eMJA: First Australian isolation of epidemic Clostridium difficile PCR ribotype 027

Notable Cases

First Australian isolation of epidemic Clostridium difficile PCR ribotype 027

Thomas V Riley, Sarah Thean, Graham Hool and Clayton L Golledge

MJA 2009; 190 (12): 706-708

Clinical record

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Discussion

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Acknowledgement

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Author details

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References

We report the first isolation in Australia of a hypervirulent epidemic strain of Clostridium difficile, PCR ribotype 027. It was isolated from a 43-year-old woman with a permanent ileostomy, who appears to have been infected while travelling in the United States. The isolate was positive for toxin A, toxin B and binary toxin, and resistant to fluoroquinolone antimicrobials, and had characteristic deletions in the tcdC gene. All diagnostic laboratories and health care facilities in Australia should now be on high alert for this organism.

Clinical record

A 43-year-old woman was admitted to a Perth hospital at the end of October 2008. She had been diagnosed with ulcerative colitis 8 years previously and, in 2002, underwent proctocolectomy and permanent ileostomy. Since then, she had experienced a number of stoma problems requiring surgical repair or local revision. On this occasion, computed tomography (CT) showed a parastomal small-bowel herniation, with a normal appearance on ileoscopy. The herniation was repaired with intraperitoneal mesh.

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