Clostridium difficile ribotype 126 in southern Taiwan: A cluster of three symptomatic cases

Introduction: Several virulent Clostridium difficile clones, designated as polymerase chain reaction (PCR) ribotypes 017, 027, or 078, are well recognized in western countries. However, the ribotype distribution of clinical C.difficile isolates in Taiwan remains unclear. Method: Between 2010 and 2012, we identified three patients with C.difficile-associated diarrhea (CDAD) at a hospital in southern Taiwan. The C.difficile strains isolated from these patients were further characterized by PCR detection of tcdA, tcdB, tcdC, cdtA, and cdtB, toxinotyping, multilocus sequence typing, ribotyping and repetitive-based PCR. Results: Three C.difficile strains harbored tcdCδ39 and belonged to multilocus sequence typing 11 (ST11), toxinotype V, and ribotype 126 (a ribotype 078-like clone). Notably, one patient developed pseudomembranous colitis and recurrent CDAD. These three isolates were noted between January 2012 and June 2012 and were identical, as evidenced by repetitive sequence-based PCR, suggestive of case clustering. Conclusion: A hypervirulent C.difficile clone, ribotype 126, causing pseudomembranous colitis and recurrent CDAD, is present in southern Taiwan.