title: HumanClostridium difficileinfection caused by a livestock-associated PCR ribotype 237 strain in Western Australia.
abstract: BACKGROUND
  Clostridium difficileinfection (CDI) is a significant gastrointestinal disease in the developed world and increasingly recognised as a zoonotic infection. In North America and Europe, the PCR ribotype (RT) 078 strain ofC. difficileis commonly found in production animals and as a cause of disease in humans although proof of transmission from animals is lacking. This strain is absent in Australian livestock. We report a case of human CDI caused by a strain ofC. difficilebelonging to known Australian livestock-associated RT 237.
  
  
  METHODS
  A young male was admitted for multiple trauma following a motor vehicle accident and placed on piperacillin/tazobactam for pneumonia. After 4 days of treatment, he developed symptoms of CDI, which was confirmed in the laboratory. His symptoms resolved after 6 days of intravenous metronidazole. The strain ofC. difficileisolated was identified as RT 237, an unusual RT previously found in with several Western Australia piggeries.
  
  
  CONCLUSIONS
  This case of CDI caused by an unusual livestock-associatedC. difficileRT 237 supports the hypothesis of zoonotic transmission. The case highlights the potential of livestock to act as reservoir forC. difficileand the need for continued surveillance of CDI in both human and animal populations.
authors.affiliation: School of Pathology and Laboratory Medicine, The University of Western Australia, 6009 Nedlands, Western Australia.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Mc Govern
authors.affiliation: Department of Microbiology, Path West Laboratory Medicine, Queen Elizabeth II Medical Centre, 6009 Nedlands, Western Australia.
authors.forename: Niki F
authors.initials: NF
authors.lastname: Foster
authors.affiliation: Department of Infectious Diseases, Royal Perth Hospital, 6000 Perth, Western Australia.
authors.forename: Lynette A
authors.initials: LA
authors.lastname: Pereira
authors.affiliation: School of Pathology and Laboratory Medicine, The University of Western Australia, 6009 Nedlands, Western Australia.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Knight
authors.affiliation: School of Pathology and Laboratory Medicine, The University of Western Australia, 6009 Nedlands, Western Australia.
authors.forename: Briony
authors.initials: B
authors.lastname: Elliott
authors.affiliation: School of Pathology and Laboratory Medicine, The University of Western Australia, 6009 Nedlands, Western Australia.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Chang
authors.affiliation: School of Pathology and Laboratory Medicine, The University of Western Australia, 6009 Nedlands, Western Australia.|Department of Microbiology, Path West Laboratory Medicine, Queen Elizabeth II Medical Centre, 6009 Nedlands, Western Australia.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Riley
keywords: Clostridium difficile infection (CDI); PCR ribotyping; antibiotics; diarrhoea; metronidazole; zoonosis