title: Clostridium difficile ribotype 126 in southern Taiwan: a cluster of three symptomatic cases.
abstract: BACKGROUND
  Several virulent Clostridium difficile clones, designated as polymerase chain reaction (PCR) ribotypes 017, 027, or 078, are well recognized in western countries. However, the ribotype distribution of clinical C. difficile isolates in Taiwan remains unclear.
  
  
  METHODS
  Between 2010 and 2012, we identified three patients with C. difficile-associated diarrhea (CDAD) at a hospital in southern Taiwan. The C. difficile strains isolated from these patients were further characterized by PCR detection of tcdA, tcdB, tcdC, cdtA, and cdtB, toxinotyping, multilocus sequence typing, ribotyping and repetitive-based PCR.
  
  
  RESULTS
  Three C. difficile strains harbored tcdCΔ39 and belonged to multilocus sequence typing 11 (ST11), toxinotype V, and ribotype 126 (a ribotype 078-like clone). Notably, one patient developed pseudomembranous colitis and recurrent CDAD. These three isolates were noted between January 2012 and June 2012 and were identical, as evidenced by repetitive sequence-based PCR, suggestive of case clustering.
  
  
  CONCLUSIONS
  A hypervirulent C. difficile clone, ribotype 126, causing pseudomembranous colitis and recurrent CDAD, is present in southern Taiwan.
authors: Departments of Internal Medicine, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan.
authors: Yuan-Pin
authors: YP
authors: Hung
authors: Departments of Internal Medicine, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan.
authors: Hsiao-Ju
authors: HJ
authors: Lin
authors: Department of Microbiology and Immunology, National Cheng Kung University, Medical College, Tainan, Taiwan.
authors: Bo-Yang
authors: BY
authors: Tsai
authors: Departments of Internal Medicine, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan; Departments of Experiment and Diagnosis, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan.
authors: Hsiao-Chieh
authors: HC
authors: Liu
authors: Departments of Experiment and Diagnosis, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan.
authors: Hsiu-Chuan
authors: HC
authors: Liu
authors: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Jen-Chieh
authors: JC
authors: Lee
authors: Department of Internal Medicine, E-da Hospital, Kaohsiung, Taiwan.
authors: Yi-Hui
authors: YH
authors: Wu
authors: Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: Mark H
authors: MH
authors: Wilcox
authors: Department of Microbiology, Old Medical School, Leeds General Infirmary, UK.
authors: Warren N
authors: WN
authors: Fawley
authors: Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Po-Ren
authors: PR
authors: Hsueh
authors: Department of Microbiology and Immunology, National Cheng Kung University, Medical College, Tainan, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, Tainan, Taiwan. Electronic address: peijtsai@mail.ncku.edu.com.
authors: Pei-Jane
authors: PJ
authors: Tsai
authors: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
authors: Wen-Chien
authors: WC
authors: Ko
mesh_terms: D000368:Aged; D001427:Bacterial Toxins / Q000235:genetics; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D016000:Cluster Analysis; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D021521:Ribotyping; D013624:Taiwan / Q000453:epidemiology
chemical_list: D001427:Bacterial Toxins
keywords: Clostridium difficile; Ribotype 078-like; Ribotype 126; Taiwan