RESUMO
A typing system for Clostridium difficile using sequencing of the surface-layer protein A encoding gene (slpA) was evaluated and used to analyse clinical isolates in Japan. A total of 160 stool specimens from symptomatic patients in Japan was examined and 87 C. difficile isolates were recovered. slpA sequence typing was found to have reliable typability and discriminatory power in comparison with PCR ribotyping, and the typing results were highly reproducible and comparable. slpA sequence typing was used to type C. difficile in DNA extracted directly from stool specimens. Among the 90 stool specimens in which direct typing results were obtained, 77 specimens were positive for C. difficile culture, and typing results from isolated strains agreed with those from direct typing in all 77 specimens. The slpA sequence type smz was dominant at all four hospitals examined, and this endemic type was detected by culture and/or direct typing in 61 (62 %) of 99 stool specimens positive for toxic culture and/or direct slpA sequence typing. Comparison of epidemic strains reported throughout the world revealed one isolate identified as slpA sequence type gc8, which was found to correspond to PCR ribotype 027 (BI/NAP1/027), whereas no isolates were found with the slpA gene identical to that of PCR ribotype 078 strain. slpA sequence typing is valuable for comparison of C. difficile strains epidemic in diverse areas because the typing results are reproducible and can easily be shared. In addition, slpA sequence typing could be applied to direct typing without culture.
Assuntos
Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Clostridioides difficile/classificação , Clostridioides difficile/genética , Infecções por Clostridium/microbiologia , Doenças Endêmicas , Polimorfismo Genético , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/epidemiologia , DNA Bacteriano/química , DNA Bacteriano/genética , Fezes/microbiologia , Genótipo , Humanos , Japão/epidemiologia , Dados de Sequência Molecular , Reprodutibilidade dos Testes , Ribotipagem , Sensibilidade e Especificidade , Análise de Sequência de DNARESUMO
The authors treated a patient for what appears to be the first reported occurrence of acute peritonitis and salpingitis associated with streptococcal toxic shock syndrome (STSS). This was caused by Lancefield group G alpha-haemolytic Streptococcus dysgalactiae subsp. equisimilis TKCH2004-001. The isolate showed M protein type stc36 and carried the spegg gene. To the best of the authors' knowledge, the present report represents the first case of STSS complicating acute peritonitis and salpingitis caused by Lancefield group G alpha-haemolytic S. dysgalactiae subsp. equisimilis.
Assuntos
Peritonite/microbiologia , Salpingite/microbiologia , Choque Séptico/microbiologia , Streptococcus/crescimento & desenvolvimento , Doença Aguda , Adulto , Evolução Fatal , Feminino , Humanos , Peritonite/patologia , Peritonite/terapia , Reação em Cadeia da Polimerase , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Salpingite/patologia , Salpingite/terapia , Análise de Sequência de DNA , Choque Séptico/terapia , Streptococcus/genéticaRESUMO
Recurrence of Clostridium difficile-associated diarrhea (CDAD) is a serious and still unsolved problem. Little is known about the precise mechanism of the recurrence with CDAD. To elucidate the issue, we analyzed C. difficile strains obtained from the patient with multiple recurrence of CDAD. A 72-year-old female received rectoidectomy was developed CDAD after administration of cefmetazole sodium for 5 days. She was recovered from illness by the administration 2g of vancomycin hydrochloride for 2 weeks. However she was recurred CDAD twice within 2 months thereafter. Six C. difficile isolates recovered from the stool specimens obtained during each episode were typed by polymerase chain reaction amplifying of rRNA intergenic spacer regions 8 PCR ribotyping was carried out. The PCR ribotype of the first episode was identical (ribotype smz) to that of the second episode, and the PCR ribotype of the third were distinct (ribotype hr) from those on previous two episodes. These findings indicate that the second episode was caused by the reactivation of continuously infected C. difficile strain (relapse) and the third episode was by reinfection of the new
Assuntos
Clostridioides difficile/isolamento & purificação , Enterocolite Pseudomembranosa/microbiologia , Reação em Cadeia da Polimerase , Idoso , Clostridioides difficile/genética , Diarreia/microbiologia , Feminino , Humanos , RNA Bacteriano/isolamento & purificação , RecidivaRESUMO
Clostridium difficile is a major cause of antibiotics-associated diarrhea (AAD), and accounts for 15-20% of all the cases. Especially, AAD caused by C. difficile is called as C. difficile-associated diarrhea (CDAD). Diagnosis of CDAD is made by identification of C. difficile in the feces obtained from the patients with diarrhea after administration of antibiotics. We herein compared 3 methods, detection of toxin A and glutamate dehydrogenase (GDH) as well as culture for C. difficile. Two hundred and thirty-two samples obtained from 148 patients with CDAD were investigated. Fifty-five (23.7%), 56 (24.1%), and 93 (40.1%) of the 232 samples were positive for toxin A, GDH, and culture, respectively. Sensitivity, specificity, predictive value of positive result, and predictive value of negative result of method of detection of toxin A were estimated to 53%, 96%, 90%, 75% and those of GDH were 56%, 99%, 98%, 78%. These results indicated that we should carefully interpret the results obtained by these methods, especially in the cases that showed negative for C. difficile.
