SpringerLink
Log in

Community-acquired fulminant colitis caused by binary toxin-producing Clostridium difficile in Japan

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

We report a case of community-acquired fulminant colitis caused by Clostridium difficile in Japan. A 46-year-old woman was diagnosed with severe infectious enterocolitis and was admitted at another hospital. The stool culture was positive for toxigenic C. difficile. Since the patient presented with fulminant C. difficile infection (CDI) with toxic megacolon, respiratory insufficiency, and circulatory failure, she was transferred to Kyorin University Hospital for intensive care. Intubation and antibiotic therapy were performed. The general condition improved with conservative treatment, and she was discharged without sequelae. While the recovered isolate was toxin A and B-positive and binary toxin-positive, it was identified as polymerase chain reaction (PCR) ribotype ts0592 and slpA sequence type ts0592. The isolate was different from PCR ribotype 027 epidemic in Europe and North America. In Japan, binary toxin-producing strains are rare and have not caused an epidemic to date. Furthermore, there are few data on community-acquired CDI in Japan. In this case, a non-elderly woman with no major risk factors such as antibiotic use, administration of proton pump inhibitor and history of gastrointestinal surgery developed community-acquired fulminant CDI caused by the binary toxin-positive strain, and ICU treatment was required. Further studies focusing on the role of binary toxin-positive C. difficile in the severity of community-acquired CDI are necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

C. difficile :

Clostridium (Clostridioides) difficile

CDI:

Clostridium (Clostridioides) difficile infection

PCR:

Polymerase chain reaction

slpA :

Surface layer protein A gene

CT:

Computed tomography

ADP:

Adenosine diphosphate

ICU:

Intensive care unit

References

  1. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353:2442–9.

    Article  CAS  PubMed  Google Scholar 

  2. Miller M, Gravel D, Mulvey M, et al. Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis. 2010;50:194–201.

    Article  CAS  PubMed  Google Scholar 

  3. Gerding DN, Johnson S, Rupnik M, et al. Clostridium difficile binary toxin CDT: mechanism, epidemiology, and potential clinical importance. Gut Microbes. 2014;5:15–27.

    Article  PubMed  Google Scholar 

  4. Goorhuis A, Bakker D, Corver J, et al. Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. Clin Infect Dis. 2008;47:1162–70.

    Article  CAS  PubMed  Google Scholar 

  5. Kato H, Ito Y, van den Berg RJ, et al. First isolation of Clostridium difficile 027 in Japan. Euro Surveill. 2007;12:E070111.3.

    CAS  PubMed  Google Scholar 

  6. Mayfield JL, Leet T, Miller J, et al. Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis. 2000;31:995–1000.

    Article  CAS  PubMed  Google Scholar 

  7. Japanese Society of Chemotherapy Committee on Guidelines for Treatment of Anaerobic Infectious. Japanese Association for Anaerobic Infection Research: Chap. 2-12-7. Anaerobic infections (individual fields): antibiotic-associated diarrhea and enterocolitis. J Infect Chemother. 2011;17:137–9.

    Article  Google Scholar 

  8. Khanna S, Pardi DS, Aronson SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol. 2012;107:89–95.

    Article  PubMed  Google Scholar 

  9. Dial S, Kezouh A, Dascal A, et al. Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection. CMAJ. 2008;179:767–72.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Stubbs SL, Brazier JS, O’Neill HL, et al. PCR targeted to the 16S–23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. J Clin Microbiol. 1999;37:461–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Kato H, Kato H, Ito Y, et al. Ty** of Clostridium difficile isolates endemic in Japan by sequencing of slpA and its application to direct ty**. J Med Microbiol. 2010;59:556–62.

    Article  CAS  PubMed  Google Scholar 

  12. He M, Miyajima F, Roberts P, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet. 2013;45:109–13.

    Article  CAS  Google Scholar 

  13. Keel K, Brazier JS, Post KW, et al. Prevalence of PCR ribotypes among Clostridium difficile isolates from pigs, calves, and other species. J Clin Microbiol. 2007;45:1963–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Nishimura S, Kou T, Kato H, et al. Fulminant pseudomembranous colitis caused by Clostridium difficile PCR ribotype 027 in a healthy young woman in Japan. J Infect Chemother. 2014;20:729–31.

    Article  PubMed  Google Scholar 

  15. Tagashira Y, Kato H, Senoh M, et al. Two cases of fulminant colitis due to binary toxin-positive Clostridium difficile that are not PCR ribotype 027 or type 078. J Med Microbiol. 2013;62:1486–9.

    Article  PubMed  Google Scholar 

  16. Senoh M, Kato H, Fukuda T, et al. Predominance of PCR-ribotypes, 018 (smz) and 369 (trf) of Clostridium difficile in Japan: a potential relationship with other global circulating strains? J Med Microbiol. 2015;64:1226–36.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This research was partially supported by AMED under Grant number JP 18fk0108049j2302.

Author information

Authors and Affiliations

  1. Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan

    Noriaki Oguri, Akihito Sakuraba, Hiromu Morikubo, Oki Kikuchi, Taro Sato, Soutaro Tokunaga, Shintaro Minowa, Osamu Ikezaki, Tatsuya Mitsui, Miki Miura, Daisuke Saito, Mari Hayashida, Hideaki Mori & Tadakazu Hisamatsu

  2. Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan

    Takako Osaki & Shigeru Kamiya

  3. Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan

    Mitsutoshi Senoh & Haru Kato

Authors
  1. Noriaki Oguri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihito Sakuraba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiromu Morikubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oki Kikuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Taro Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Soutaro Tokunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shintaro Minowa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Osamu Ikezaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tatsuya Mitsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Miki Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Daisuke Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mari Hayashida
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hideaki Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Takako Osaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Shigeru Kamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Mitsutoshi Senoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Haru Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Tadakazu Hisamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tadakazu Hisamatsu.

Ethics declarations

Conflict of interest

All authors (Noriaki Oguri, Akihito Sakuraba, Hirom Morikubo, Oki kikuchi, Taro Sato, Soutaro, Tokunaga, Shintaro Minowa, Osamu Ikezaki, Tatsuya Mitsui, Miki Miura, Daisuke Saito, Mari Hayashida, Hideaki Mori, Takako Osaki, Shigeru Kamiya, Mitsutoshi Senoh Haru Kato and Tadakazu Hisamatsu) declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oguri, N., Sakuraba, A., Morikubo, H. et al. Community-acquired fulminant colitis caused by binary toxin-producing Clostridium difficile in Japan. Clin J Gastroenterol 12, 325–329 (2019). https://doi.org/10.1007/s12328-019-00949-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-019-00949-z

Keywords

Search

Navigation