Clostridium difficile has historically been recognized in humans as a cause of diarrhea in elderly, hospitalized, and immunocompromised individuals.1,2 Over the last decade, it has increasingly become community acquired and has been identified in young, healthy humans.1,2 It has rarely been identified in nonhuman primates.3 An adult, male, black-handed spider monkey (Ateles geoffroyi) at a zoo suffered an acute onset of anorexia, depression, and diarrhea that failed to respond to antibiotic and fluid therapy, resulting in death within 24 hours of the first observed clinical signs. A diagnosis of fibrinonecrotic enterocolitis was made on necropsy, and C. difficile was isolated from the intestines. The four remaining spider monkeys in the colony subsequently developed moderate to severe watery diarrhea, depression, and anorexia. Serial samples collected over eight weeks confirmed toxigenic C. difficile in all four animals. Initial treatment with metronidazole was discontinued when animals refused to take the antibiotic orally. Treatment with oral vancomycin resolved clinical signs until antibiotics were discontinued. Subsequent treatment with endoscopic fecal microbiota transplantation, using material prepared from feces from spider monkeys at another institution, resulted in engraftment of the donor’s fecal microbiomes in all four monkeys, resolution of diarrhea, and absence of C. difficile and its toxins from subsequent stool studies.1 Microbial samples from the index case and three of the four surviving animals were subtyped by the state department of health and were found to be different than the community NAP types in their database, but 80% similar to each other based on PGFE subtyping.
1. Bakken JS, Borody T, Brandt LJ, et al. Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol. 2011;9(12):1044–1049.
2. Lessa FC, Bamberg WM, Beldavs ZG, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:825–834.
3. Rolland RM, Chalifoux LV, Snook SS, Ausman LM, Johnson LD. Five spontaneous deaths associated with Clostridium difficile in a colony of cotton-top tamarins (Saguinus oedipus). Lab Anim Sci. 1997;47(5):472–476.