Clostridium species found in Norovirus outbreaks in the Netherlands

Abstract number: P1496

Svraka S., Kuijper E., Duizer E., Koopmans M.

Objectives: Outbreaks (OBs) of acute gastroenteritis (AGE) of suspected viral aetiology are reported to RIVM as part of the Norovirus (NoV) OB surveillance system. Since 2002, the epidemiology of NoV has changed. Simultaneously, the emergence of a variant of Clostridium difficile (CD) ribotype 027, which appeared to have increased pathogenicity, was reported. The coincidental increase in NoV OBs and emergence of CD ribotype 027 raised the question if these events could be related. In theory, an episode of NoV illness can result in increased growth of Clostridium spp. and subsequently lead to more severe or prolonged illness. Additionally, spread of Clostridium spp. could be increased by multiple episodes of vomiting and diarrhoea caused by NoV infection. Therefore, we studied the prevalence of CD in OBs of AGE caused by NoV, rotaviruses (RV) and of unknown aetiology.

Methods: Stool samples of OBs caused by NoV, RV, and of unexplained aetiology were tested by Premier C. difficile Toxin A&B EIA, positive samples were tested for the presence of CD by culture methods using an ethanol shock pretreatment. Suspected colonies were tested using CD-specific GluD and ribotyping PCR. Negative samples were further tested using 16S rRNA PCR.

Results: See the table.

Table 1. Number of Clostridium spp. positive samples and OBs of unexplained, NoV and RV AGE OBs.

Conclusions: CD ribotype 027 was not found in any of the OBs tested. One CD ribotype 001 was detected in a gastroenteritis OB of unexplained aetiology, but several Clostridium spp. were found in NoV OBs. These data suggest that NoV infections enable Clostridia to colonise the gastro intestinal tracts, perhaps in a similar way as antibiotic treatment. These double infections may contribute to increased severity of the gastroenteritis episode and were revealed only by comprehensive virological and bacteriological screening of faecal samples.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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