Clostridium difficile PCR ribotype 078 toxinotype V found in diarrhoeal pigs identical to isolates from affected humans.

In diseased piglets from two Dutch pig-breeding farms with neonatal diarrhoea for more than a year, culture and PCR analyses identified the involved microorganism as Clostridium difficile PCR ribotype 078 harbouring toxin A (tcdA) and B (tcdB), and binary toxin genes. Isolated strains showed a 39 bp deletion in the tcdC gene and they were ermB gene-negative. A number of 11 porcine and 21 human isolated C.

Typing Clostridium difficile strains based on tandem repeat sequences.

Background: Genotyping of epidemic Clostridium difficile strains is necessary to track their emergence and spread. Portability of genotyping data is desirable to facilitate inter-laboratory comparisons and epidemiological studies.

Results: This report presents results from a systematic screen for variation in repetitive DNA in the genome of C.

First isolation of Clostridium difficile PCR-ribotype 027/toxinotype III in Poland.

Of 175 Clostridium difficile strains isolated from patient hospitalized in one academic hospital in Warsaw between 2005-2006, one isolate belonged to PCR-ribotype 027/toxinotype III. This isolate had tcdA, tcdB, binary toxin genes (cdtA and cdtB), a 18-bp deletion and a 1 bp deletion at 117 position in the tcdC gene. Antimicrobial susceptibility tests revealed high level resistance to erythromycin, moxifloxacin and gatifloxacin.

Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078.

Background: Since 2005, an increase in the prevalence of Clostridium difficile infection (CDI) due to polymerase chain reaction ribotype 078 has been noticed in The Netherlands. This strain has also been identified as the predominant strain in pigs and calves.

Methods: CDI caused by type 078 was studied in relation to CDI caused by the hypervirulent type 027 and by types other than 027 and 078.

Emergence of reduced susceptibility to metronidazole in Clostridium difficile.

Objectives: Antimicrobial treatment for Clostridium difficile infection (CDI) has typically been metronidazole, although reports have questioned the efficacy of this option. We screened recently isolated C. difficile (2005-06) for susceptibility to metronidazole and compared results for historic isolates (1995-2001).

Interpretation and precision of the Observer Scar Assessment Scale improved by a revised scoring.

Objective: To apply Rasch measurement to develop a rule for clinical interpretation of the Observer Scar Assessment Scale (OSAS) to help surgeons judge reported sum scores clinically.

Study Design And Setting: We used cross-sectional data of a multicenter randomized clinical trial for the treatment of nontuberculous cervicofacial lymphadenitis in children. Rasch analysis was used on the OSAS scores obtained from scar photographs of 100 children after surgical or antibiotic treatment.

Fluoroquinolone resistance in Clostridium difficile isolates from a prospective study of C. difficile infections in Europe.

The European Study Group on Clostridium difficile (ESGCD) conducted a prospective study in 2005 to monitor and characterize C. difficile strains circulating in European hospitals, collecting 411 isolates. Eighty-three of these isolates, showing resistance or intermediate resistance to moxifloxacin (MX), were selected for this study to assess susceptibility to other fluoroquinolones (FQs) and to analyse the gyr genes, encoding the DNA gyrase subunits GyrA and GyrB.

Comparison of seven techniques for typing international epidemic strains of Clostridium difficile: restriction endonuclease analysis, pulsed-field gel electrophoresis, PCR-ribotyping, multilocus sequence typing, multilocus variable-number tandem-repeat analysis, amplified fragment length polymorphism, and surface layer protein A gene sequence typing.

Using 42 isolates contributed by laboratories in Canada, The Netherlands, the United Kingdom, and the United States, we compared the results of analyses done with seven Clostridium difficile typing techniques: multilocus variable-number tandem-repeat analysis (MLVA), amplified fragment length polymorphism (AFLP), surface layer protein A gene sequence typing (slpAST), PCR-ribotyping, restriction endonuclease analysis (REA), multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE). We assessed the discriminating ability and typeability of each technique as well as the agreement among techniques in grouping isolates by allele profile A (AP-A) through AP-F, which are defined by toxinotype, the presence of the binary toxin gene, and deletion in the tcdC gene. We found that all isolates were typeable by all techniques and that discrimination index scores for the techniques tested ranged from 0.

Clostridium difficile: changing epidemiology and new treatment options.

Purpose Of Review: The review summarizes changes in the epidemiology and treatment of Clostridium difficile-associated disease.

Recent Findings: Recent outbreaks of Clostridrium difficile-associated diarrhoea with increased severity, high relapse rate and significant mortality, have been related to the emergence of a new, hypervirulent C. difficile strain in north America, Japan and Europe.

An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotype among renal transplant recipients: interhuman transmission or a common environmental source?

Background: An outbreak of Pneumocystis jiroveci pneumonia (PCP) occurred among renal transplant recipients attending the outpatient department at the Leiden University Medical Centre (Leiden, The Netherlands) from 1 March 2005 through 1 February 2006. Clinical, epidemiological, and molecular data were analyzed to trace the outbreak's origin.

Methods: Renal transplant recipients with a clinical suspected diagnosis of PCP were included in the study.

Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial.

Background: The optimal treatment of nontuberculosis mycobacterial cervical lymphadenitis in children has not been established. Until recently, surgical excision was the standard treatment, but the number of reports of successful antibiotic treatment is increasing, which questions whether surgery is the preferred treatment. In this randomized, multicenter trial, we compared surgical excision with antibiotic treatment.

Detection of respiratory pathogens by real-time PCR in children with clinical suspicion of pertussis.

The use of a multiplex respiratory real-time PCR in patients clinically suspected of pertussis increases the number of pathogens detected.

Evaluation of real-time PCR and conventional diagnostic methods for the detection of Clostridium difficile-associated diarrhoea in a prospective multicentre study.

In this prospective multicentre study, an enzyme-linked fluorescent assay (VIDAS CDA2; bioMérieux), an enzyme-linked assay [Premier Toxins A and B (PTAB); Meridian] and an in-house real-time PCR amplifying the tcdB gene were compared with the cell cytotoxicity assay used as the 'gold standard' for diagnosis of Clostridium difficile-associated diarrhoea (CDAD). Faecal samples from patients with a request for C. difficile diagnosis and samples from patients with diarrhoea hospitalized for at least 72 h were collected for 3 consecutive months from four university medical centres in The Netherlands.

Typing and subtyping of Clostridium difficile isolates by using multiple-locus variable-number tandem-repeat analysis.

Using the genomic sequence of Clostridium difficile strain 630, we developed multiple-locus variable-number tandem-repeat analysis (MLVA) with automated fragment analysis and multicolored capillary electrophoresis as a typing method for C. difficile. All reference strains, representing 31 serogroups, 25 toxinotypes, and 7 known subtypes of PCR ribotype 001, could be discriminated from each other.

Tuberculin skin testing is useful in the screening for nontuberculous mycobacterial cervicofacial lymphadenitis in children.

Background: We evaluated the diagnostic usefulness of tuberculin skin testing in the screening for nontuberculous mycobacterial (NTM) infection in children.

Methods: We enrolled 180 children who had chronic cervicofacial lymphadenitis in our study. Skin testing was done using antigens of Mycobacterium tuberculosis, Mycobacterium avium, Mycobacterium kansasii, and Mycobacterium scrophulaceum.

Inter-laboratory comparison of three different real-time PCR assays for the detection of Pneumocystis jiroveci in bronchoalveolar lavage fluid samples.

Pneumocystis jiroveci pneumonia (PCP) is an opportunistic infection affecting immunocompromised patients. While conventional diagnosis of PCP by microscopy is cumbersome, the use of PCR to diagnose PCP has great potential. Nevertheless, inter-laboratory validation and standardization of PCR assays is lacking.

The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children.

Background: Nontuberculous mycobacteria (NTM) are a common cause of chronic cervicofacial lymphadenitis in young children. The differential diagnosis includes other infections, lymphoepithelial cysts and malignancies.

Objective: To assess the sonographic findings of NTM cervicofacial lymphadenitis in children.

First case of an oculofacial lesion due to Mycobacterium haemophilum infection in an immunocompetent child.

Oculofacial lesions caused by infections with nontuberculous mycobacterial organisms are unusual, but infections with Mycobacterium haemophilum species in immunocompetent patients have not yet been described. We present a case of an oculofacial lesion in a girl as a result of a Mycobacterium haemophilum infection.