Fatal community-acquired ribotype 002 Clostridium difficile bacteremia

• Published in: Anaerobe 2017-04, Vol.44, p.1-2
• Main Authors: Dauby, Nicolas, Libois, Agnès, Van Broeck, Johan, Delmée, Michel, Vandenberg, Olivier, Martiny, Delphine
• Format: Article
• Language: English
• Subjects: Aged; Bacteremia; Bacteremia - diagnosis; Bacteremia - microbiology; Bacteremia - pathology; Blood - microbiology; Clostridium difficile; Clostridium difficile - classification; Clostridium difficile - genetics; Clostridium difficile - isolation & purification; Clostridium Infections - diagnosis; Clostridium Infections - microbiology; Clostridium Infections - pathology; Colitis - complications; Community-acquired infections; Community-Acquired Infections - diagnosis; Community-Acquired Infections - microbiology; Community-Acquired Infections - pathology; Fatal Outcome; Feces - microbiology; Humans; Male; Malnutrition; Minisatellite Repeats; Molecular Typing; Ribotyping
• ISSN: 1075-9964; 1095-8274
• DOI: 10.1016/j.anaerobe.2016.12.013

Extra-colonic infections, and especially bacteremia, are infrequent manifestations of Clostridium difficile infection. C. difficile bacteremia is generally health-care associated and polymicrobial. We report the case of a patient on hunger strike that presented a C. difficile colitis and mono-microbial bacteremia on its admission to the hospital. Multilocus variable number tandem repeat analysis of stool and blood isolates indicated clonality. The strain was characterized as a ribotype 002, an emerging ribotype previously associated with high fatality rate. The patient received treatment by intra-venous amoxicillin-clavulanate and oral vancomycin but eventually died on the seventh day of admission with concomitant pneumonia and pulmonary embolism. •Clostridium difficile bacteremia is uncommon and usually health-care associated.•We report a case of fatal community-acquired CDB associated with a C. difficile colitis in a patient on hunger strike.•Multilocus variable number tandem repeat analysis of stool and blood isolates indicated clonality.•The strain belonged to ribotype 002 which is an emerging cause of severe and health-care associated C. difficile infections.•We hypothesize that severe malnutrition lead to dysbiosis and impaired mucosal immunity promoting translocation from the gut.