title: Potentially hypervirulent Clostridium difficile PCR ribotype 078 lineage isolates in pigs and possible implications for humans in Taiwan.
abstract: Clostridium difficile is a human and animal pathogen. Recently, the incidence of community-acquired C. difficile infection has increased, and many studies have indicated that C. difficile might be food-borne. The correlation between C. difficile infection in humans and in animals has been a topic of debate. The objective of this study was to determine the genetic relatedness of C. difficile from human and pigs in Taiwan. We investigated the molecular epidemiology of C. difficile in healthy humans and pigs from 2011 to 2015. The isolation rate of C. difficile from pigs in 13 commercial farms was 49% (100/204), and a high proportion of hypervirulent (C. difficile carrying tcdA, tcdB, and cdtA/B genes and a 39-bp deletion in the tcdC gene) ribotype 078 lineage isolates (90%, 90/100; including 078, 126, 127, and 066-like isolates) were identified. In addition, the C. difficile ribotype 127 isolates from pigs typically exhibited moxifloxacin resistance (37/43; 86%). In healthy humans, the isolation rate was 4.3% (3/69), and all healthy human isolates were non-toxigenic. In particular, we compared the porcine isolates with two patient strains (ribotype 127) obtained from two hospitals in central Taiwan. The multilocus variable number tandem repeat analysis revealed a high genetic relatedness between ribotype 127 from patients and pigs. This study indicated that isolates of the ribotype 078 lineage, and especially ribotype 127, were widely distributed in pig farms and showed a high frequency of moxifloxacin resistance. The closely related ribotype 127 from patients and pigs may have had a common origin or low diversity. In conclusion, C. difficile ribotype 127 is a noteworthy pathogen in pigs and poses a potential public health threat.
authors.affiliation: Graduate Institute of Veterinary Pathobiology, College of Veterinary Medicine, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung 402, Taiwan. Electronic address: pata0112@gmail.com.
authors.forename: Ying-Chen
authors.initials: YC
authors.lastname: Wu
authors.affiliation: Graduate Institute of Veterinary Pathobiology, College of Veterinary Medicine, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung 402, Taiwan. Electronic address: frinlee@hotmail.com.
authors.forename: Jen-Jie
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Microbiology and Immunology, National Cheng Kung University, Medical College, No. 1, University Rd., Tainan 70101, Taiwan. Electronic address: anemoday@hotmail.com.
authors.forename: Bo-Yang
authors.initials: BY
authors.lastname: Tsai
authors.affiliation: Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung 402, Taiwan. Electronic address: kuraki0225@yahoo.com.tw.
authors.forename: Yi-Fen
authors.initials: YF
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, No.699, Sec. 8, Taiwan Blvd., Taichung 435, Taiwan. Electronic address: chioming2002@yahoo.com.tw.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Laboratory Medicine, China Medical University Hospital, No.91 Hsuehshih Rd., Taichung 404, Taiwan. Electronic address: t6719@mail.cmuh.org.tw.
authors.forename: Ni
authors.initials: N
authors.lastname: Tien
authors.affiliation: Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, No. 1, University Rd., Tainan 70101, Taiwan. Electronic address: peijtsai@mail.ncku.edu.com.
authors.forename: Pei-Jane
authors.initials: PJ
authors.lastname: Tsai
authors.affiliation: Graduate Institute of Veterinary Pathobiology, College of Veterinary Medicine, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung 402, Taiwan. Electronic address: thc@dragon.nchu.edu.tw.
authors.forename: Ter-Hsin
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000818:Animals; D016360:Clostridioides difficile / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity*; D016000:Cluster Analysis; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D014644:Genetic Variation; D006801:Humans; D058885:Multilocus Sequence Typing; D060885:Multiplex Polymerase Chain Reaction; D021521:Ribotyping; D013047:Specific Pathogen-Free Organisms; D013552:Swine; D013553:Swine Diseases / Q000453:epidemiology / Q000382:microbiology*; D013624:Taiwan / Q000453:epidemiology; D014774:Virulence / Q000235:genetics
keywords: Clostridium difficile; Pig; Ribotype 078; Ribotype 127; Taiwan; Zoonosis