Epidemiology of Clostridum difficile

and relationship between animal and human infection Leticia Pérez Sánchez - June 2017

C. difficile is an obligated anaerobic, gram positive and spore-forming bacterium, that is a common inhabitant of the gut in several mammal species.

This microorganism contains toxigenic strains which are considered the cause of C. difficile infection (CDI) in humans and animals.

INTRODUCTION

CDI IN PIGS CDI IN HUMANS

Positive

regulator

Permeability

regulator

Negative

regulator

Toxin A Toxin B

1

2

3 4

5

Diarrhea Non-diarrhea

Pseudomembranous

colitis (90%) (fig. 4)

Colitis

(10%) Paralytic

ileus (3%)

Toxic

megacolon

CLINICAL SIGNS

< Year 2000 2000 – Today

TRANSMISSION

Nosocomial cases

Spore reservoir:

HOSPITAL

ENVIRONMENT

Community-acquired

Direct contact Indirect contact

ANIMAL CONSUMPTION OF

CONTAMINATED MEAT

ANIMAL WASTE

A

B

C

Farm Slaughterhouse Meat People

Variable prevalence at

the end of fattening

Contamination occurs

Employee Feces Environment

Eating low-cooked or

ready-to-eat meat

Consumer characteristics to develop CDI:

- Intestinal microbiota

- Immune status

- Hospitalization

- In treatment

CONCLUSIONS REFERENCES

1Figure 1. Locus of pathogenicity (PaLoc) of C.difficile and function of PaLoc genes.

2Figure 2. C. difficile vegetative cells produce toxins A y B and hydrolytic enzymes.

1. Local production of toxins A and B. 2. Opening of epithelial cell junctions.

3. Epithelial cell apoptosis . 4. Local production of hydrolytic enzymes. 5. Watery

diarrhea.

Asymptomatics

(>50%)

Symptomatics

NEONATAL PIGLETS

Diarrhea (A)

"volcanic lesions " (C) Mesocolon

edema (B)

Figure 3. 3A. Watery-pasty diarrhea in piglets. 4B. Mesocolon edema. 4C.

Neutrophils infiltrating the lamina propia, with focal ulcers in the mucosa

associated with necrotic cellular debris (“volcanic lesion”: arrow).

5Figure 4. Colonoscopy.

1. Halsey, J. 2008. Current and future treatment madalities for C. difficile-asociated disease. Am J Health Syst

Pharm. 65(8):705-715.

2. Meyer, L., Espinoza, R. y Quera, R. 2014. Infección por C. difficile: epidemiología, diagnostico y estrategias

terapéuticas. Rev. Medica clinica Las Condes 25:473-84.

3. Bollo, J. 2009. Clostridiosis. Available from : https://www.3tres3.com/diarreas-en-lactacion/clostridiosis_4339/

4. Lizer J, Madson D, Schwartz K, Harris H, Bosworth B, Kinyon J, Ramirez A. 2013. Experimental infection of

conventional neonatal pigs with Clostridium difficile: A new model. J Swine Health Prod, 21:22-29.

5. Rocha CH, Naour S, Álvarez-Lobos M, Paredes-Sabja D. 2012. Infecciones causadas por C.difficile: una visión

actualizada. Rev Chilena Infectol, 29 :434-445.

1. C. difficile isolates obtained from animals and humans reveals that these can be identical. That is why it is considered that animals could be a reservoir.

2. Administration of antibiotics is the main risk factor for human disease. However, the relative increase of community-based infections suggests that there may be other factors such as contamination of meat at the slaughterhouse or in the subsequent processing.

3. Epidemiological surveillance, based on molecular typing tests, will be essential to know if there is a relationship between the isolates in humans and animals.

OBJECTIVE

To develop a bibliographical review summarizing the most important elements of the epidemiology of Clostridium difficile.