Management of an outbreak of botulism with benign clinical presentation

Botulism is a life-threatening presynaptic disorder of the neuromuscular transmission produced by the neurotoxin elaborated by the botulinum neurotoxin-producing clostridia. We describe the management of a case series of 14 patients, members of 5 different families that were exposed to home-canned tuna and developed symptoms compatible with a mild clinical presentation of foodborne botulism. The electrophysiological study of the index case represented a reliable diagnostic test as it demonstrated a slight presynaptic dysfunction of the neuromuscular junction. Definite diagnosis was later confirmed by microbiological tests. Out of 14, only 3 patients presenting with a shorter period from symptom onset and with signs of multiple cranial neuropathies received botulinum antitoxin. All the patients remained stable and recovered progressively. Treatment with antitoxin may not be necessary in patients with late-presenting disease and mild and stable clinical picture.     

Factors Related to Outcomes of Fecal Microbiota Transplantation in Patients with Clostridioides difficile Infection

Background/AimsThe aim of this study was to evaluate factors related to outcomes of fecal microbiota transplantation (FMT) in patients with Clostridioides difficile infection (CDI) and viability of frozen stock for FMT.MethodsClinical data of patients who had received FMT for CDI were prospectively collected. Next-generation 16S rRNA gene sequencing of bacteria was performed from donors’ and recipients’ stool. Colony-forming units (CFUs) of cultures from frozen stock solutions for FMT were measured at 0, 4, 8, 12, 24, 48 weeks after preparation of the solutions.ResultsIn total, 25 FMT procedures were performed in 20 cases (14 fresh and 11 frozen FMT). Forty-five percent of cases involved fulminant CDI. The overall success rate was 55% after the 1st FMT and 75% after the 2nd FMT. The success rate was significantly higher in partially treated CDI than in refractory CDI (100% vs 71.4%; p=0.001). In successful cases only, the decrease in alpha-diversity in the recipient stool microbiomes was recovered after FMT to a level similar to that in donor stools. There was a significant difference in the microbiome composition in pre-FMT recipients’ stool between successful and failed cases (p=0.001). The CFUs of frozen solution for FMT did not decrease for 48 weeks in both aerobic and anaerobic cultures.ConclusionsFMT is highly effective in partially treated CDI but not in refractory CDI. The microbiome differs between failed and successful cases. Frozen stock for FMT is viable up to 48 weeks.     

水苏糖对艰难梭菌在小鼠肠道内定植与菌群的影响

目的利用艰难梭菌感染(CDI)小鼠模型,评价水苏糖是否具有抑制小鼠肠道内艰难梭菌定植的作用,并分析其对肠道菌群结构的影响。方法将C57BL/6雌鼠随机分为3组,其中不做任何处理的设定为空白对照组,水苏糖干预组和磷酸盐缓冲液(PBS)模型组在建立CDI小鼠模型后分别连续10 d每日给予水苏糖和PBS灌胃处理。利用荧光定量聚合酶链式反应(PCR)检测感染后第10 d各组小鼠粪便中艰难梭菌的含量,并利用16S rRNA基因测序分析各组小鼠肠道菌群结构的变化。结果水苏糖干预导致CDI小鼠粪便中艰难梭菌含量显著降低。水苏糖干预组小鼠粪便的菌群丰富度显著高于PBS模型组,但没有恢复到空白对照组的水平。在门水平上,水苏糖干预可导致CDI小鼠粪便的拟杆菌门(Bacteroidetes)、厚壁菌门(Firmicutes)的相对丰富度显著增高,变形菌门(Proteobacteria)的相对丰富度显著降低。在种水平上,水苏糖干预导致CDI小鼠粪便中格氏副拟杆菌(Parabacteroides goldsteinii)、汉森氏布氏菌(Blautia hansenii)、多形拟杆菌(Bacteroides thetaiotaomicron)的相对丰度显著增高;Parasutterella excrementihominis、狄氏副拟杆菌(Parabacteroides distasonis)的相对丰度显著降低。结论水苏糖干预可有效降低CDI小鼠肠道内艰难梭菌定植量,增加CDI小鼠肠道微生物丰富度,特异性地改变多形拟杆菌和格氏副拟杆菌等菌种的相对丰度。     

重度复杂艰难梭菌感染1例

背景艰难梭菌(Clostridium difficile,CD)是引起医院内肠道感染的主要致病菌之一,通常由长期或不规范使用抗菌药物引起,CD感染(CD infection,CDI)主要是由产毒素CD过度繁殖释放毒素导致肠道菌群失调引起,主要临床症状为腹痛、水样腹泻、发热.通过对这例重度复杂CDI诊治的梳理,以期在临床上对此病尽早识别、规范治疗.患者颅脑部手术后应用多种抗生素预防及治疗感染,出现腹胀腹泻症状后,易误诊为感染性腹泻,继续升级抗生素造成病情加重.病例简介本例患者曾被误诊为感染性腹泻,继续升级抗生素造成病情加重,后经粪便化验、复查CT进一步确诊为重度复杂CDI.结论临床医生要拓宽思路,结合临床经验进行综合诊断,必要时请专科医生协助诊断.我们认识到当怀疑为严重或复杂的CDI时,应立即开始经验治疗,早期识别、积极治疗至关重要.     

Faecal microbiota transplantation for eradication of co-infection with Clostridioides difficile and extensively drug-resistant KPC-producing Klebsiella pneumoniae

Abstract

Clostridioides difficile infection may be complicated by co-infection with other pathogens. We here describe the successful use of faecal microbiota transplantation to eradicate concomitant C. difficile and extensively drug-resistant (XDR) KPC-producing Klebsiella pneumoniae. Donor microbiota efficiently engrafted in the patient, and a donor-like microbial assemblage persisted in the patient during six months follow-up. The report explores the potential for the donor microbiota to eradicate and replace multi-resistant microorganisms.     

Fecal microbiota transplantation for treatment of patients with recurrent Clostridioides difficile infection

ABSTRACT

Introduction

Recurrent Clostridiodes difficile infection (rCDI) is a growing public health burden, and is associated with poor patient outcomes. Fecal microbiota transplantation (FMT) is a novel therapy with an aim to restore the disrupted microbiota with demonstrated success in the management of rCDI and a favorable safety profile.     

ICU艰难梭菌定植与感染的危险因素研究

目的探讨重症监护室(ICU)艰难梭菌定植与感染患者的危险因素,为实施有效的防控方案提供依据。方法采用前瞻性研究方法,连续收集2017年1月1日-2018年6月1日入住某院ICU患者的临床资料,采集患者粪便及其周围环境标本进行艰难梭菌检测,分析影响因素。结果多因素Logistic回归分析结果显示,年龄、质子泵抑制剂、侵入性操作、机械通气、糖尿病和β-内酰胺酶抑制剂使用是艰难梭菌的感染和定植的危险因素。结论对CDI患者进行隔离,对高龄、侵入性操作、机械通气、合并糖尿病及使用β-内酰胺酶抑制剂、质子泵抑制剂等艰难梭菌感染高危因素的患者密切关注;加强环境表面清洁消毒工作,降低艰难梭菌芽孢传播的风险,为今后研究制定艰难梭菌感染防控措施提供依据。     

Receptor Binding Domains of TcdB from Clostridioides difficile for Chondroitin Sulfate Proteoglycan-4 and Frizzled Proteins Are Functionally Independent and Additive

Toxin B (TcdB) produced by Clostridioides difficile is a main pathogenicity factor that affects a variety of different cell types within the colonic mucosa. TcdB is known to utilize frizzled-1,2,7 and chondroitin sulfate proteoglycan-4 (CSPG4) as protein receptors. By using human cervical cancer cell line HeLa CSPG4 knockout (CSPG4^−/−) cells as well as TcdB mutants which do not bind to either CSPG4 or frizzled-1,2,7, or both, we evaluated the impact of the individual receptors for cytopathic and cytotoxic effects of TcdB. We compared TcdB from the reference strain {"type":"entrez-protein","attrs":{"text":"VPI10463","term_id":"1642177071","term_text":"VPI10463"}}VPI10463 (TcdB_VPI) and the endemic strain {"type":"entrez-nucleotide","attrs":{"text":"R20291","term_id":"774925","term_text":"R20291"}}R20291 (TcdB_R20) which does not interact with frizzled-1,2,7. TcdB_VPI devoid of CSPG4 binding (TcdB_VPI ΔCROP) shows identical cytopathic potency as full-length TcdB in HeLa CSPG4^−/− cells, indicating that interaction with frizzled proteins is not affected in the presence of the C-terminal CROP domain. We validated CSPG4 as cellular receptor for both TcdB toxinotypes in HeLa and HEp-2 cells. By exchange of a single phenylalanine residue, 1597 with serine, we generated a mutated TcdB_VPI variant (TcdB_VPI F1597S) that in accordance with TcdB_R20 lacks binding to frizzled-1,2,7 and showed identical potency as TcdB_R20 on HeLa cells. This enabled us to estimate the respective share of CSPG4 and frizzled-1,2,7 in the cytotoxic and cytopathic effect induced by TcdB. Our data reveal that binding to frizzled-1,2,7 and to CSPG4 occurs independently and in an additive manner.     

No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis

Background

We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications.