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Concurrent outbreaks with co-infection of norovirus and Clostridium difficile in a long-term-care facility

  • A. LUDWIG (a1) (a2), K. SATO (a3), P. SCHIRMER (a2), A. MANIAR (a4) (a5), C. LUCERO-OBUSAN (a2), C. FLEMING (a6), R. RYONO (a2), G. ODA (a2), M. WINTERS (a2) and M. HOLODNIY (a2) (a7)...

We describe an outbreak of simultaneous Clostridium difficile and norovirus infections in a long-term-care facility. Thirty patients experienced acute gastroenteritis, and four had co-infection with identical C. difficile 027 and genotype II.4 New Orleans norovirus strains. Co-occurring infection requires improved understanding of risk factors, clinical impact, and testing strategies.

Corresponding author
*Author for correspondence: A. Ludwig, M.D., Veterans Health Administration, Office of Public Health, 3801 Miranda Avenue (132), Palo Alto, CA 94304, USA. (Email:
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1. E Scallan , Foodborne illness acquired in the United States – major pathogens. Emerging Infectious Diseases 2011; 17: 715.

2. BA Lopman , Clinical manifestation of norovirus gastroenteritis in health care settings. Clinical Infectious Diseases 2004; 39: 318324.

3. CP Johnston , Outbreak management and implications of a nosocomial norovirus outbreak. Clinical Infectious Diseases 2007; 45: 534540.

5. DB Blossom , C McDonald . The challenge posed by reemerging Clostridium difficile infection. Clinical Infectious Diseases 2007; 45: 222227.

6. GE Bignardi , K Staples , N Majmudar . A case of norovirus and Clostridium difficile infection: casual or causal relationship? Journal of Hospital Infection 2007; 67: 198200.

9. RA Luna , Rapid stool-based diagnosis of Clostridium difficile infection by real-time PCR in a children's hospital. Journal of Clinical Microbiology 2011; 49: 851857.

10. P Spigaglia , P Mastrantonio . Molecular analysis of the pathogenicity locus and polymorphism in the putative negative regulator of toxin production (TcdC) among Clostridium difficile clinical isolates. Journal of Clinical Microbiology 2002; 40: 34703475.

11. M Wilcox , W Fawley . Viral gastroenteritis increases the reports of Clostridium difficile infection. Journal of Hospital Infection 2007; 66: 395396.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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