Biological characteristics associated with virulence in Clostridioides difficile ribotype 002 in Hong Kong

Research output: Contribution to journalArticlepeer-review


  • Ka Yi Kong
  • Thomas N Y Kwong
  • Hung Chan
  • Kristine Wong
  • Samuel S Y Wong
  • Anu P Chaparala
  • Raphael C Y Chan
  • Lin Zhang
  • Joseph J Y Sung
  • Jun Yu
  • Margaret Ip
  • William K K Wu
  • Sunny H Wong

Colleges, School and Institutes

External organisations

  • University of California, San Diego
  • The Chinese University of Hong Kong


Clostridioides difficile infection (CDI) is a common cause of nosocomial diarrhea and can sometimes lead to pseudo-membranous colitis and toxic megacolon. We previously reported that the PCR ribotype 002 was a common C. difficile ribotype in Hong Kong that was associated with increased mortality. In this study, we assessed in vitro bacteriological characteristics and in vivo virulence of ribotype 002 compared to other common ribotypes, including ribotypes 012, 014 and 046. We observed significantly higher toxin A (p < 0.05) and toxin B (p < 0.05) production, sporulation (p < 0.001) and germination rates (p < 0.0001) in ribotype 002 than other common ribotypes. In a murine model of C. difficile infection, ribotype 002 caused significantly more weight loss (p < 0.001) and histological damage (p < 0.001) than other common ribotypes. These findings may have contributed to the higher prevalence and mortality observed, and provided mechanistic insights that can help public surveillance and develop novel therapeutics to combat against this infection.


Original languageEnglish
Pages (from-to)631-638
Number of pages8
JournalEmerging Microbes and Infections
Issue number1
Early online date17 Mar 2020
Publication statusE-pub ahead of print - 17 Mar 2020


  • Clostridioides difficile, germination, ribotype, sporulation, toxins