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Journal of Clinical Microbiology, February 2006, p. 353-358, Vol. 44, No. 2
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.2.353-358.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Correlation of Disease Severity with Fecal Toxin Levels in Patients with Clostridium difficile-Associated Diarrhea and Distribution of PCR Ribotypes and Toxin Yields In Vitro of Corresponding Isolates

Thomas Åkerlund,1* Bo Svenungsson,2 Åsa Lagergren,3 and Lars G. Burman1

Department of Bacteriology, Swedish Institute for Infectious Disease Control, S-17182, Solna,1 Department of Communicable Disease Control and Prevention, Karolinska Hospital, Stockholm,2 Division of Infectious Diseases, Department of Medicine, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden3

Received 22 June 2005/ Returned for modification 13 August 2005/ Accepted 13 November 2005

We investigated in vivo and in vitro yields of toxins A and B from and PCR ribotypes of Clostridium difficile isolates from 164 patients with differing severities of C. difficile-associated diarrhea (CDAD) (patients were grouped as follows: <3 loose stools per day, n = 45; 3 to 10 per day, n = 97; >10 per day, n = 22). The median fecal toxin levels in each group were 0.5, 6.8, and 149 U/g feces (P < 0.001), respectively. Patients with severe diarrhea also had more-frequent occurrence of blood in stool and vomiting, but there was no association with fecal toxin levels per se. There was no correlation between fecal toxin level and toxin yield in vitro for the corresponding C. difficile isolate or between its PCR ribotype and disease severity. A broad range of toxin yields among isolates belonging to major PCR ribotypes indicated a presence of many subtypes. We hypothesize that bacterial and host factors that affect C. difficile toxin levels in feces are important determinants of symptoms in CDAD patients. An inverse correlation between toxin yield and spore count (r = 0.66) in stationary-phase cultures supported the notion that toxin production and sporulation represent opposite alternative survival strategies for C. difficile cells facing nutrient shortage.

* Corresponding author. Mailing address: Department of Bacteriology, Swedish Institute for Infectious Disease Control, S-17182, Solna, Sweden. Phone: 46 8 4572467. Fax: 46 8 301797. E-mail: Thomas.Akerlund{at}smi.ki.se.

Journal of Clinical Microbiology, February 2006, p. 353-358, Vol. 44, No. 2
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.2.353-358.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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