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Journal of Clinical Microbiology, March 2008, p. 1157-1158, Vol. 46, No. 3
0095-1137/08/$08.00+0     doi:10.1128/JCM.01536-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

LETTER TO THE EDITOR

Clostridium difficile PCR Ribotype 078: an Emerging Strain in Humans and in Pigs?


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In a recent paper, Keel and colleagues concluded that Clostridium difficile PCR ribotype 078 was the most common PCR ribotype among isolates from swine (83% of 119 isolates) and isolates from calves (94% of 33 isolates) in The United States (1). In contrast, only 1 of 23 human isolates collected from two hospitals belonged to type 078. The recent finding of Songer et al. that type 078 is frequently found in meat products suggests that transmission from animals to humans is possible (J. G. Songer, H. T. Trinh, A. D. Thompson, G. E. Killgore, L. C. McDonald, and B. M. Limbago, presented at the Second International Clostridium difficile Symposium, Maribor, Slovenia, 6 to 9 June 2007). Our results from The Netherlands are in agreement with the hypothesis and indicate that C. difficile type 078 is of more clinical importance than was reported by Keel and colleagues (1).

In a 2-month period in 2005, 17 hospitals participated in a surveillance study of the incidence of Clostridium difficile-associated diarrhea (CDAD) in The Netherlands (2). PCR type 078 was found in 5 out of 67 (7.5%) CDAD patients and represented the third most frequently occurring type, after type 027 (16%) and type 014 (16%). In 2006, a surveillance study in a 982-bed hospital located in Amersfoort revealed 105 patients with CDAD, where type 078 was present in 3 patients (3.9%). In 2007, we performed a surveillance study in a 1,004-bed hospital in Zwolle and found type 078 to be present in 5 out of 47 patients (10.6%). All 13 type 078 isolates belonged to toxinotype V, contained the genes tcdA and tcdB, were binary toxin positive, and had a 39-bp deletion in tcdC. The average age of 13 patients was 63 years, ranging from 8 to 85 years, and all had one or more comorbid conditions. A health care onset was observed in 6 (46%) patients and a community onset in 7 (54%) patients, 3 of whom had been discharged in the 3 months prior to the onset of CDAD (health care association) and 4 of whom had not previously been admitted to a health care facility (community association). Severe diarrhea was present in nine patients (69%). Two patients died within 30 days of diagnosis, one death (8%) being attributable to CDAD.

In accordance with the findings of Keel and coworkers, we also found C. difficile ribotype 078 in pigs, but in our case, this ribotype was exclusive and was found only in diarrheal neonatal piglets in 6 out of 12 diseased and sampled litters (S. B. Debast, L. A. M. G. van Leengoed, C. Harmanus, E. J. Kuijper, and A. B. Bergwerff, submitted for publication). At the pathological investigation, these animals typically showed colitis. Like our hospital isolates, piglet-derived C. difficile ribotype 078 contained the genes tcdA and tcdB, were binary toxin positive, and had a 39-bp deletion in tcdC.

We conclude that C. difficile PCR ribotype 078 is a frequently encountered pathogen of CDAD in the human population in The Netherlands, represented mainly as a community onset disease. Since type 078 is also found as an important pathogen of CDAD in pigs, studies are currently ongoing to investigate this association in more detail.


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  1. Keel, K., J. S. Brazier, K. W. Post, S. Weese, and J. G. Songer. 2007. Prevalence of PCR ribotypes among Clostridium difficile isolates from pigs, calves, and other species. J. Clin. Microbiol. 45:1963-1964.[Abstract/Free Full Text]
  2. Paltansing, S., R. J. van den Berg, R. A. Guseinova, C. E. Visser, E. R. van der Vorm, and E. J. Kuijper. 2007. Characteristics and incidence of Clostridium difficile-associated disease in The Netherlands, 2005. Clin. Microbiol. Infect. 13:1058-1064.[CrossRef][Medline]
Abraham Goorhuis
Department of Medical Microbiology
Reference laboratory for Clostridium difficile
Center of Infectious Diseases
Leiden University Medical Center
PO Box 9600
NL-2300 RC Leiden, The Netherlands

Sylvia B. Debast
Department of Medical Microbiology
Meander Medical Centre
PO Box 1502
NL-3800 BM Amersfoort, The Netherlands

Leo A. M. G. van Leengoed
Utrecht University
Faculty of Veterinary Medicine
Department of Farm Animal Health
Internal Medicine Division
PO Box 80.151
NL-3508 TD Utrecht, The Netherlands

Celine Harmanus
Department of Medical Microbiology
Reference laboratory for Clostridium difficile
Center of Infectious Diseases
Leiden University Medical Center
PO Box 9600
NL-2300 RC Leiden, The Netherlands

Daan W. Notermans
Centre for Infectious Disease Control
National Institute for Public Health and the Environment (RIVM)
Bilthoven, The Netherlands

Aldert A. Bergwerff
Utrecht University
Institute for Risk Assessment Sciences
Veterinary Public Health Division
PO Box 80.175
NL-3508 TD Utrecht, The Netherlands

Edward J. Kuijper*
Department of Medical Microbiology
Reference laboratory for Clostridium difficile
Center of Infectious Diseases
Leiden University Medical Center
PO Box 9600
NL-2300 RC Leiden, The Netherlands

* Phone: 31-71-5263574. Fax: 31-71-5248148. E-mail: e.j.kuijper{at}lumc.nl


Author's Reply


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Much of the information regarding ribotype 078/toxinotype V strains as human pathogens emerged during the process of publication of Keel et al. (1). Data on the occurrence of this genotype of Clostridium difficile in humans are neither extensive nor conclusive, but I agree with the authors that some sort of connection among food animals, foods, and humans is likely. Data in another of our publications (2) suggest that human strains arose from those found in pigs.


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  1. Keel, K., J. S. Brazier, K. W. Post, S. Weese, and J. G. Songer. 2007. Prevalence of PCR ribotypes among Clostridium difficile isolates from pigs, calves, and other species. J. Clin. Microbiol. 45:1963-1964.[Abstract/Free Full Text]
  2. Stabler, R. A., D. N. Gerding, J. G. Songer, D. Drudy, J. S. Brazier, H. T. Trinh, A. A. Witney, J. Hinds, and B. W. Wren. 2006. Comparative phylogenomics of Clostridium difficile reveals clade specificity and microevolution of hypervirulent strains. J. Bacteriol. 188:7297-7305.[Abstract/Free Full Text]
J. Glenn Songer
Department of Veterinary Science and Microbiology
Bldg. 90, Rm. 229
University of Arizona
Tucson, Arizona 85721
Phone: (520) 621-2962
Fax: (520) 621-6366
E-mail: gsonger{at}u.arizona.edu

Journal of Clinical Microbiology, March 2008, p. 1157-1158, Vol. 46, No. 3
0095-1137/08/$08.00+0     doi:10.1128/JCM.01536-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



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