The Ecology and Pathobiology of Clostridium difficile Infections: An Interdisciplinary Challenge

Erik R. Dubberke, Washington University School of Medicine in St. Louis
David B. Haslam, Washington University School of Medicine in St. Louis
Cristina Lanzas, Cornell University
L D. Bobo, Washington University School of Medicine in St. Louis
C D. Burnham, Washington University School of Medicine in St. Louis
Yrjo T. Grohn, Cornell University
P I. Tarr, Washington University School of Medicine in St. Louis

Abstract

Clostridium difficile is a well recognized pathogen of humans and animals. Although C. difficile was first identified over 70 years ago, much remains unknown in regards to the primary source of human acquisition and its pathobiology. These deficits in our knowledge have been intensified by dramatic increases in both the frequency and severity of disease in humans over the last decade. The changes in C. difficile epidemiology might be due to the emergence of a hypervirulent stain of C. difficile, ageing of the population, altered risk of developing infection with newer medications, and/or increased exposure to C. difficile outside of hospitals. In recent years, there have been numerous reports documenting C. difficile contamination of various foods, and reports of similarities between strains that infect animals and strains that infect humans as well. The purposes of this review are to highlight the many challenges to diagnosing, treating, and preventing C. difficile infection in humans, and to stress that collaboration between human and veterinary researchers is needed to control this pathogen.