Reconsidering the Sporulation Characteristics of Hypervirulent Clostridium difficile BI/NAP1/027

Burns, D.A.; Heeg, Daniela; Cartman, Stephen T.; Minton, Nigel P.

doi:10.1371/journal.pone.0024894

Cited by 91 publications

(75 citation statements)

References 26 publications

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“…Increased sporulation capacity has been hypothesized to contribute to increased transmission of this strain type (46,49). In contrast, other studies have shown that ribotype 027 is not more virulent than other strain types (184,185) and that the sporulation rate and toxin production rate are not linked to strain type (170,186,187), so this remains an area of controversy.…”

Section: Evolving Epidemiology Clinical Implications Of Strain Typingmentioning

confidence: 98%

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

2013

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SUMMARY Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile . This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.

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Section: Evolving Epidemiology Clinical Implications Of Strain Typingmentioning

confidence: 98%

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

2013

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“…The best known of these hypervirulent strains is the PCR ribotype O27/restriction endonuclease analysis (REA) group B1 (6,7). These strains are known to produce significantly higher levels of toxins and potentially higher numbers of spores (8)(9)(10), although the latter phenotype has been refuted by some (11).…”

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confidence: 99%

Functional Characterization of Clostridium difficile Spore Coat Proteins

et al. 2013

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dSpores of Clostridium difficile play a key role in the dissemination of this important human pathogen, and until recently little has been known of their functional characteristics. Genes encoding six spore coat proteins (cotA, cotB, cotCB, cotD, cotE, and sodA) were disrupted by ClosTron insertional mutagenesis. Mutation of one gene, cotA, presented a major structural defect in spore assembly, with a clear misassembly of the outermost layers of the spore coat. The CotA protein is most probably subject to posttranslational modification and could play a key role in stabilizing the spore coat. Surprisingly, mutation of the other spore coat genes did not affect the integrity of the spore, although for the cotD, cotE, and sodA mutants, enzyme activity was reduced or abolished. This could imply that these enzymatic proteins are located in the exosporium or alternatively that they are structurally redundant. Of the spore coat proteins predicted to carry enzymatic activity, three were confirmed to be enzymes using both in vivo and in vitro methods, the latter using recombinant expressed proteins. These were a manganese catalase, encoded by cotD, a superoxide dismutase (SOD), encoded by sodA, and a bifunctional enzyme with peroxiredoxin and chitinase activity, encoded by cotE. These enzymes being exposed on the spore surface would play a role in coat polymerization and detoxification of H 2 O 2 . Two additional proteins, CotF (a tyrosine-rich protein and potential substrate for SodA) and CotG (a putative manganese catalase) were shown to be located at the spore surface.

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“…The pathogenesis of severe CDI caused by BI/ NAP1/027 has not been definitively delineated. Potential factors contributing to BI/NAP1/027 pathogenicity and transmission include enhanced sporulation (subsequently refuted) (22), increased toxin A and B production (1), and the presence of the binary toxin (23).…”

Section: Pathogenesis Of Bi/nap1/027mentioning

confidence: 99%

Clinical Utility of Laboratory Detection of Clostridium difficile Strain BI/NAP1/027

Kociolek

Gerding

2016

J Clin Microbiol

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dClostridium difficile strain BI/NAP1/027 is associated with increased C. difficile infection (CDI) rates and severity, and the efficacy of some CDI therapies may be strain dependent. Although cultured C. difficile isolates can be reliably subtyped by various methods, the long turnaround times, high cost, and limited availability of strain typing preclude their routine use. Nucleic acid amplification tests identify BI/NAP1/027 rapidly from stool, but the emergence of closely related strains compromises test specificity. Although detection of epidemiologically significant pathogens is generally useful for infection control programs, specific data supporting use of rapid detection of BI/NAP1/027 as an infection control tool are still awaited.

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Reconsidering the Sporulation Characteristics of Hypervirulent Clostridium difficile BI/NAP1/027

Cited by 91 publications

References 26 publications

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

Functional Characterization of Clostridium difficile Spore Coat Proteins

Clinical Utility of Laboratory Detection of Clostridium difficile Strain BI/NAP1/027

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