Virulence Factors of Clostridioides (Clostridium) difficile Linked to Recurrent Infections

Laura Tijerina-Rodríguez, Licet Villarreal-Treviño, Rayo Morfín-Otero, Adrián Camacho-Ortíz, E. Garza-González*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Citations (Scopus)


From 20 to 30% of Clostridioides (Clostridium) difficile infection (CDI), patients might develop recurrence of the infection (RCDI) and, after the first recurrence, the risk of further episodes increases up to 60%. Several bacterial virulence factors have been associated with RCDI, including the elevated production of toxins A and B, the presence of a binary toxin CDT, and mutations in the negative regulator of toxin expression, tcdC. Additional factors have shown to regulate toxin production and virulence in C. difficile in RCDI, including the accessory-gene regulator agr, which acts as a positive switch for toxin transcription. Furthermore, adhesion and motility-associated factors, such as Cwp84, SlpA, and flagella, have shown to increase the adhesion efficiency to host epithelia, cell internalization, and the formation of biofilm. Finally, biofilm confers to C. difficile protection from antibiotics and acts as a reservoir for spores that allow the persistence of the infection in the host. In this review, we describe the key virulence factors of C. difficile that have been associated with recurrent infections.

Original languageEnglish
Article number7127850
Pages (from-to)7127850
JournalCanadian Journal of Infectious Diseases and Medical Microbiology
Publication statusPublished - 2019
Externally publishedYes

Bibliographical note

Funding Information:
ACKNOWLEDGEMENTS: The Authors are deeply indebted to Professor H. Karzel for his suggestions during many stimulating discussions. Work supported in part by the research group G.R.S.A.G.A. of the Italian National Research Council (C.N.R.), while the second author was enjoying a study grant of C.N.R..

Publisher Copyright:
© 2019 Laura Tijerina-Rodríguez et al.

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases


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