Clostridioides difficile colonization of Twin Patients Recovering From Infant Botulism

Area of Science:

• Microbiology
• Infectious Diseases
• Pediatrics

Background:

• Infant botulism (IB) is a rare but serious condition caused by Clostridium botulinum. Co-colonization with other enteric pathogens can complicate diagnosis and management.
• Clostridioides difficile is a significant cause of healthcare-associated infections, particularly in infants and immunocompromised individuals.

Purpose of the Study:

• To investigate the prevalence of Clostridioides difficile co-colonization in infants with suspected infant botulism.
• To longitudinally track C. difficile colonization in infant twins diagnosed with IB and C. difficile co-colonization.

Main Methods:

• Stool specimens from 107 infants with suspected IB were cultured for C. botulinum and C. difficile.
• Longitudinal stool cultures were performed on twin infants with confirmed IB and C. difficile co-colonization to determine the duration of each organism's presence.
• C. difficile isolates were typed using restriction endonuclease analysis (REA).

Main Results:

• Twins X and Y were colonized with C. botulinum for approximately 3-4 months and C. difficile for 7-8 months.
• Continuous C. difficile colonization was observed as C. botulinum colonization waned.
• The twins shared four identical REA types of C. difficile, including epidemic strain type J9. Neither twin developed C. difficile-associated illness.

Conclusions:

• Clostridioides difficile co-colonization is infrequently observed in infants with confirmed infant botulism.
• Infant botulism was followed by asymptomatic C. difficile colonization in the studied twins.
• This case highlights the potential for C. difficile to spread between close contacts and persist in the infant gut microbiome, even without causing illness.