Clostridium difficile: a healthcare associated infection of unknown significance in adults in sub-Saharan Africa

Background: Clostridium difficile infection (CDI) causes a high burden of disease in high-resource healthcare systems, with significant morbidity, mortality and financial implications. CDI is a healthcare-associated infection for which the primary risk factor is antibiotic usage and it is the leading cause of bacterial diarrhoea in HIV infected patients in USA. Little is known about the disease burden of CDI in sub-Saharan Africa, where HIV and healthcare associated infection have a higher prevalence and antibiotic usage is less restricted. Aim: To review published literature on CDI in sub-Saharan Africa, highlighting areas for future research. Methods: English language publications since 1995 were identified from online databases (PubMed, Medline, Google Scholar, SCOPUS) and personal collections of articles, using combinations of keywords to include C. difficile, Africa and HIV. Results: Ten relevant studies were identified. There is considerable variation in methodology to assess for carriage of toxigenic C. difficile and its associations. Eight studies report carriage of toxigenic C. difficile. Three (of four) studies found an association with antibiotic usage. One (of four) studies showed an association with HIV infection. One study showed no association with degree of immunosuppression in HIV. Two (of three) studies showed an association between carriage of toxigenic C. difficile and diarrhoeal illness. Conclusion: Whilst the carriage of toxigenic C. difficile is well described in sub-Saharan Africa, the impact of CDI in the Region remains poorly l understood and warrants high quality research

Acute diarrhea in children

© 2015, Serbia Medical Society. All rights reserved. Acute diarrhea (AD) is the most frequent gastroenterological disorder, and the main cause of dehydration in childhood. It is manifested by a sudden occurrence of three or more watery or loose stools per day lasting for seven to 10 days, 14 days at most. It mainly occurs in children until five years of age and particularly in neonates in the second half-year and children until the age of three years. Its primary causes are gastrointestinal infections, viral and bacterial, and more rarely alimentary intoxications and other factors. As dehydration and negative nutritive balance are the main complications of AD, it is clear that the compensation of lost body fluids and adequate diet form the basis of the child’s treatment. Other therapeutic measures, except antipyretics in high febrility, antiparasitic drugs for intestinal lambliasis, anti-amebiasis and probiotics are rarely necessary. This primarily regards uncritical use of antibiotics and intestinal antiseptics in the therapy of bacterial diarrhea. The use of antiemetics, antidiarrhetics and spasmolytics is unnecessary and potentially risky, so that it is not recommended for children with AD

Infectious diarrheas of infants and young children

artículo -- Universidad de Costa Rica, Instituto de Investigaciones en Salud. 1985Acute diarrhea' disease was once attributed to "indigestion." Although shigellosis, cholera, salmonellosis, giardiasis, and amebiasis have long been recognized as distinct clinical entities, it was not too long ago that many medical personnel had difficulty accepting the fact that most diarrheas are of infectious origin. The occurrence of diarrhea with the onset of weaning in many animal species and in man' and the systematic failure to identify pathogens responsible for diarrhea in the general population have, in the past, cast some doubt on its etiology.Universidad de Costa Rica, Instituto de Investigaciones en SaludUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

High Prevalence of Multidrug-Resistant Clostridioides difficile Following Extensive Use of Antimicrobials in Hospitalized Patients in Kenya

Introduction: Clostridioides difficile is a neglected pathogen in many African countries as it is generally not regarded as one of the major contributors toward the diarrheal disease burden in the continent. However, several studies have suggested that C. difficile infection (CDI) may be underreported in many African settings. The aim of this study was to determine the prevalence of CDI in hospitalized patients, evaluate antimicrobial exposure, and detect toxin and antimicrobial resistance profiles of the isolated C. difficile strains. Methods: In this cross-sectional study, 333 hospitalized patients with hospital-onset diarrhoea were selected. The stool samples were collected and cultured on cycloserine-cefoxitin egg yolk agar (CCEY). Isolates were presumptively identified by phenotypic characteristics and Gram stain and confirmed by singleplex real-time PCR (qPCR) assays detecting the species-specific tpi gene, toxin A (tcdA) gene, toxin B (tcdB) gene, and the binary toxin (cdtA/cdtB) genes. Confirmed C. difficile isolates were tested against a panel of eight antimicrobials (vancomycin, metronidazole, rifampicin, ciprofloxacin, tetracycline, clindamycin, erythromycin, and ceftriaxone) using E-test strips. Results: C. difficile was detected in 57 (25%) of diarrheal patients over the age of two, 56 (98.2%) of whom received antimicrobials before the diarrheal episode. Amongst the 71 confirmed isolates, 69 (97.1%) harbored at least one toxin gene. More than half of the toxigenic isolates harbored a truncated tcdA gene. All isolates were sensitive to vancomycin, while three isolates (2.1%) were resistant to metronidazole (MIC \u3e32 mg/L). High levels of resistance were observed to rifampicin (65/71, 91.5%), erythromycin (63/71, 88.7%), ciprofloxacin (59/71, 83.1%), clindamycin (57/71, 80.3%), and ceftriaxone (36/71, 50.7.8%). Among the resistant isolates, 61 (85.9%) were multidrug-resistant. Conclusion: Multidrug-resistant C. difficile strains were a significant cause of healthcare facility-onset C. difficile infections in patients with prior antimicrobial exposure in this Kenyan hospital