Estudio de la infección "Clostridium difficile": incidencia, epidemiología, características clínicas, factores de riesgo de gravedad y recurrencia

Clostridium difficile causes a broad range of diseases in humans, from mild colitis to pseudomembranous colitis and disease refractory to treatment, fulminant and fatal. It is an infection whose frequency, seriousness and related morbidity and mortality have increased in recent years [1-4]. Nowadays it is regarded as an emerging public health problem, and prevention and monitoring are particularly recommended. In recent years, different authors have described a change in its epidemiology, which affects not only the populations traditionally involved, but also children and patients from the community [2, 5]. Moreover, the Spanish situation has proven to be different, in terms of the ribotypes present, to other countries in Europe, Canada and the USA. Thus, the performance of an in-depth study in this type of patients in Spain, as well as the source of the acquisition of Clostridium difficile infection (CDI), is of major relevance. The main predisposing factor to acquiring CDI is the use of antibiotics in the previous 8 weeks (90% cases in some series), even with a single prophylactic dose. Other risk factors are a previous stay in health-care centers, particularly hospitals, being old and immunodepression, including transplantations and HIV [6]. The severity of CDI has been associated both with host factors and microorganism-specific factors...

Characterization of plasmids in a human clinical strain of Lactococcus garvieae

The present work describes the molecular characterization of five circular plasmids found in the human clinical strain Lactococcus garvieae 21881. The plasmids were designated pGL1-pGL5, with molecular sizes of 4,536 bp, 4,572 bp, 12,948 bp, 14,006 bp and 68,798 bp, respectively. Based on detailed sequence analysis, some of these plasmids appear to be mosaics composed of DNA obtained by modular exchange between different species of lactic acid bacteria. Based on sequence data and the derived presence of certain genes and proteins, the plasmid pGL2 appears to replicate via a rolling-circle mechanism, while the other four plasmids appear to belong to the group of lactococcal theta-type replicons. The plasmids pGL1, pGL2 and pGL5 encode putative proteins related with bacteriocin synthesis and bacteriocin secretion and immunity. The plasmid pGL5 harbors genes (txn, orf5 and orf25) encoding proteins that could be considered putative virulence factors. The gene txn encodes a protein with an enzymatic domain corresponding to the family actin-ADP-ribosyltransferases toxins, which are known to play a key role in pathogenesis of a variety of bacterial pathogens. The genes orf5 and orf25 encode two putative surface proteins containing the cell wall-sorting motif LPXTG, with mucin-binding and collagen-binding protein domains, respectively. These proteins could be involved in the adherence of L. garvieae to mucus from the intestine, facilitating further interaction with intestinal epithelial cells and to collagenous tissues such as the collagen-rich heart valves. To our knowledge, this is the first report on the characterization of plasmids in a human clinical strain of this pathogen.