Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2016 Apr;22(4):853-61.
doi: 10.1097/MIB.0000000000000696.

Host Immune Response to Clostridium difficile Infection in Inflammatory Bowel Disease Patients

Michelle Hughes  1 , Taha Qazi, Adam Berg, Janice Weinberg, Xinhua Chen, Ciaran P Kelly, Francis A Farraye
Affiliations
Comparative Study

Host Immune Response to Clostridium difficile Infection in Inflammatory Bowel Disease Patients

Michelle Hughes et al. Inflamm Bowel Dis. 2016 Apr.

Abstract

Background: Clostridium difficile infection (CDI) affects patients with inflammatory bowel disease (IBD). The aim of this study was to compare humoral response to C. difficile toxins in IBD patients and control outpatients.

Methods: We prospectively followed adult IBD patients and control subjects with serum and stool samples obtained at enrollment and during periods of CDI and tested by PCR. Semiquantitative serum levels of IgM, IgG, and IgA to C. difficile toxins A and B were measured.

Results: Overall, 119 stool and 117 serum samples were obtained from 150 subjects. Different levels of IgA to toxin A (P = 0.0016) and toxin B (P = 0.0468) were noted between different IBD groups. Toxin A IgA levels were higher in the Crohn's disease group (P = 0.0321) and ileal pouch anal anastomosis (IPAA) group (P = 0.001) compared with the ulcerative colitis (UC) group, and toxin B IgA levels were higher in the IPAA group compared with the UC group (P = 0.0309). There were lower levels of toxin A IgA in IBD patients compared with those in subjects without new CDI (P = 0.0488) and higher levels in IBD patients with compared with those in subjects without CDI history before enrollment (P = 0.016). There were nonsignificant lower toxin A IgG levels in IBD patients compared with those in subjects without prior CDI (P = 0.095) and higher levels in control subjects with a history of CDI compared with IBD patients with prior CDI (P = 0.049).

Conclusions: Patients with UC have lower IgA levels to C. difficile toxins compared with those with Crohn's disease and those after IPAA. Patients with IBD with prior CDI failed to demonstrate any increase in antitoxin IgG. Our findings suggest that IBD patients may benefit from immunization strategies targeting C. difficile toxins.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Dr. Francis Farraye has previously served as a consultant for Cubist Pharmaceuticals. Drs. Ciaran Kelly and Xinhua Chen are receiving an NIH grant (RO1 AI 095256). The remaining authors have no sources of funding or conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Inclusion of Patients, Rates of Sample Collection and Sample Processing
* Inflammatory Bowel Disease ± Clostridium difficile infection
Figure 2
Figure 2
Comparison of baseline antitoxin antibodies to Clostridium difficile toxins among study participants
Figure 3
Figure 3
Comparison of mean antitoxin antibody titers to Clostridium difficile toxin A and toxin B among study participants with and without new Clostridium difficile infection.
Figure 4
Figure 4
Comparison of mean antitoxin antibody titers to Clostridium difficile toxin A and toxin B among study participants with and without prior Clostridium difficile infection.
See this image and copyright information in PMC

References

    1. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370:1198–1208. - PMC - PubMed
    1. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:825–834. - PMC - PubMed
    1. Centers for Disease Control and Prevention (CDC) Vital signs: preventing Clostridium difficile infections. MMWR Morb Mortal Wkly Rep. 2012;61:157–162. - PubMed
    1. Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect. 1998;40:1–15. - PubMed
    1. Garey KW, Sethi S, Yadav Y, et al. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect. 2008;70:298–304. - PubMed

Publication types

MeSH terms