Evidence for Infections by the Same Strain of Beta 2-toxigenic Clostridium perfringens Type A Acquired in One Hospital Ward

SALAMON, DOMINIKA; OCHOŃSKA, DOROTA; WOJAK, ILONA; MIKOŁAJCZYK, EWA; BULANDA, MAŁGORZATA; BRZYCHCZY-WŁOCH, MONIKA

doi:10.33073/pjm-2019-035

Abstract

This study conducts a comparative phenotypic and genetic analysis of C. perfringens strains isolated from two patients hospitalized at the same time in 2017 in the surgical ward of the Provincial Specialist Hospital in Włocławek (Kujawsko-Pomorskie Province) who developed necrotizing soft tissue infections (NSTI). To explain the recurring cases of this infection, a comparative analysis was performed for these strains and the ones originating from infections recorded at the same hospital in three patients with gas gangrene in 2015. The two C. perfringens isolates studied in 2017 (8554/M/17 from patient No. 1 and 8567/M/17 from patient No. 2) had identical biochemical profiles. A comparison of research results using multiplex PCR from 2017 with a genetic analysis of strains from 2015 enabled us to demonstrate that the strains currently studied have the genes encoding the same toxins (α and β2) as the two strains analyzed in 2015: no. 7143 (patient No. 3) and no. 7149 (patient No. 2). A comparative analysis of the strain profiles obtained with pulsed-field gel electrophoresis (PFGE) in 2017 with the results from 2015 has found one identical and genetically unique restriction profile, corresponding to one clone of C. perfringens comprising of two strains: no. 8567/M/17 (patient No. 2 in 2017) and no. 7143 (patient No. 3 in 2015). The epidemiological data and detailed analysis of the course of both events suggest that this clone of C. perfringens possibly survived in adverse conditions of the external environment in the operating block of this hospital for many months.

References

Allaart JG, van Asten AJAM, Vernooij JCM, Gröne A. Beta2 toxin is not involved in in vitro cell cytotoxicity caused by human and porcine cpb2-harbouring Clostridium perfringens. Vet Microbiol. 2014;171(1–2):132–138. https:/doi.org/10.1016/j.vetmic.2014.03.020
Search in Google Scholar Back to article
Brzychczy-Włoch M, Bulanda M. Analysis of genetic similarities between Clostridium perfringens isolates isolated from patients with gas gangrene and from hospital environment conducted with the use of the PFGE method. Pol J Surg. 2014;86(3):141–146. https:/doi.org/10.2478/pjs-2014-0026
Search in Google Scholar Back to article
Brzychczy-Włoch M, Ochońska D, Piotrowska A, Bulanda M. Gas gangrene of different origin associated with Clostridium perfringens type A in three patients simultaneously hospitalized in a single department of Orthopedics and Traumatology in Poland. Pol J Microbiol. 2016;65(4):399–406. https:/doi.org/10.5604/17331331.1227665
Search in Google Scholar Back to article
Johansson A, Aspan A, Bagge E, Båverud V, Engström BE, Johansson KE. Genetic diversity of Clostridium perfringens type A isolates from animals, food poisoning outbreaks and sludge. BMC Microbiol. 2006;6(1):47. https:/doi.org/10.1186/1471-2180-6-47
Search in Google Scholar Back to article
Kędzielska J, Obuch-Woszczatyński P, Pituch H, Młynarczyk G. [Clostridium perfringens as the etiological agent of antibiotic associated diarrhea] (in Polish). Postepy Mikrobiol. 2012;51(1):17–25.
Search in Google Scholar Back to article
Kiu R, Caim S, Alexander S, Pachori P, Hall LJ. Probing genomic aspects of the multi-host pathogen Clostridium perfringens reveals significant pangenome diversity, and a diverse array of virulence factors. Front Microbiol. 2017;8:2485. https:/doi.org/10.3389/fmicb.2017.02485
Search in Google Scholar Back to article
Kuzaka B, Wróblewska MM, Borkowski T, Kawecki D, Kuzaka P, Młynarczyk G, Radziszewski P. Fournier’s gangrene: clinical presentation of 13 cases. Med Sci Monit. 2018;24:548–555. https:/doi.org/10.12659/MSM.905836
Search in Google Scholar Back to article
Maslanka SE, Kerr JG, Williams G, Barbaree JM, Carson LA, Miller JM, Swaminathan B. Molecular subtyping of Clostridium perfringens by pulsed-field gel electrophoresis to facilitate food-borne-disease outbreak investigations. J Clin Microbiol. 1999;37(7): 2209–2214.
Search in Google Scholar Back to article
Myers GSA, Rasko DA, Cheung JK, Ravel J, Seshadri R, DeBoy RT, Ren Q, Varga J, Awad MM, Brinkac LM, et al. Skewed genomic variability in strains of the toxigenic bacterial pathogen, Clostridium perfringens. Genome Res. 2006;16(8):1031–1040. https:/doi.org/10.1101/gr.5238106
Search in Google Scholar Back to article
Navarro M, McClane B, Uzal F. Mechanisms of action and cell death associated with Clostridium perfringens toxins. Toxins (Basel). 2018;10(5):212. https:/doi.org/10.3390/toxins10050212
Search in Google Scholar Back to article
Park M, Deck J, Foley SL, Nayak R, Songer JG, Seibel JR, Khan SA, Rooney AP, Hecht DW, Rafii F. Diversity of Clostridium perfringens isolates from various sources and prevalence of conjugative plasmids. Anaerobe. 2016;38:25–35. https:/doi.org/10.1016/j.anaerobe.2015.11.003
Search in Google Scholar Back to article
Rood JI, Adams V, Lacey J, Lyras D, McClane BA, Melville SB, Moore RJ, Popoff MR, Sarker MR, Songer JG, et al. Expansion of the Clostridium perfringens toxin-based typing scheme. Anaerobe. 2018;53:5–10. https:/doi.org/10.1016/j.anaerobe.2018.04.011
Search in Google Scholar Back to article
Stevens DL, Aldape MJ, Bryant AE. Life-threatening clostridial infections. Anaerobe. 2012;18(2):254–259. https:/doi.org/10.1016/j.anaerobe.2011.11.001
Search in Google Scholar Back to article
Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. 2017;377(23):2253–2265. https:/doi.org/10.1056/NEJMra1600673
Search in Google Scholar Back to article
EUCAST. Breakpoint tables for interpretation of MICs and zone diameters Ver. 7.1 [Internet]. Basel (Switzerland): European Committee on Antimicrobial Susceptibility Testing; 2017 [cited 2019 Jan 21]. Available from http://www.eucast.org/ast_of_bacteria/previous_versions_of_documents/
Search in Google Scholar Back to article
van Belkum A, Tassios PT, Dijkshoorn L, Haeggman S, Cookson B, Fry NK, Fussing V, Green J, Feil E, Gerner-Smidt P, et al.; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Epidemiological Markers (ESGEM). Guidelines for the validation and application of typing methods for use in bacterial epidemiology. Clin Microbiol Infect. 2007;13 Suppl 3:1–46. https:/doi.org/10.1111/j.1469-0691.2007.01786.x
Search in Google Scholar Back to article
van Asten AJAM, Nikolaou GN, Gröne A. The occurrence of cpb2-toxigenic Clostridium perfringens and the possible role of the β2-toxin in enteric disease of domestic animals, wild animals and humans. Vet J. 2010;183(2):135–140. https:/doi.org/10.1016/j.tvjl.2008.11.005
Search in Google Scholar Back to article
Wróblewska M, Kuzaka B, Borkowski T, Kuzaka P, Kawecki D, Radziszewski P. Fournier’s gangrene – current concepts. Pol J Microbiol. 2014;63(3):267–273.
Search in Google Scholar Back to article
Xiao Y, Wagendorp A, Moezelaar R, Abee T, Wells-Bennik MHJ. A wide variety of Clostridium perfringens type A food-borne isolates that carry a chromosomal cpe gene belong to one multilocus sequence typing cluster. Appl Environ Microbiol. 2012;78(19): 7060–7068. https:/doi.org/10.1128/AEM.01486-12
Search in Google Scholar Back to article
Żaba R, Grzybowski A, Prokop J, Żaba Z, Żaba C. Fournier’s gangrene: historical survey, current status, and case description. Med Sci Monit. 2009;15(2):CS34–CS39.
Search in Google Scholar Back to article

Evidence for Infections by the Same Strain of Beta 2-toxigenic Clostridium perfringens Type A Acquired in One Hospital Ward

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