Community-acquired fulminant Clostridioides (Clostridium) difficile infection by ribotype 027 isolate in Japan: a case report

Masayuki Hiraki; Rei Suzuki; Nobuo Tanaka; Hiroki Fukunaga; Yoshinori Kinoshita; Hayato Kimura; Shusaku Tsutsui; Masaru Murata; Shunji Morita

doi:10.1186/s40792-021-01220-9

Community-acquired fulminant Clostridioides (Clostridium) difficile infection by ribotype 027 isolate in Japan: a case report

Surg Case Rep. 2021 Jun 8;7(1):137. doi: 10.1186/s40792-021-01220-9.

Authors

Masayuki Hiraki^{1

2}, Rei Suzuki³, Nobuo Tanaka³, Hiroki Fukunaga³, Yoshinori Kinoshita⁴, Hayato Kimura⁵, Shusaku Tsutsui⁶, Masaru Murata³, Shunji Morita³

Affiliations

¹ Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan. hiraki-masayuki@kansaih.johas.go.jp.
² Department of Surgery, Kansai Rosai Hospital, Japan Organization of Occupational Health and Safety, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan. hiraki-masayuki@kansaih.johas.go.jp.
³ Department of Surgery, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan.
⁴ Department of Respiratory Medicine, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan.
⁵ Department of Diagnostic Pathology, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan.
⁶ Department of Gastroenterology, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyogo, 664-8540, Japan.

Abstract

Background: Clostridioides (Clostridium) difficile infection (CDI) has become an increasingly significant disease not only as healthcare-associated infection, but also as community-acquired (CA) infection worldwide. CDI caused by the NAP1/BI/027 strain is reported to be more severe, difficult to cure, and frequently associated with recurrences in North America and Europe.

Case presentation: A 68-year-old woman was referred to our hospital for continuous lower abdominal pain 4 weeks after eradication therapy against Helicobacter pylori. While she was treated with fasting on the suspicion of ischemic colitis, she experienced septic shock. Emergent subtotal proctocolectomy revealed fulminant pseudomembranous C. difficile colitis. The C. difficile isolate recovered from the patient was identified as ribotype 027, which has been reported to be uncommon in Japan.

Conclusion: We report a rare case of CA fulminant pseudomembranous colitis caused by ribotype 027 C. difficile after H. pylori eradication therapy.

Keywords: Clostridioides (Clostridium) difficile infection; Community-acquired CDI; Fulminant colitis; Helicobacter pylori eradication therapy; PCR-ribotype 027; Proctocolectomy.