title: Prevalence of Clostridium difficile toxinotypes in infected patients at a tertiary care center in Lebanon.
abstract: BACKGROUND
  Due to the increase in the incidence of Clostridium difficile associated diseases at a tertiary care center in Lebanon, this study was undertaken to determine the prevalent C. difficile toxinotypes.
  
  
  METHODS
  The immunocard method was used to test for toxins A and B in 88 collected stool samples, followed with API 20A to confirm for C. difficile. PCR amplification of the triose phosphate isomerase (tpi) gene, the toxin encoding genes tcdA, and tcdB, followed by toxinotyping, were performed on recovered isolates and stool specimens.
  
  
  RESULTS
  Out of the 88 stool samples obtained, 30 (65.2%) were Immunocard positive, culture and or tpi positive for C. difficile. Of the 30 isolates, 4 were PCR negative for the tcdA and tcdB genes (A-B-), and 26 were PCR positive for the tcdA and / or tcdB genes with 4 being A+B+, 1 A+B-, and 21 A-B+. The results of toxinotyping showed that 2 isolates belonged to toxinotype 0, 4 to toxinotype XI, 2 to toxinotype XII, 1 to toxinotype XVI, 1(A+B-) and twenty (A-B+) designated as toxinotype 0-like. C. difficile was detected in 65.2% of patients' stools with prevalence of toxinotype 0-like.
  
  
  CONCLUSIONS
  Identification of toxinotypes of C. difficile is important to determine the virulence potential of strains and control their spread.
authors.affiliation: Faculty of Medicine, American University of Beirut and Medical Center, Beirut, Lebanon. romymoukhaiber@hotmail.com.
authors.forename: Romy
authors.initials: R
authors.lastname: Moukhaiber
authors.forename: George F
authors.initials: GF
authors.lastname: Araj
authors.forename: Kohar Annie B
authors.initials: KA
authors.lastname: Kissoyan
authors.forename: Katia A
authors.initials: KA
authors.lastname: Cheaito
authors.forename: Ghassan M
authors.initials: GM
authors.lastname: Matar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000032:analysis / Q000235:genetics*; D001427:Bacterial Toxins / Q000032:analysis / Q000235:genetics*; D002648:Child; D016360:Clostridioides difficile / Q000235:genetics* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D004768:Enterotoxins / Q000032:analysis / Q000235:genetics*; D005243:Feces / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D015995:Prevalence; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile