A Nosocomial Outbreak of Diarrhea Caused by Toxin A-negative, Toxin B-positive <I>Clostridium difficile</I> in A Cancer Center Hospital

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  • SATO Hiroko
    Division of Clinical Laboratory, Chiba Cancer Center Hospital
  • KATO Haru
    Department of Bacterial Pathogenesis and Infection Control, National Institute of Infectious Diseases
  • KOIWAI Kenji
    Chiba Prefectual Institute of Public Health
  • SAKAI Chikara
    Division of Hematology and Oncology, Chiba Cancer Center Hospital

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Other Title
  • がんセンターにおけるtoxin A陰性toxin B陽性<I>Clostridium difficile</I>による下痢症の院内集団発生
  • がんセンターにおけるtoxin A陰性toxin B陽性Clostridium difficileによる下痢症の院内集団発生
  • ガン センター ニ オケル toxin A インセイ toxin B ヨウセイ Clostridium difficile ニ ヨル ゲリショウ ノ インナイ シュウダン ハッセイ
  • A Nosocomial Outbreak of Diarrhea Caused by Toxin A-negative, Toxin B-positive Clostridium difficile in A Cancer Center Hospital

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Abstract

Between February and July 2001, 15 patients were diagnosed as Clostridium difficile-associated diarrhea in a ward of hematological neoplasm and lung cancer in a cancer center hospital. Of these 15 patients, 10 had malignant lymphoma, and 12 and 11 had exposure to antimicrobial agents and cancer chemotherapy, respectively, before the onset of diarrhea. Toxin A-positive, toxin B-positive (A+B+) C. difficile was recovered from five patients and the remaining 10 patients suffered from diarrhea caused by toxin A-negative, toxin B-positive (A-B+) strains. All of the 10A-B+isolates represented an identical banding pattern by PCR ribotyping and classified into one type (two subtypes) by pulsed field gel electrophoresis typing, indicating that a nosocomial outbreak of diarrhea caused by A-B+C. difficile occurred among the patients hospitalized on this ward. Detection of toxin A in stool specimens by a toxin A detection kit was performed on 14 patients. Although two patients who carried A+B+strains were positive for toxin A assay, toxin A detection test was negative in 12 patients including 10 patients with A-B+C. difficile infection. Diagnosis of C. difficile-associated diarrhea by combination of toxin A assay in feces and culture of C. difficile could successfully lead to recognition of an outbreak caused by A-B+C. difficile in a cancer center hospital.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 78 (4), 312-319, 2004

    The Japanese Association for Infectious Diseases

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