Over the last several years we have seen multiple instances where Clostridium difficile and foodborne illness have been related. However, the Clostridium difficile infection has generally been associated with the foodborne illness after treatment for the infection by antibiotics, not as a result of actual ingestion of the Clostridium difficile bacteria. However, in the recent Salmonella Typhimurium Peanut Butter outbreak, we have two cases where children seem to be co-infected with both Clostridium difficile and Salmonella Typhimurium. Which begs the question – Is Clostridium difficile foodborne?

A little background first – Wikipedia reports that Clostridium difficile is a species of Gram-positive bacteria of the genus Clostridium. Clostridia are anaerobic, spore-forming rods (bacillus). C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. The C. difficile bacteria, which naturally reside in the body, become overgrown: The overgrowth is harmful because the bacterium releases toxins that can cause bloating, constipation, and diarrhea with abdominal pain, which may become severe.

The CDC reports that mortality rates from Clostridium difficile disease in the United States increased from 5.7 per million population in 1999 to 23.7 per million in 2004. Increased rates may be due to emergence of a highly virulent strain of C. difficile.

Here are a few articles that I have found or have been sent on the topic. Clearly more research needs to be done.

Possible Seasonality of Clostridium difficile in Retail Meat, Canada

Rodriguez-Palacios A, Reid-Smith RJ, Staempfli HR, Diagnault D, Janecko N, Avery BP et al. Possible seasonality of Clostridium difficle in retail meat, Canada. Emerg Infect Dis. 2009 May

We previously reported Clostridium difficile in 20% of retail meat in Canada, which raised concerns about potential foodborne transmissibility. Here, we studied the genetic diversity of C. difficile in retail meats, using a broad Canadian sampling infrastructure and 3 culture methods. We found 6.1% prevalence and indications of possible seasonality (highest prevalence in winter).

Clostridium difficile in Retail Meat Products, USA, 2007

Songer JG, Trinh HT, Killgore GE, Thompson AD, McDonald LC, Limbago BM. Clostridium difficile in retail meat products, USA, 2007. Emerg Infect Dis. 2009 May

To determine the presence of Clostridium difficile, we sampled cooked and uncooked meat products sold in Tucson, Arizona. Forty-two percent contained toxigenic C. difficile strains (either ribotype 078/toxinotype V [73%] or 027/toxinotype III [NAP1 or NAP1-related; 27%]). These findings indicate that food products may play a role in interspecies C. difficile transmission.

Clostridium difficile in Ready-to-Eat Salads, Scotland

Bakri MM, Brown DJ, Butcher JP, Sutherland AD. Clostridium difficile in ready-to-eat salads, Scotland. Emerg Infect Dis. 2009 May

Of 40 ready-to-eat salads, 3 (7.5%) were positive for Clostridium difficile by PCR. Two isolates were PCR ribotype 017 (toxin A–, B+), and 1 was PCR ribotype 001. Isolates were susceptible to vancomycin and metronidazole but variably resistant to other antimicrobial drugs. Ready-to-eat salads may be potential sources for virulent C. difficile.