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Journal of Clinical Microbiology, November 2003, p. 5227-5232, Vol. 41, No. 11
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.11.5227-5232.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Frequency of Binary Toxin Genes among Clostridium difficile Strains That Do Not Produce Large Clostridial Toxins

Barbara Geric,1,2* Stuart Johnson,3,4 Dale N. Gerding,2,5 Miklavz Grabnar,1 and Maja Rupnik1

Department of Biology, University of Ljubljana, Ljubljana, Slovenia,1 Northwestern University Medical School,2 VA Chicago Health Care Center Lakeside Division, Chicago,5 Hines VA Hospital, Hines,3 Loyola University Medical Center, Maywood, Illinois4

Received 1 May 2003/ Returned for modification 2 July 2003/ Accepted 9 August 2003

Pathogenic strains of Clostridium difficile commonly produce two large clostridial toxins (LCTs), A and B, virulence factors responsible for C. difficile disease. Some strains have been reported to produce an additional toxin, a binary toxin designated CDT. Binary toxin has cytotoxic effects on cells in culture, but its role in human disease is not yet defined. In this study we examined the frequency of binary toxin genes (cdtB and cdtA) among C. difficile isolates that do not produce LCTs (A- B-) from a large United States-based collection organized by restriction endonuclease analysis (REA) typing. Of 58 strains tested, 9 (15.5%) were cdtB and cdtA positive, including 4 of 46 (8.7%) non-LCT-producing REA groups, with an estimated prevalence of at least 2% of all non-LCT-producing isolates within the collection. Five of the binary toxin-positive strains belonged to toxinotype XI, which does not produce LCTs but has minor parts of the LCT coding region or pathogenicity locus (PaLoc). We describe two new binary toxin-positive variants, one without any remnant of the LCT genes. This previously unknown variation was found in three isolates that were unrelated by REA typing. LCT-negative, binary toxin-positive strains were isolated from symptomatic and asymptomatic patients and from the hospital environment.

* Corresponding author. Mailing address: Department of Biology, University of Ljubljana, Vecna pot 111, 1000 Ljubljana, Slovenia. Phone: 386 (0)1 423-3388. Fax: 386 (0)1 257-3390. E-mail: barbara.geric{at}uni-lj.si.

Journal of Clinical Microbiology, November 2003, p. 5227-5232, Vol. 41, No. 11
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.11.5227-5232.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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