Clostridium difficilein foods and animals: history and measures to reduce exposure (original) (raw)
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Clostridium difficile in Food and Animals: A Comprehensive Review
Advances in Experimental Medicine and Biology, 2016
Zoonoses are infections or diseases that can be transmitted between animals and humans through direct contact, close proximity or the environment. Clostridium difficile is ubiquitous in the environment, and the bacterium is able to colonise the intestinal tract of both animals and humans. Since domestic and food animals frequently test positive for toxigenic C. difficile, even without showing any signs of disease, it seems plausible that C. difficile could be zoonotic. Therefore, animals could play an essential role as carriers of the bacterium. In addition, the presence of the spores in different meats, fish, fruits and vegetables suggests a risk of foodborne transmission. This review summarises the current available data on C. difficile in animals and foods, from when the bacterium was first described up to the present.
Applied and Environmental Microbiology, 2011
Recently, an apparent rise in the number of cases attributed to community-acquired Clostridium difficile infection has led researchers to explore additional sources of infection. The finding of C. difficile in food animals and retail meat has raised concern about potential food-borne and occupational exposures. The objective of this study was to compare C. difficile isolated from a closed population of healthy individuals consisting of both humans and swine in order to investigate possible food safety and occupational risks for exposure. Using a multistep enrichment isolation technique, we identified 11.8% of the human wastewater samples and 8.6% of the swine samples that were positive for C. difficile. The prevalences of C. difficile in swine production groups differed significantly (P < 0.05); however, the prevalences in the two human occupational group cohorts did not differ significantly (P ؍ 0.81). The majority of the human and swine isolates were similar based on multiple typing methods. The similarity in C. difficile prevalence in the human group cohorts suggests a low occupational hazard, while a greatly decreased prevalence of C. difficile in later-stage swine production groups suggests a diminished risk for food-borne exposure. The similarity of strains in the two host species suggests the possibility of a common environmental source for healthy individuals in a community setting.
2011
Clostridium difficile has been recognized as one of the leading causes of nosocomial diarrhea and pseudomembranous colitis in human hospitals and nursing homes since the 1970s; however, recent occurrences of community-acquired cases have led researchers to search for additional sources of these infections. Some of the possible sources being investigated include food animals and retail meat. The objective of this study was to compare the prevalence and genotypic characteristics of C. difficile isolated from a closed population in Texas consisting of both humans and swine. Implicit in this objective, we seek to investigate the possible food safety and occupational risks associated with swine and C. difficile. Isolation of C. difficile was performed utilizing an enrichment technique and restrictive media. Polymerase chain reaction (PCR) was used to test for the presence of the toxin A and B genes, the tcdC gene deletion, and the binary toxin gene. Genotypic characteristics were compared using PCR toxinotyping and pulsed-field gel electrophoresis (PFGE). Antimicrobial susceptibility was tested using commercially available tests (ETest®) for 11 different antibiotics. Statistical comparisons (both vii NOMENCLATURE bp base pair CA-CDAD Community-acquired Clostridium difficile-associated disease CA-CDI Community-acquired Clostridium difficile infection CCFA Cycloserine cefoxitin fructose agar CCFB Cycloserine cefoxitin fructose broth CDAD Clostridium difficile-associated disease CDMN Clostridium difficile moxalactam norloxacin CDMNA Clostridium difficile moxalactam norfloxacin agar MIC Minimum inhibitory concentration MLVA Multilocus variable-number tandem-repeat analysis NAP North American pulsed-field type PCR Polymerase chain reaction PFGE Pulsed-field gel electrophoresis PYG Peptone yeast glucose RO Reverse osmosis TCDMNB Sodium taurocholate Clostridium difficile moxalactam norfloxacin broth TCCFB Sodium taurocholate cycloserine cefoxitin fructose broth VL Viande-Levure broth viii
The ecology and pathobiology of Clostridium difficile infections: An interdisciplinary challenge
2011
Clostridium difficile is a well recognized pathogen of humans and animals. Although C. difficile was first identified over 70 years ago, much remains unknown in regards to the primary source of human acquisition and its pathobiology. These deficits in our knowledge have been intensified by dramatic increases in both the frequency and severity of disease in humans over the last decade.
Detection ofClostridium difficilein Retail Ground Meat Products in Manitoba
Canadian Journal of Infectious Diseases and Medical Microbiology, 2012
The aim of the present study was to determine whetherClostridium difficilewas present in uncooked retail ground beef and ground pork products sold in Winnipeg, Manitoba. Using an alcohol treatment protocol and inoculation of cultures onC difficileMoxalactam Norfloxacin (CDMN), toxigenicC difficilewas found in 6.3% of 48 meat samples. TheC difficileisolates belonged to different pulsotypes, all of which had been previously isolated from the stool of Manitoba patients withC difficiledisease. Because cooking of meat will not eradicateC difficilespores, this raises a concern regarding potential foodborne transmissibility of this organism.
Clostridium difficile in Retail Meat Products, USA, 2007
Emerging Infectious Diseases, 2009
To determine the presence of Clostridium diffi cile, we sampled cooked and uncooked meat products sold in Tucson, Arizona. Forty-two percent contained toxigenic C. diffi cile strains (either ribotype 078/toxinotype V [73%] or 027/ toxinotype III [NAP1 or NAP1-related; 27%]). These fi ndings indicate that food products may play a role in interspecies C. diffi cile transmission.
Clostridium difficile as an emerging foodborne pathogen of public health significance
The recent decades have witnessed the emergence and re-emergence of foodborne pathogens that cause significant morbidity and mortality worldwide. Clostridium difficile is an anaerobic, spore-forming pathogen that is a common cause of hospital and antimicrobial-associated diarrhea. Clostridium difficile has been isolated from food animals, vegetables, and retail meat that it might be a zoonotic and foodborne pathogen. Zoonotic transmission of Clostridium difficile has occurred after direct or indirect contact with contaminated animal feces. Understanding how the bacterium enters foods and humans are important for developing sciencebased prevention strategies. The presence of asymptomatic animals that bring and shed bacterium into the environment, infecting individuals or communities directly or through the food chain, is a major public health concern. The most common symptom of Clostridium difficile infections is diarrhea, which is not visibly bleeding and may be soft or watery. In addition, hypoalbuminemia, and sometimes fulminating colitis are some of the other symptoms exhibited by the patient. Since nucleic acid tests have a lower specificity, some clinicians agree that toxin enzyme immunoassays are better predictors of disease. The use of toxin gene cycle thresholds to predict the existence and absence of toxins has recently piqued interest. A variety of novel Clostridium difficile infections therapies are in different growth stages, including an antibiotic ridinilazole and RBX2660, and a vaccine is all in phase 3 trials. Certain measures like hand hygiene, isolation precautions, environmental sanitation, and limited use of broad-spectrum antibiotics may help in the prevention and control of infection due to Clostridium difficile.
Clostridium difficilein Retail Ground Meat, Canada
Emerging Infectious Diseases, 2007
Clostridium difficile was isolated from 12 (20%) of 60 retail ground meat samples purchased over a 10-month period in 2005 in Canada. Eleven isolates were toxigenic, and 8 (67%) were classified as toxinotype III. The human health implications of this finding are unclear, but with the virulence of toxinotype III strains further studies are required.
BMC Microbiology, 2014
Background: Clostridium difficile is an important cause of intestinal infections in some animal species and animals might be a reservoir for community associated human infections. Here we describe a collection of animal associated C. difficile strains from 12 countries based on inclusion criteria of one strain (PCR ribotype) per animal species per laboratory. Results: Altogether 112 isolates were collected and distributed into 38 PCR ribotypes with agarose based approach and 50 PCR ribotypes with sequencer based approach. Four PCR ribotypes were most prevalent in terms of number of isolates as well as in terms of number of different host species: 078 (14.3% of isolates; 4 hosts), 014/020 (11.6%; 8 hosts); 002 (5.4%; 4 hosts) and 012 (5.4%; 5 hosts). Two animal hosts were best represented; cattle with 31 isolates (20 PCR ribotypes; 7 countries) and pigs with 31 isolates (16 PCR ribotypes; 10 countries). Conclusions: This results show that although PCR ribotype 078 is often reported as the major animal C. difficile type, especially in pigs, the variability of strains in pigs and other animal hosts is substantial. Most common human PCR ribotypes (014/020 and 002) are also among most prevalent animal associated C. difficile strains worldwide. The widespread dissemination of toxigenic C. difficile and the considerable overlap in strain distribution between species furthers concerns about interspecies, including zoonotic, transmission of this critically important pathogen.
Clostridium difficile: a new zoonotic agent?
Wiener klinische Wochenschrift, 2009
Wiener klinische Wochenschrift The Middle European Journal of Medicine Clostridium difficile: ein neuer Zoonoseerreger? Zusammenfassung. Clostridium difficile wird meist als nosokomialer Erreger, der mit Diarrhö oder pseudomembranöser Colitis einhergeht, angesehen. Im Jahr 2007 wurden von Spitälern in Österreich 2.761 Clostridiumdifficile-Infektionen (277 davon mit tödlichem Ausgang) gemeldet, im Vergleich dazu waren im Jahr 2003 nur 777 Fälle (53 davon mit tödlichem Ausgang) registriert worden. Neben diesem Anstieg der nosokomialen Erkrankungen wird auch über ein vermehrtes Auftreten von ambulant erworbenen C. difficile-Infektionen berichtet. Aktuelle Publikationen belegen das Vorkommen von C. difficile bei Tieren und in Lebensmitteln. Ziel der vorliegenden Studie war der Nachweis von C. difficile in Tieren und Lebensmitteln in Österreich. Zwischen März 2008 und Juli 2008 wurden Stuhl-und Kotproben von 67 Rindern, 61 Schweinen und 59 Broilern in österreichischen Schlachthöfen gesammelt. Zudem wurden Fleischproben (51 Rind [25 davon faschiert], 27 Schwein [17 faschiert] und 6 Hühnerfleischproben) zwischen Februar 2008 und April 2008 in Supermärkten gekauft und untersucht. Von den 187 getesteten Proben konnten in 8 C. difficile nachgewiesen werden: dabei waren 3/67 (4,5%) Kuhproben, 2/61 (3,3%) Schweineproben und 3/59 (5%) Hühnerproben positiv. Sechs der acht Isolate (2/67 [3%] Kuhproben, 2/61 [3,3%] Schweineproben und 2/59 [3,4%] Hühnerproben) waren toxinbildende C. difficile. In einem der zwei Toxin-positiven C. difficile Schweineproben war auch der Nachweis eines binären Toxin-Bildners des PCR-Ribotyps 126 möglich. In keiner der untersuchten Fleischproben konnte C. difficile nachgewiesen werden. Die Ergebnisse dieser Studie bestätigen, dass Tiere als Reservoir dienen können und eine Übertragung von C. difficile über Lebensmittel möglich ist. Summary. Clostridium difficile is mainly considered a nosocomial pathogen associated with diarrhea and pseudomembranous colitis in hospitalized patients. Austrian hospitals reported 2761 cases of C. difficile infection (including 277 lethal outcomes) in 2007, compared with 777 cases (including 54 lethal outcomes) in 2003. The occurrence of community-acquired C. difficile infection is also increasingly reported. Recent studies have shown the occurrence of C. difficile in food and animals. The aim of the present study was to determine the occurrence of C. difficile in food and animals in Austria. Between March and July 2008, gut or fecal samples from 67 cows, 61 pigs and 59 broiler chickens were collected at Austrian abattoirs. Between February and April 2008 meat samples (51 beef [25 ground], 27 pork [17 ground] and 6 samples of chicken meat) were purchased at retail outlets. Of the 187 samples tested, eight yielded C. difficile: in cows 3/67 samples (4.5%) were positive, in pigs 2/61 (3.3%), in broiler chickens 3/59 (5%). Six of the eight isolates yielded toxigenic C. difficile (toxins A and B): 2/67 (3%) cow samples, 2/61 (3.3%) pig samples, 2/59 (3.4%) chicken samples. Genes for the binary toxin were detected in one of the two pig isolates, a PCR ribotype 126 strain. None of the 84 meat samples yielded C. difficile. The results of this Austrian study suggest that animal reservoirs are possible sources, via food, of human C. difficile infection.