) encoding genes. C. difficile strains were analyzed by multiplex-PCR for a housekeeping gene (tpi), toxins A (tcdA) and B (tcdB) and a binary toxin gene (cdtB). Unthawed aliquots of stool samples positive for toxigenic C. difficile were subjected to a commercial ELISA to evaluate the presence of A/B toxins. Clostridium perfringens (type A) was isolated from five (27%) samples, and only one sample was positive for beta-2 enconding gene (cpb2). Two (11%) stool samples were positive for C. difficile, but negative for A/B toxins. These two wild canids were also positive for C. perfringens type A. This is the first report of C. difficile in crab-eating fox.(AU)

O objetivo deste estudo foi isolar Clostridium perfringens e C. difficile em cachorro-do-mato (Cerdocyon thous) da região Nordeste do Brasil. Amostras de fezes de 18 cachorros-do-mato mantidos em cativeiro e oriundos de quatro estados da região Nordeste do Brasil (Alagoas, Bahia, Paraíba e Pernambuco) foram coletadas e submetidas a isolamento de C. perfringens e C. difficile. As colônias sugestivas de C. perfringens foram analisadas para os genes que codificam as principais toxinas de C. perfringens (alfa, beta, épsilon e iota), toxina beta-2 (cpb2), enterotoxina (cpe) e NetB- (netB) e NetF- (netF). As cepas de C. difficile foram analisadas por PCR-multiplex para o gene tpi, toxinas A (tcdA) e B (tcdB) e um gene de toxina binária (cdtB). Alíquotas de amostras de fezes positivas para C. difficile toxigênico foram submetidas a um ELISA comercial para avaliar a presença de toxinas A/B. Clostridium perfringens (tipo A) foi isolado de cinco (27%) amostras, e apenas uma amostra foi positiva para o gene da toxina beta-2 (cpb2). Duas (11%) amostras de fezes foram positivas para C. difficile, mas negativas para toxinas A/B. Estes dois canídeos silvestres também foram positivos para C. perfringens tipo A. Este é o primeiro relato de C. difficile em cachorro-do-mato.(AU)

Isolation and genotyping of Clostridium perfringens and Clostridium difficile in Capuchin Monkeys (Sapajus spp) / Isolamento e genotipagem de Clostridium perfringens and Clostridium difficile em macacos-prego (Sapajus spp)

The importance of Clostridium perfringens and C. difficile for most wild animal species remains unclear. This study aimed to isolate and genotype C. perfringens and C. difficile in stool samples from free-living and captive capuchin monkeys (Sapajus flavius and Sapajus libidinosus) in Brazil. Ten free-living S. flavius and 14 captive S. libidinosus were sampled for this study. To isolate C. difficile, stool samples were inoculated on plates containing cycloserine-cefoxitin fructose agar supplemented with horse blood and sodium taurocholate. Two different protocols for C. perfringens isolation were tested: direct plating onto selective agar and enrichment in brain heart infusion (BHI) broth followed by plating onto selective agar. C. difficile was not detected in the present study. The results were identical for both protocols tested for isolation of C. perfringens. Four samples (16.7%) were positive for C. perfringens type A, including one sample from a free-living animal (4.2%) and three from captive animals (12.5%), meaning there was no significant difference between these two groups. C. perfringens isolates were negative for all additional virulence factors evaluated, including enterotoxin encoding-gene (cpe) and beta-2 encoding-gene (cpb2). These results suggested that C. perfringens type A is found in the microbiota of capuchin monkeys, although it is less frequent than previously reported in domestic animals.

A importância de Clostridium perfringens e C. difficile para a maioria das espécies silvestres ainda não está clara. O objetivo do presente estudo foi isolar e genotipar C. perfringens e C. difficile em amostras de fezes de macacos-prego (Sapajus flavius e Sapajus libidinosus) de vida livre e criados em cativeiros no Brasil. Dez S. flavius de vida livre e 14 S. libidinosus de cativeiro foram incluídos no presente estudo. Para isolamento de C. difficile, as amostras de fezes foram inoculadas em agar cicloserina-cefoxitina frutose, suplementado com sangue e taurocolato de sódico. Para isolamento de C. perfringens, foram testados dois protocolos: plaqueamento direto em ágar seletivo e enriquecimento em caldo seguido de plaqueamento em ágar seletivo. C difficile não foi detectado no presente estudo. Os resultados foram idênticos para ambos os protocolos testados para isolamento de C. perfringens, resultando em quatro animais (16,7%) positivos para C. perfringens tipo A. Destes, uma amostra era de um animal de vida livre (4,2%) e três de animais de cativeiro (12,5%), não havendo diferença entre esses dois grupos. Os isolados de C. perfringens foram negativos para todos os fatores de virulência adicionais avaliados, incluindo o gene codificador de enterotoxina (cpe) e o gene codificador beta-2 (cpb2). O presente estudo sugere C. perfringens tipo A como parte da microbiota de macacos-prego, embora esse agente seja menos frequente como comensal, do que relatado anteriormente, em animais domésticos.

Isolation and genotyping of Clostridium perfringens and Clostridium difficile in Capuchin Monkeys (Sapajus spp) / Isolamento e genotipagem de Clostridium perfringens and Clostridium difficile em macacos-prego (Sapajus spp)

The importance of Clostridium perfringens and C. difficile for most wild animal species remains unclear. This study aimed to isolate and genotype C. perfringens and C. difficile in stool samples from free-living and captive capuchin monkeys (Sapajus flavius and Sapajus libidinosus) in Brazil. Ten free-living S. flavius and 14 captive S. libidinosus were sampled for this study. To isolate C. difficile, stool samples were inoculated on plates containing cycloserine-cefoxitin fructose agar supplemented with horse blood and sodium taurocholate. Two different protocols for C. perfringens isolation were tested: direct plating onto selective agar and enrichment in brain heart infusion (BHI) broth followed by plating onto selective agar. C. difficile was not detected in the present study. The results were identical for both protocols tested for isolation of C. perfringens. Four samples (16.7%) were positive for C. perfringens type A, including one sample from a free-living animal (4.2%) and three from captive animals (12.5%), meaning there was no significant difference between these two groups. C. perfringens isolates were negative for all additional virulence factors evaluated, including enterotoxin encoding-gene (cpe) and beta-2 encoding-gene (cpb2). These results suggested that C. perfringens type A is found in the microbiota of capuchin monkeys, although it is less frequent than previously reported in domestic animals.(AU)

A importância de Clostridium perfringens e C. difficile para a maioria das espécies silvestres ainda não está clara. O objetivo do presente estudo foi isolar e genotipar C. perfringens e C. difficile em amostras de fezes de macacos-prego (Sapajus flavius e Sapajus libidinosus) de vida livre e criados em cativeiros no Brasil. Dez S. flavius de vida livre e 14 S. libidinosus de cativeiro foram incluídos no presente estudo. Para isolamento de C. difficile, as amostras de fezes foram inoculadas em agar cicloserina-cefoxitina frutose, suplementado com sangue e taurocolato de sódico. Para isolamento de C. perfringens, foram testados dois protocolos: plaqueamento direto em ágar seletivo e enriquecimento em caldo seguido de plaqueamento em ágar seletivo. C difficile não foi detectado no presente estudo. Os resultados foram idênticos para ambos os protocolos testados para isolamento de C. perfringens, resultando em quatro animais (16,7%) positivos para C. perfringens tipo A. Destes, uma amostra era de um animal de vida livre (4,2%) e três de animais de cativeiro (12,5%), não havendo diferença entre esses dois grupos. Os isolados de C. perfringens foram negativos para todos os fatores de virulência adicionais avaliados, incluindo o gene codificador de enterotoxina (cpe) e o gene codificador beta-2 (cpb2). O presente estudo sugere C. perfringens tipo A como parte da microbiota de macacos-prego, embora esse agente seja menos frequente como comensal, do que relatado anteriormente, em animais domésticos.(AU)

Detection of vancomycin-resistant enterococci (VRE) in stool specimens submitted for Clostridium difficile toxin testing

The aim of this study was to determine the association between Clostridium difficile (C. difficile) and vancomycin-resistant Enterococcus (VRE) and efficacy of screening stools submitted for C. difficile toxin assay for prevalence of VRE. Between April 2012 and February 2014, 158 stool samples submitted for C. difficile toxin to the Marmara University Microbiology Laboratory, were included in the study. Stool samples were analyzed by enzyme immuno assay test; VIDAS (bioMerieux, France) for Toxin A&B. Samples were inoculated on chromID VRE (bioMerieux, France) and incubated 24 h at 37 °C. Manuel tests and API20 STREP (bioMerieux, France) test were used to identify the Enterococci species. After the species identification, vancomycin and teicoplanin MIC's were performed by E test and molecular resistance genes for vanA vs vanB were detected by polymerase chain reaction (PCR). Of the 158 stool samples, 88 were toxin positive. The prevalence of VRE was 17%(n:19) in toxin positives however, 11.4% in toxin negatives(n:70). All VRE isolates were identified as Enterococcus faecium. These results were evaluated according to Fischer's exact chi-square test and p value between VRE colonization and C. difficile toxin positivity was detected 0.047 (p 0.05). PPV and NPV were 79% and 47% respectively. In our study, the presence of VRE in C. difficile toxin positives is statistically significant compared with toxin negatives (p 0.05). Screening for VRE is both additional cost and work load for the laboratories. Therefore VRE screening among C. difficile toxin positive samples, will be cost effective for determination of high risk patients in the hospitals especially for developing countries.(AU)

Isolation of recombinant antibodies directed against surface proteins of Clostridium difficile

Clostridium difficile has emerged as an increasingly important nosocomial pathogen and the prime causative agent of antibiotic-associated diarrhoea and pseudomembranous colitis in humans. In addition to toxins A and B, immunological studies using antisera from patients infected with C. difficile have shown that a number of other bacterial factors contribute to the pathogenesis, including surface proteins, which are responsible for adhesion, motility and other interactions with the human host. In this study, various clostridial targets, including FliC, FliD and cell wall protein 66, were expressed and purified. Phage antibody display yielded a large panel of specific recombinant antibodies, which were expressed, purified and characterised. Reactions of the recombinant antibodies with their targets were detected by enzyme-linked immunosorbent assay; and Western blotting suggested that linear rather than conformational epitopes were recognised. Binding of the recombinant antibodies to surface-layer proteins and their components showed strain specificity, with good recognition of proteins from C. difficile 630. However, no reaction was observed for strain R20291a representative of the 027 ribotype. Binding of the recombinant antibodies to C. difficile M120 extracts indicated that a component of a surface-layer protein of this strain might possess immunoglobulin-binding activities. The recombinant antibodies against FliC and FliD proteins were able to inhibit bacterial motility.(AU)

Analysis of risk factors and clinical manifestations associated with Clostridium difficile disease in Serbian hospitalized patients

Clostridium difficile is the leading cause of infectious diarrhoea in hospitalized patients. The aim of this study was to determine the risk factors important for the development of hospital-acquired Clostridium difficile-associated disease and clinical manifestations of Clostridium difficile-associated disease. The clinical trial group included 37 hospitalized patients who were selected according to the inclusion criteria. A control group of 74 hospitalized patients was individually matched with cases based on hospital, age (within 4 years), sex and month of admission.Clostridium difficile-associated disease most commonly manifested as diarrhoea (56.76%) and colitis (32%), while in 8.11% of patients, it was diagnosed as pseudomembranous colitis, and in one patient, it was diagnosed as fulminant colitis. Statistically significant associations (p 0.05) were found with the presence of chronic renal failure, chronic obstructive pulmonary disease, cerebrovascular accident (stroke) and haemodialysis. In this study, it was confirmed that all the groups of antibiotics, except for tetracycline and trimethoprim-sulfamethoxazole, were statistically significant risk factors for Clostridium difficile-associated disease (p 0.05). However, it was difficult to determine the individual role of antibiotics in the development of Clostridium difficile-associated disease.[...](AU)

Prevention of Clostridium difficile infection in hamsters using a non-toxigenic strain / Prevenção da infecção por Clostridium difficile em hamsters usando uma estirpe não toxigênica

The present study aimed to evaluate five non-toxigenic strains of Clostridium difficile (NTCD) in vitro and to select one strain to prevent C. difficile (CDI) infection in hamsters ( Mesocricetus auratus ). The NTCD strains were evaluated for spore production in vitro, antimicrobial susceptibility and presence of antimicrobial resistance genes. Approximately 107 spores of the selected strain (Z31) were administered by esophageal gavage in hamsters pretreated with 30mg kg-1 of clindamycin. The challenge with a toxigenic strain of C. difficile was conducted at 36 and 72h, and the animals were observed for 28 days. The NTCD strain of C. difficile (Z31) was able to prevent CDI in all animals that received it.(AU)

O presente trabalho objetivou a avaliação in vitro de cinco estirpes não toxigênicas de Clostridium difficile (NTCD) e seleção de uma delas para prevenção de infecção por C. difficile (CDI) em hamsters (Mesocricetus auratus ). As estirpes NTCD foram avaliadas quanto à produção de esporos in vitro, sensibilidade antimicrobiana e presença de genes de resistência a antimicrobianos. Aproximadamente 107 esporos da estirpe selecionada (Z31) foram administrados por gavagem esofágica em hamsters previamente tratados com 30mg kg-1 de clindamicina. O desafio com uma estirpe toxigênica de C. difficile ocorreu nos tempos experimentais 36 e 72h, e os animais foram observados por 28 dias. A estirpe NTCD de C. difficile (Z31) foi capaz de prevenir a CDI em todos os animais que a receberam.(AU)

Antimicrobial susceptibility of Clostridium difficile isolated from animals and humans in Brazil / Sensibilidade antimicrobiana de Clostridium difficile isoladas de animais e humanos no Brasil

The objective of this study was to evaluate antimicrobial susceptibility in Clostridium difficile strains isolated from animals and humans in Brazil. The 54 C. difficile strains used were isolated from stool samples from piglets (n=16), dogs (n=13), humans (n=13), foals (n=8) calves (n=2), an ocelot (n=1) and a maned wolf (n=1). Antimicrobial susceptibility was determined using the serial plate agar dilution method for penicillin, florfenicol, oxytetracycline, erythromycin, vancomycin, metronidazole and tylosin. The C. difficile strains assessed were susceptible to metronidazole and vancomycin. Florfenicol resistance was rarely observed; 52 (96.4%) strains were sensitive to this antimicrobial. Five (9.3%), five (9.3%), 14 (25.9%) and 20 (37.0%) strains were resistant to oxytetracycline, penicillin, tylosin and erythromycin respectively.(AU)

O objetivo do presente trabalho foi avaliar a sensibilidade antimicrobiana de estirpes de Clostridium difficile isoladas de animais e humanos no Brasil. Foram utilizados 54 estirpes de C. difficile isoladas de fezes de leitões (n=16), cães (n=13), seres humanos (n=13), potros (n=8), bezerros (n=2), jaguatirica (n=1) e um lobo-guará (n=1). A sensibilidade antimicrobiana foi determinada pelo método de diluição seriada em ágar para penicilina, florfenicol, oxitetraciclina, eritromicina, vancomicina, metronidazol e tilosina. Todos os isolados foram sensíveis ao metronidazol e á vancomicina. Resistência ao florfenicol foi rara, sendo que 52 (96,4%) das estirpes foram sensíveis a esse antimicrobiano. Cinco (9,3%), cinco (9,3%), 14 (25,9%) e 20 (37,0%) foram resistentes a oxitetraciclina, penicilina, tilosina e eritromicina, respectivamente.(AU)

Padronização de um modelo de infecção por Clostridium difficile em hamsters sírios Mesocricetus auratus / Standardization of a model of Clostridium difficile infection in syrian hamsters Mesocricetus auratus

O objetivo do presente trabalho foi padronizar um modelo de infecção por Clostridium difficile (ICD) em hamsters sírios (Mesocricetus auratus). Para seleção dos isolados capazes de causar letalidade, cinco animais por grupo receberam uma dose de clindamicina (30mg kg-1) por gavagem. Após 48 horas, administraram-se 107 unidades formadoras de colônia (UFC), por animal, de quatro diferentes isolados toxigênicos de C. difficile. Selecinou-se um dos isolados capazes de causar diarreia e letalidade e administrou-se 4x102; 4x104; 4x106; 4x108UFC por animal, novamente com cinco hamsters por grupo. Em todas as diluições testadas, foi possível observar a ocorrência de diarreia e morte. A maior concentração testada (4x108UFC por animal) causou óbito de 100% dos hamsters do grupo. Todos os animais que vieram a óbito apresentaram tiflite hemorrágica, foram positivos para as toxinas A/B e foi possível isolar C. difficile do conteúdo intestinal, confirmando a reprodução experimental da doença. A dose letal para 50% da população foi estabelecida em 6,3x104UFC por animal. O modelo de indução de ICD em hamsters descritos no presente estudo passa a ser uma ferramenta valiosa para estudos relativos à patogenia, tratamento e controle dessa doença.(AU)

The aim of this study was to standardize a model of Clostridium difficile infection (CDI) in Syrian hamsters (Mesocricetus auratus). In order to evaluate strains capable of causing lethality, five hamsters per group received clindamycin (30mg kg-1) by gavage. After 48 hours, 107 colony forming units (CFU) of spores' solution of four strains were administered per animal. One strain capable of causing diarrhea and death was selected and administered at the following concentrations: 4x102; 4x104; 4x106; 4x108 CFU per animal. All dilutions tested were able to cause diarrhea and death. The highest concentration showed 100% of mortality. Post mortem evaluation revealed hemorrhagic typhlitis in all death animals. In addition, all intestinal contents were positive for A/B toxins, and toxigenic C. difficile strains were isolated, confirming the induction of infection by this microorganism. The dose lethal to 50% of the population was calculated: 6.3x104 CFU per animal. The standardized model of CDI in hamster is now available for studies on pathogenesis, treatment and control of this disease.(AU)

Enteritis associated with Clostridium difficile and opportunistic candidiasis in a foal

A twelve-day-old foal was admitted to the Veterinary School of UFMG with profuse diarrhea. The animal was treated with several medications, including antibiotics. Despite the clinical care, the clinical condition did not improve. Due to poor prognosis, the foal was euthanized. Gross and histopathological examinations, showed pseudomembranous and/or membranous glossitis, esophagitis and gastritis with intense amount of pseudohyphae and blastoconidia compatible with Candida spp Also, fibrinous and necrotizing typhlocolitis was observed. Clostridium difficile was isolated from intestinal contents which were also positive for toxins A/B by ELISA. Using a multiplex-PCR assay, genes encoding toxin A (tcdA) and toxin B (tcdB) were detected. The severe lesions caused by Candida in this foal probably occurred due to changes in the microbiota induced by the treatment with antibiotics. However, the possibility of an acquired immunodeficiency cannot be excluded because information about quantity and quality of the colostrum ingested by this foal was not obtained.(AU)

Ocorrência de Clostridium Difficile em leitões submetidos à antibioticoterapia nas regiões de Santa Catarina / Ocurrence of Clostridium Difficile in pigs submitted to antibiotic therapy in Santa Catarina State

O Clostridium difficile é um bastonete oportunista Grampositivo, anaeróbio obrigatório, formador de esporos, encontrado no solo, água e microbiota entérica de várias espécies animais. Tem sido descrito como causa de enterite em seres humanos e animais. Em suínos tem adquirido grande importância, devido ao grande número de casos de enterites neonatais que afeta o cólon de leitões entre um a sete dias de idade. Essa bactéria produz dois tipos de toxinas, A (enterotóxica) e B (citotóxica), que possuem papel importante na patogênese da doença. Com o objetivo de pesquisar a presença da bactéria em leitões com até sete dias de idade submetidos à antibioticoterapia bem como a produção das toxinas A e B nas amostras isoladas, realizaram-se oito coletas em diferentes regiões do Estado de Santa Catarina, totalizando 490 amostras de fezes e suabes retais de leitões, coletados no período de janeiro a março de 2008. Os suabes retais foram processados no mesmo dia da coleta no Laboratório de Microbiologia (CAV/ UDESC) e as fezes foram congeladas a -4 ºC em ependorf estéril para posterior realização do teste de ELISA. Foram isoladas 23 amostras do C. difficile, sendo que nenhuma delas produziu as toxinas A e B, pela análise do teste do ELISA. Já das 69 amostras de fezes analisadas, 32 (46,37%) foram positivas para a presença das toxinas, 3 (4,34%) intermediárias e 34 (49,27%) negativas, conforme demonstrou o teste de ELISA.

The Clostridium difficile is a Gram-positive opportunist, anaerobic, spore-forming rod found in the soil, water and enteric microbiota of many animal species. It has been described as the cause for enteritis in human beings and animals. In swine it has grown in importance due to the large number of cases of neonatal enteritis that affects the colon of one to seven-day-old piglets. This bacterium produces two kinds of toxins: A (enterotoxin) and B (cytotoxin). They have an important role in the disease’s pathogenesis. Aiming at researching the presence of the bacterium in up to seven days piglets submitted to antibiotic therapy as well as the production of the toxins A and B in isolated samples, 8 collections were made in different regions of the state of Santa Catarina, totalizing 490 samples of stool and retal swabs of piglets, gathered in the period of January to March 2008. The retal swabs were processed in the same day they were collected in the Microbiology Lab of CAV/UDESC and the stools were frozen at -4oC in steril Ependorf so that they could be submitted to the ELISA test later. Twenty-tree colonies of C. difficile were isolated, but no one produced the A and B toxins according to the ELISA test. Of the 69 stools analyzed, 32 (46.37%) were positive samples, 3 (4.34%) were intermediate samples, and 34 (49.27%) were negative samples, according to the ELISA test.

Ocorrência de Clostridium Difficile em leitões submetidos à antibioticoterapia nas regiões de Santa Catarina / Ocurrence of Clostridium Difficile in pigs submitted to antibiotic therapy in Santa Catarina State

O Clostridium difficile é um bastonete oportunista Grampositivo, anaeróbio obrigatório, formador de esporos, encontrado no solo, água e microbiota entérica de várias espécies animais. Tem sido descrito como causa de enterite em seres humanos e animais. Em suínos tem adquirido grande importância, devido ao grande número de casos de enterites neonatais que afeta o cólon de leitões entre um a sete dias de idade. Essa bactéria produz dois tipos de toxinas, A (enterotóxica) e B (citotóxica), que possuem papel importante na patogênese da doença. Com o objetivo de pesquisar a presença da bactéria em leitões com até sete dias de idade submetidos à antibioticoterapia bem como a produção das toxinas A e B nas amostras isoladas, realizaram-se oito coletas em diferentes regiões do Estado de Santa Catarina, totalizando 490 amostras de fezes e suabes retais de leitões, coletados no período de janeiro a março de 2008. Os suabes retais foram processados no mesmo dia da coleta no Laboratório de Microbiologia (CAV/ UDESC) e as fezes foram congeladas a -4 ºC em ependorf estéril para posterior realização do teste de ELISA. Foram isoladas 23 amostras do C. difficile, sendo que nenhuma delas produziu as toxinas A e B, pela análise do teste do ELISA. Já das 69 amostras de fezes analisadas, 32 (46,37%) foram positivas para a presença das toxinas, 3 (4,34%) intermediárias e 34 (49,27%) negativas, conforme demonstrou o teste de ELISA.(AU)

The Clostridium difficile is a Gram-positive opportunist, anaerobic, spore-forming rod found in the soil, water and enteric microbiota of many animal species. It has been described as the cause for enteritis in human beings and animals. In swine it has grown in importance due to the large number of cases of neonatal enteritis that affects the colon of one to seven-day-old piglets. This bacterium produces two kinds of toxins: A (enterotoxin) and B (cytotoxin). They have an important role in the diseases pathogenesis. Aiming at researching the presence of the bacterium in up to seven days piglets submitted to antibiotic therapy as well as the production of the toxins A and B in isolated samples, 8 collections were made in different regions of the state of Santa Catarina, totalizing 490 samples of stool and retal swabs of piglets, gathered in the period of January to March 2008. The retal swabs were processed in the same day they were collected in the Microbiology Lab of CAV/UDESC and the stools were frozen at -4oC in steril Ependorf so that they could be submitted to the ELISA test later. Twenty-tree colonies of C. difficile were isolated, but no one produced the A and B toxins according to the ELISA test. Of the 69 stools analyzed, 32 (46.37%) were positive samples, 3 (4.34%) were intermediate samples, and 34 (49.27%) were negative samples, according to the ELISA test.(AU)