C diff: New, more virulent strain emerges
Clostridium difficile continues to emerge in a more pathogenic form with a new epidemiological profile.
Particularly disturbing are new reports in four states of infections in patients previously thought to be at low risk for C. diff.
Considered in the context of recent high-morbidity, hospital-associated outbreaks in North America, Great Britain, and the Netherlands, the cases of severe C diff appear to reflect a "changing epidemiology," the Centers for Disease Control and Prevention reports.1
Clinical features that have been less common in the past include close-contact transmission, high recurrence rate, young patient age, bloody diarrhea, and lack of antimicrobial exposure.
C. difficile exotoxins A and B cause colonic dysfunction and cell death. A new emerging epidemic strain of the pathogen produces 16 times more toxin A and 23 times more toxin B compared with other common strains.
Virulent strains can cause more severe disease in populations at high risk, but also cause more frequent, severe disease in populations previously at low risk (e.g., otherwise healthy persons with little or no exposure to health-care settings or antimicrobial use).
In Pennsylvania and three other states, severe C diff infections have occurred in two groups traditionally considered at low risk: healthy people living in the community and peripartum women (those in the last month of gestation or the first few months after delivery).
The findings underscore the importance of judicious antimicrobial use, the need for community clinicians to maintain a higher index of suspicion for C diff, and the need for surveillance to better understand the changing epidemiology of the pathogen, the CDC concluded.
Reference
- Centers for Disease Control and Prevention. Severe Clostridium difficile — Associated Disease in Populations Previously at Low Risk — Four States, 2005. MMWR 2005 54(47);1201-1205
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