Prevalence and pathogenicity of binary toxin–positive Clostridium difficile strains that do not produce toxins A and B

International audienceClostridium difficile causes antibiotic-associated diarrhoea and pseudomembranous colitis. The main virulence factors of C. difficile are the toxins A (TcdA) and B (TcdB). A third toxin, called binary toxin (CDT), can be detected in 17% to 23% of strains, but its role in human disease has not been clearly defined. We report six independent cases of patients with diarrhoea suspected of having C. difficile infection due to strains from toxinotype XI/PCR ribotype 033 or 033-like, an unusual toxinotype/PCR ribotype positive for CDT but negative for TcdA and TcdB. Four patients were considered truly infected by clinicians and were specifically treated with oral metronidazole. One of the cases was identified during a prevalence study of A(-)B(-)CDT(+) strains. In this study, we screened a French collection of 220 nontoxigenic strains and found only one (0.5%) toxinotype XI/PCR ribotype 033 or 033-like strain. The description of such strains raises the question of the role of binary toxin as a virulence factor and could have implications for laboratory diagnostics that currently rarely include testing for binary toxin

Special needs of internationally adopted adolescents in 4 European receiving countries: Relation to mothers’ adoption satisfaction

Introduction: The extent and nature of SN among international adoptees at adolescence in different receiving countries (RC) has not been completely described, nor have differences between children of Eastern Europe (EE) and non-EE origin been fully assessed. Furthermore, the impact of SN on parent adoption satisfaction has not been systematically assessed or compared between RC. Aims: In 4 European RC (1) determine the prevalence and type of SN among internationally adopted adolescents, (2) compare these for children of EE and non-EE origin, (3) relate SN to mothers’ adoption satisfaction. Methods: 685 mothers of internationally adopted adolescents in four different RC (France n = 246, Italy n = 322, Norway n = 60, Spain n = 57) completed on-line surveys including (a) child's medical, behavior, psychological, or school problems, (b) Pinderhughes’ Adoption Satisfaction Questionnaire. Results: Mothers reported that 54% of the adolescents (58 %M, arrival age:53.53±40.35 months, current:14.98±1.70 years, 44% EE origin) had at least one SN. Learning disabilities were most common (40% of adolescents), followed by ADHD (30%), and medical issues (21%), but patterns differed by receiving country. Except for speech/language problems, the frequency of specific SN (developmental delay, attention deficit hyperactivity disorder [ADHD], behavior problems, learning disabilities, psychiatric issues, prenatal alcohol exposure) varied significantly between RC. The frequency of these conditions between children of EE and non-EE origin also varied by RC. Mothers’ adoption satisfaction did not differ significantly between RC; the presence of ADHD, behavior and/or psychiatric problems consistently related to mothers’ adoption satisfaction in all 4 RC. The relation to mothers’ ASQ and the presence and number of SN was assessed by hierarchical linear regression, controlling for child demographic characteristics. Both the presence and number of SN negatively predicted mothers’ adoption satisfaction. Child's age at adoption (and to a lesser extent, current age) also negatively predicted mothers’ ASQ score. Conclusions: SN were relatively common among internationally adopted adolescents in 4 European RC, but the pattern of specific conditions and relationship to mothers’ adoption satisfaction differed among RC. However, ADHD, behavioral and/or psychiatric problems consistently related to mothers’ ASQ in all 4 RC. In regressions controlling for demographic characteristics, the presence of any SN and the number of SN related to mothers’ adoption satisfaction. SN represent an additional stress on adoptive families; further work is needed to understand how differences in RC may impact post-adoption adjustment and experiences