Research and Development Department, Kerman branch, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Kerman, Iran; Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
Research and Development Department, Kerman branch, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Kerman, Iran.
Acta Trop. 2023 Nov;247:107002. doi: 10.1016/j.actatropica.2023.107002. Epub 2023 Aug 18.
While Clostridium perfringens (C. perfringens) toxinotype F is known as the cause of 15% of antibiotic-associated diarrhea (AAD) and sporadic diarrhea (SD) cases, the association of the other C. perfringens toxinotypes with AAD/SD is not investigated. Therefore, the incidence of C. perfringens-associated diarrhea was investigated in hospitalized patients in six Iranian hospitals. A total of 151 stool specimens from AAD/SD patients were investigated for C. perfringens strains and the isolates were analyzed for the major (cpa, cpb, etx, and iap) and minor (cpe, cpb, netb, PFO, and tpeL) toxin genes by PCR. C. perfringens isolation ratio was 28.5% (43 of 151 patients). C. perfringens isolation rates were not significant between different gender and age groups (p > 0.05), whereas it was significant between different wards and hospitals (p < 0.01). The cpa gene was detected in all C. perfringens isolates (n = 116). After that, the highest prevalence belonged to tpeL (87.1%), followed by pfo (84.5%), cpb (69.8%), cpe (55.2%), etx (12.9%), and netb (1.7%) genes. Based on these gene profiles, 35 (30.2%), 64 (55.2%), 15 (12.9%), and two (1.7%) isolates belonged to toxinotypes A, F, D, and G, respectively, and the other toxinotypes were not detected. This study persists in considering toxinotype F in Iranian AAD patients as it was the dominant C. perfringens toxinotype. Remarkably, the isolation of toxinotype D suggests it as a potential trigger in C. perfringens-associated AAD for the first time and highlights it as a possible zoonotic agent for humans.
已知产气荚膜梭菌（C. perfringens）毒素型 F 是导致 15%的抗生素相关性腹泻（AAD）和散发性腹泻（SD）病例的原因，但其他 C. perfringens 毒素型与 AAD/SD 的关联尚未得到研究。因此，研究人员在伊朗的六家医院对住院患者中产气荚膜梭菌相关性腹泻的发病率进行了调查。共调查了 151 份 AAD/SD 患者的粪便标本，以检测产气荚膜梭菌菌株，并通过 PCR 分析了主要（cpa、cpb、etx 和 iap）和次要（cpe、cpb、netb、PFO 和 tpeL）毒素基因。产气荚膜梭菌的分离率为 28.5%（151 例患者中有 43 例）。不同性别和年龄组之间的产气荚膜梭菌分离率无显著性差异（p>0.05），但不同病房和医院之间有显著性差异（p<0.01）。所有产气荚膜梭菌分离株（n=116）均检测到 cpa 基因。此后，tpeL 的检出率最高（87.1%），其次是 pfo（84.5%）、cpb（69.8%）、cpe（55.2%）、etx（12.9%）和 netb（1.7%）基因。根据这些基因谱，35 株（30.2%）、64 株（55.2%）、15 株（12.9%）和 2 株（1.7%）分离株分别属于毒素型 A、F、D 和 G，其余毒素型未检出。本研究认为，在伊朗 AAD 患者中，毒素型 F 仍然是产气荚膜梭菌的主要毒素型。值得注意的是，毒素型 D 的分离表明其是产气荚膜梭菌相关性 AAD 的潜在触发因素，这首次突出了它作为人类可能的人畜共患病病原体的可能性。
