title: Clinical features of Clostridium difficile-associated diarrhoea due to binary toxin (actin-specific ADP-ribosyltransferase)-producing strains.
abstract: Toxins A and B are known to be the primary virulence factors of Clostridium difficile. Other potential virulence factors have been identified such as binary toxin (actin-specific ADP-ribosyltransferase toxin, or CDT). A retrospective case-control study was performed in order to identify clinical features and risk factors of C. difficile-associated diarrhoea due to binary toxin-producing strains. Each case (a patient with diarrhoea due to binary toxin-producing strain) was compared with two controls (patients with diarrhoea due to a C. difficile strain that did not produce binary toxin) matched for ward and date of hospitalization. cdtA and cdtB genes were screened by PCR. Production of CDT was studied by Western blotting using an antiserum against Ia and Ib from the Clostridium perfringens iota toxin, and the activity of the binary toxin was assessed using an ADP-ribosyltransferase assay. Twenty-six cases (14 males and 12 females) were identified in 1999 and 2000. Cases and controls did not differ significantly for sex, age, previous administration of antibiotics or frequency of endoscopic examination. Diarrhoea was community-acquired more often in cases than in controls (65.4 vs 35.7 %, P = 0.017) and more often represented the cause of hospitalization (61.5 vs 26.2 %, P = 0.003). Moreover, diarrhoea in cases was more frequently associated with abdominal pain (63.6 vs 39.4 %, P = 0.07) and with liquid stools (76.9 vs 59.5 %, P = 0.14) than in controls. These results suggest that there could be a correlation between the production of binary toxin and the severity of diarrhoea.
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Barbut
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Decré
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Lalande
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Burghoffer
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Latifa
authors.initials: L
authors.lastname: Noussair
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Gigandon
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Espinasse
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Raskine
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Robert
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Mangeol
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Branger
authors.affiliation: Service de Microbiologie, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris cedex 12, France 2Hôpital Beaujon, 92118 Clichy, France 3Hôpital Cochin, 75679 Paris cedex 14, France 4Hôpital Ambroise Paré, 92104 Boulogne Billancourt cedex, France 5Hôpital Lariboisière, 75475 Paris cedex 10, France 6Hôpital Pitié-Salpétrière, 75651 Paris cedex 13, France 7Centre Hospitalier de Montfermeil, 93370 Montfermeil, France 8UPRES no. EA2392, Faculté de Médecine, UFR Saint-Antoine, Université Paris 6, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Petit
mesh_terms: D000328:Adult; D001426:Bacterial Proteins / Q000502:physiology*; D001427:Bacterial Toxins; D015153:Blotting, Western; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000378:metabolism / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000382:microbiology / Q000503:physiopathology*; D003967:Diarrhea / Q000382:microbiology / Q000503:physiopathology*; D004768:Enterotoxins / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile