Clostridium difficile is the most important enteropathogen involved in gut nosocomial post-antibiotic infections. The emergence of hypervirulent strains has contributed to increased mortality and morbidity of CDI. The C. difficile toxins contribute directly to CDI-associated lesions of the gut, but other bacterial factors are needed for the bacteria to adhere and colonize the intestinal epithelium. The C. difficile flagella, which confer motility and chemotaxis for successful intestinal colonization, could play an additional role in bacterial pathogenesis by contributing to the inflammatory response of the host and mucosal injury. Indeed, by activating the TLR5, flagella can elicit activation of the MAPK and NF-κB cascades of cell signaling, leading to the secretion of pro-inflammatory cytokines. In the current study, we demonstrate, by using an animal model of CDI, a synergic effect of flagella and toxins in eliciting an inflammatory mucosal response. In this model, the absence of flagella dramatically decreases the degree of mucosal inflammation in mice and the sole presence of toxins without flagella was not enough to elicit epithelial lesions. These results highlight the important role of C. difficile flagella in eliciting mucosal lesions as long as the toxins exert their action on the epithelium.

Septicemia due to Neisseria elongata subsp. glycolytica occurs infrequently. We report a case of septicemia in a patient undergoing antimitotic chemotherapy. Gram-negative coccobacilli were isolated from blood cultures. The identity of the isolate by phenotypic methods was uncertain. In contrast, identity was confirmed by 16S ribosomal DNA sequencing, which appeared to be very useful for correct identification. CASE REPORTA 66-year-old retired male was admitted to the internal medicine unit of the hospital for a second antimitotic chemotherapy treatment for a squamous cell carcinoma. Nine days after the beginning of the chemotherapy (cisplatin-vinocelbine), he was leukopenic (leukocyte count of 300/mm 3 ), and he presented with fever (39°C), diarrhea, and pulmonary rhonchi. The chest X-ray film did not show pulmonary infiltrates. Laboratory studies revealed the following values: hemoglobin, 89 g/liter (normal range, 120 to 150 g/liter); platelet count, 21,000/ mm 3 (normal range 150,000 to 400,000/mm 3 ); and C-reactive protein, 209 mg/liter (normal range, Ͻ5 mg/liter). Two sets of blood cultures (Vital; bioMérieux, Marcy l'Etoile, France) were performed. Subsequently, empirical antimicrobial therapy was started with intravenous ceftazidime (1 g/8 h) plus intravenous ciprofloxacin (200 mg/12 h) as recommended in our hospital for neutropenic fever. The fever decreased in 24 h, but the patient suddenly died 8 days after the onset of the antimicrobial therapy.Gram-negative, aerobic, nonmotile coccobacilli were detected in two blood culture bottles after 2 days of incubation. Subcultures were performed, and growth was observed after 24 h of incubation with 5% CO 2 on plates containing chocolate, blood, and Trypticase soy agar (bioMérieux). The colonies were small (0.5 to 1 mm) and nonpigmented. No hemolysis on sheep or horse blood was observed. The organism was strictly aerobic and catalase and oxidase positive. Its growth was enhanced in a 5% CO 2 atmosphere. The glucose test result was ambiguous with the API NH assay (bioMérieux), but the oxidation of glucose was negative in medium supplemented with 1% carbohydrate (MEVAG; Bio-Rad, Marnes-la-Coquette, France). All tests were negative with the API NE strip (bioMérieux). The strain was negative for the following characteristics: urease, indole production, o-nitrophenyl-␤-D-galactopyranoside, growth on Simmons citrate, hydrolysis of Tween 80, accumulation of lipids after growth on ␤-hydroxybutyrate, and ␥-glutamyl transferase. It was asaccharolytic, resistant to the vibriostatic compound O/129, and did not reduce nitrate but did reduce nitrite. The phenylalanine deaminase reaction is dependent on the culture medium used (7). Therefore, to successfully utilize this test, the isolate was grown on various media (Mueller-Hinton, blood, and chocolate agar) prior to inoculation with a heavy inoculum into the phenylalanine deaminase solution. Pseudomonas aeruginosa and Proteus mirabilis were used as negative and positive controls, respectively.