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Toxigenic and non-toxigenic Clostridium difficile: determinants of intestinal colonisation and role in childhood atopic manifestations
  1. J Penders1,2,
  2. E E Stobberingh2,
  3. P A van den Brandt3,
  4. R van Ree4,
  5. C Thijs1,3
  1. 1
    Department of Epidemiology, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, The Netherlands
  2. 2
    Department of Medical Microbiology, University Hospital of Maastricht, Maastricht, The Netherlands
  3. 3
    Department of Epidemiology, Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, The Netherlands
  4. 4
    Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands
  1. Dr J Penders, Department of Epidemiology, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; j.penders{at}

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In a previous paper published in this journal, we reported on the role of the intestinal microbiota in the development of atopic manifestations, as examined in a prospective birth cohort (KOALA).1 We showed that infants colonised with Clostridium difficile were at increased risk of developing eczema, wheeze and sensitisation. An association between C difficile and atopic diseases has also been reported by others.2 3

A possible underlying mechanism could be through breaking oral tolerance, as C difficile can cause inflammation in gut tissues, leading to increased permeability of the mucosal barrier and thus facilitating the penetration of allergens.4 The enteropathogenicity of C difficile is associated with the production of toxins A and B, encoded by the genes tcdA and tcdB. Both toxins disrupt epithelial cell tight junctions and thereby ablate epithelial barrier function.5 According to the hypothesised mechanism, it is expected that …

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  • Funding: This study was partly supported by grants from the Dutch Asthma Foundation (grant, the Faculty of Health Sciences of the Maastricht University (Talent for the future scholarship) and Royal Friesland Foods (the Netherlands).

  • Competing interests: None.

  • Ethics approval: The KOALA study was approved by the Ethical Committee of the University Hospital of Maastricht

  • Patient consent: All parents signed informed consent for the study.