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

Area of Science:

• Infectious Diseases
• Microbiology
• Gastroenterology

Background:

• Clostridium difficile infection (CDI) is a significant cause of infectious diarrhea.
• Fulminant CDI, characterized by severe colitis, toxic megacolon, and systemic complications, requires intensive care.
• Community-acquired CDI (CA-CDI) is less common than hospital-acquired CDI, particularly in non-elderly individuals without typical risk factors.

Observation:

• A 46-year-old woman in Japan presented with community-acquired fulminant colitis due to toxigenic Clostridium difficile.
• The patient developed toxic megacolon, respiratory insufficiency, and circulatory failure, necessitating intensive care unit (ICU) admission.
• The causative C. difficile isolate was toxin A and B-positive, binary toxin-positive, PCR ribotype ts0592, and slpA sequence type ts0592.

Findings:

• The identified C. difficile strain was distinct from the epidemic PCR ribotype 027 prevalent in Europe and North America.
• Binary toxin-producing C. difficile strains are uncommon in Japan and have not been associated with widespread outbreaks.
• This case represents a rare instance of community-acquired fulminant CDI in a patient without major risk factors, requiring intensive medical intervention.

Implications:

• The case underscores the potential for severe community-acquired CDI caused by binary toxin-producing C. difficile strains, even in individuals without traditional risk factors.
• Further research is warranted to elucidate the role of binary toxin-producing C. difficile in the pathogenesis and severity of community-acquired infections.
• This case contributes to the limited data on community-acquired CDI in Japan and highlights the importance of considering diverse C. difficile strains in clinical settings.