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?difficile spores of >200?CFU/mL (MM, Squire and TV, Riley, unpublished data) posing a risk for infection of animals or contamination of agricultural produce. Besides environmental contamination in the vicinity of colonized or infected humans and animals, C.?difficile spores can be isolated from practically any environmental site, provided that the correct culture enrichment methods are employed [87]. A large study by al Saif and Brazier [49] showed high rates of detection of C.?difficile in soil and water samples in South Wales. Soil contained C.?difficile in 21% of 104 samples, and 41% of the isolates produced toxin?A. Water was positive in 88% of river samples, half of the sea, lake and swimming pool samples, and 5.5% of the tap water samples. MAPK Overall, 85% of the isolates produced toxin?A. In 2010, similar percentages were found in Slovenia [88], where 61% (42 of 69) of the river isolates were positive for C.?difficile. Interestingly, 34 different types were found, more than half of which were also found in humans and animals. Ribotype?014, a common PCR ribotype found in humans, was the most prevalent (16%). Although absolute counts of toxigenic C.?difficile in water are low (1�C5?CFU/100?mL) [49], the infectious dose is unknown, and therefore so is the impact of the environment as a source of human or animal CDI. As C.?difficile can be detected in live animals, foodborne transmission via meat is also considered to be a potential source of CA-CDI. Recently, a number of studies have been published on the prevalence of C.?difficile in (processed) meat, fish, and vegetables. These results are summarized in Table?3. Remarkably, studies conducted in Europe have persistently reported Selleck LY2109761 low prevalence rates, e.g. in up to 3% of meat samples [89�C94], in contrast to the USA and Canada, where C.?difficile is generally reported at much higher rates, e.g. in up to 42% of meat samples [95�C103]. Although high isolation frequencies are reported for C.?difficile in meat, quantitative studies show that levels of contamination are generally low, with EPZ5676 clinical trial and the heat tolerance of the spores [95] might facilitate foodborne transmission [100]. The majority of C.?difficile isolates that have been recovered from food are toxigenic and therefore potentially pathogenic, with a clear overlap in types being found in human patients. Ribotypes?078 and 027 have not been isolated from meat samples in Europe, but are the main PCR ribotypes found in food in North America (Table?3). However, this finding needs to be confirmed, because laboratory cross-contamination may have occurred in some studies [104]. If we exclude the study by Songer et?al. [97], who found a high prevalence rate, the overall prevalence of C.?difficile in meat samples in North America drops to 2�C20%, and more resembles the percentages found in Europe.
