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The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics

OBJECTIVES: Clostridium difficile is a major global human pathogen divided into five clades, of which clade 3 is the least characterized and consists predominantly of PCR ribotype (RT) 023 strains. Our aim was to analyse and characterize this clade. METHODS: In this cohort study the clinical present...

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Autores principales: Shaw, H.A., Preston, M.D., Vendrik, K.E.W., Cairns, M.D., Browne, H.P., Stabler, R.A., Crobach, M.J.T., Corver, J., Pituch, H., Ingebretsen, A., Pirmohamed, M., Faulds-Pain, A., Valiente, E., Lawley, T.D., Fairweather, N.F., Kuijper, E.J., Wren, B.W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167513/
https://www.ncbi.nlm.nih.gov/pubmed/31525517
http://dx.doi.org/10.1016/j.cmi.2019.09.004
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author Shaw, H.A.
Preston, M.D.
Vendrik, K.E.W.
Cairns, M.D.
Browne, H.P.
Stabler, R.A.
Crobach, M.J.T.
Corver, J.
Pituch, H.
Ingebretsen, A.
Pirmohamed, M.
Faulds-Pain, A.
Valiente, E.
Lawley, T.D.
Fairweather, N.F.
Kuijper, E.J.
Wren, B.W.
author_facet Shaw, H.A.
Preston, M.D.
Vendrik, K.E.W.
Cairns, M.D.
Browne, H.P.
Stabler, R.A.
Crobach, M.J.T.
Corver, J.
Pituch, H.
Ingebretsen, A.
Pirmohamed, M.
Faulds-Pain, A.
Valiente, E.
Lawley, T.D.
Fairweather, N.F.
Kuijper, E.J.
Wren, B.W.
author_sort Shaw, H.A.
collection PubMed
description OBJECTIVES: Clostridium difficile is a major global human pathogen divided into five clades, of which clade 3 is the least characterized and consists predominantly of PCR ribotype (RT) 023 strains. Our aim was to analyse and characterize this clade. METHODS: In this cohort study the clinical presentation of C. difficile RT023 infections was analysed in comparison with known ‘hypervirulent’ and non-hypervirulent strains, using data from the Netherlands national C. difficile surveillance programme. European RT023 strains of diverse origin were collected and whole-genome sequenced to determine the genetic similarity between isolates. Distinctive features were investigated and characterized. RESULTS: Clinical presentation of C. difficile RT023 infections show severe infections akin to those seen with ‘hypervirulent’ strains from clades 2 (RT027) and 5 (RT078) (35%, 29% and 27% severe CDI, respectively), particularly with significantly more bloody diarrhoea than RT078 and non-hypervirulent strains (RT023 8%, other RTs 4%, p 0.036). The full genome sequence of strain CD305 is presented as a robust reference. Phylogenetic comparison of CD305 and a further 79 previously uncharacterized European RT023 strains of diverse origin revealed minor genetic divergence with >99.8% pairwise identity between strains. Analyses revealed distinctive features among clade 3 strains, including conserved pathogenicity locus, binary toxin and phage insertion toxin genotypes, glycosylation of S-layer proteins, presence of the RT078 four-gene trehalose cluster and an esculinase-negative genotype. CONCLUSIONS: Given their recent emergence, virulence and genomic characteristics, the surveillance of clade 3 strains should be more highly prioritized.
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spelling pubmed-71675132020-04-22 The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics Shaw, H.A. Preston, M.D. Vendrik, K.E.W. Cairns, M.D. Browne, H.P. Stabler, R.A. Crobach, M.J.T. Corver, J. Pituch, H. Ingebretsen, A. Pirmohamed, M. Faulds-Pain, A. Valiente, E. Lawley, T.D. Fairweather, N.F. Kuijper, E.J. Wren, B.W. Clin Microbiol Infect Article OBJECTIVES: Clostridium difficile is a major global human pathogen divided into five clades, of which clade 3 is the least characterized and consists predominantly of PCR ribotype (RT) 023 strains. Our aim was to analyse and characterize this clade. METHODS: In this cohort study the clinical presentation of C. difficile RT023 infections was analysed in comparison with known ‘hypervirulent’ and non-hypervirulent strains, using data from the Netherlands national C. difficile surveillance programme. European RT023 strains of diverse origin were collected and whole-genome sequenced to determine the genetic similarity between isolates. Distinctive features were investigated and characterized. RESULTS: Clinical presentation of C. difficile RT023 infections show severe infections akin to those seen with ‘hypervirulent’ strains from clades 2 (RT027) and 5 (RT078) (35%, 29% and 27% severe CDI, respectively), particularly with significantly more bloody diarrhoea than RT078 and non-hypervirulent strains (RT023 8%, other RTs 4%, p 0.036). The full genome sequence of strain CD305 is presented as a robust reference. Phylogenetic comparison of CD305 and a further 79 previously uncharacterized European RT023 strains of diverse origin revealed minor genetic divergence with >99.8% pairwise identity between strains. Analyses revealed distinctive features among clade 3 strains, including conserved pathogenicity locus, binary toxin and phage insertion toxin genotypes, glycosylation of S-layer proteins, presence of the RT078 four-gene trehalose cluster and an esculinase-negative genotype. CONCLUSIONS: Given their recent emergence, virulence and genomic characteristics, the surveillance of clade 3 strains should be more highly prioritized. Elsevier 2020-04 /pmc/articles/PMC7167513/ /pubmed/31525517 http://dx.doi.org/10.1016/j.cmi.2019.09.004 Text en © 2019 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shaw, H.A.
Preston, M.D.
Vendrik, K.E.W.
Cairns, M.D.
Browne, H.P.
Stabler, R.A.
Crobach, M.J.T.
Corver, J.
Pituch, H.
Ingebretsen, A.
Pirmohamed, M.
Faulds-Pain, A.
Valiente, E.
Lawley, T.D.
Fairweather, N.F.
Kuijper, E.J.
Wren, B.W.
The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics
title The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics
title_full The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics
title_fullStr The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics
title_full_unstemmed The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics
title_short The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics
title_sort recent emergence of a highly related virulent clostridium difficile clade with unique characteristics
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167513/
https://www.ncbi.nlm.nih.gov/pubmed/31525517
http://dx.doi.org/10.1016/j.cmi.2019.09.004
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