Colonization of the large bowel by Clostridium difficile in healthy infants: quantitative study

Abstract

Colonization of the large bowel of healthy infants by Clostridium difficile was studied. Feces were collected from five breast-fed aand five formula-fed infants throughout the first year of life, and levels of C. difficile were quantitated. Three breast-fed and five formula-fed infants were colonized for periods of between 8 and 42 weeks, and another infant harbored the organism only during week 1. Colonization of breast-fed infants commenced before or during weaning, with levels reaching 10(3) to 10(5) organisms per g of wet feces. Colonization of formula-fed infants commenced before solid foods were given, with levels of 10(3) to 10(7) organisms per g of wet feces. Isolates from eight of the babies were shown to produce cytotoxin in vitro. Single fecal specimens from 60 more children aged up to 4 years were also examined, and it was found that the carriage rate of C. difficile fell sharply after 1 year of age, although in the second year it was still higher than in adults. These findings are discussed in relation to the microbial ecology of the large bowel and the paradox that levels of C. difficile in the large bowel of healthy infants are similar to those causing pseudomembranous colitis in patients.

Effect of Streptococcus parvulus and Peptostreptococcus magnus on Cytotoxin Levels of Clostridium difficile in Anaerobic Continuous Flow Culture

“…Furthermore, a number of laboratories have reported that C. difficile is the etiological agent of PMC and enterocolitis in hamster and other animals (3,4,6,11). On the other hand, C. dijficile producing a cytotoxin in vitro is frequently isolated from healthy infants (15). Therefore, the etiological role for the pathogenicity of this organism is not clarified.…”

“…Therefore, the etiological role for the pathogenicity of this organism is not clarified. Stark et al (15) reported that it is necessary to consider the difference in bacterial flora and physicochemical conditions existing in the large bowel of infants and PMC patients, and that other factors such as bacterial activation of toxin and the changes of pH, Eh, or intestinal motility should contribute to the pathogenic process in C. difficile infection.…”

“…Clostridium difficile is regarded as the pathogen of antibiotic-associated diarrhea and pseudomembranous colitis (1,2). C. difficile is, however, commonly isolated from healthy infants: Stark et al (15) reported that isolation rates were about 60% in babies less than 1 year of age. Furthermore, it was also reported that cytotoxin activity was detected from the fecal specimens of the babies in which C. difficile was isolated (7,15).…”

“…C. difficile is, however, commonly isolated from healthy infants: Stark et al (15) reported that isolation rates were about 60% in babies less than 1 year of age. Furthermore, it was also reported that cytotoxin activity was detected from the fecal specimens of the babies in which C. difficile was isolated (7,15). These findings seem to indicate that the etiological role of this organism for diarrhea has not been fully understood.…”

Demonstration of toxin A and B by polymerase chain reaction and McCoy cell assay in clinical isolates of Clostridium difficile from Denmark

“…Clostridium dfficile is a well known cause of pseudomembranous colitis (PMC) and is often involved in antibiotic-associated diarrhoea (2,13). The bacteria are commonly found in the normal intestinal flora in infants below the age of one year (9,19,22). The pathogenicity of the bacteria is associated with the production of at least two toxins, A and B. Enterotoxin A causes fluid accumulation, diarrhoea and haemorrhage in the intestine (12,16), and exerts a cytotoxic effect as well, but to a lesser degree than toxin B (7).…”