Abstract:A ocorrência de Clostridium difficile foi analisada em amostras de fezes de 175 crianças com idade variando de 1 a 35 meses. Para o isolamento primário do microrganismo foi empregado o meio de cultura seletivo diferencial "CCFA" (cicloserina-cefoxitina-frutose-agar). Num grupo de 67 crianças sem dist úrbios gastrintestinais e que não estavam sob uso de agentes antimicrobianos a ocorrência do C. difficile foi de 22,4%, enquanto que num outro grupo de 28 crianças nas mesmas condições, porém, sob tratamento com an… Show more
“…Similarly, Soyletir et al (1996) found this organism in 4.9% of Turkish children with diarrhea. In Brazil, Garcia and Uzeda (1988) isolated C. difficile from 13.8% of clinical samples from hospitalized children with acute diarrhea.…”
“…Similarly, Soyletir et al (1996) found this organism in 4.9% of Turkish children with diarrhea. In Brazil, Garcia and Uzeda (1988) isolated C. difficile from 13.8% of clinical samples from hospitalized children with acute diarrhea.…”
“…In Brazil, there are few epidemiological studies involving this pathogen as a cause of diarrhea in children [4, 8]. Since a stool sample harbored the profile of toxigenicity tcdA+/tcdB− and another cdtA+/cdtB+ , it suggested a low circulation of toxigenic C. difficile in Brazilian children, and the acute diarrhea in children could have been caused by other enteropathogens than C. difficile , like typical viral or bacterial pathogens, such as Norovirus , Rotavirus , Salmonella , or Campylobacter , and this needs to be investigated.…”
The presence of gene 16S rRNA and genes encoding toxin A (tcdA), toxin B (tcdB), and binary toxin (cdtA/cdtB) of Clostridium difficile in stool samples from children with (110) and without (150) diarrhea was determined by using a TaqMan system. Fifty-seven (21.9%) out of 260 stool samples harbored the 16S rRNA gene. The genetic profile of tcdA+/tcdB− and cdtA+/cdtB+ was verified in one C. difficile-positive diarrhea sample and of tcdA+/tcdB+ in three C. difficile-positive nondiarrhea samples. The presence of tcdA+/tcdB+ in stools obtained from children without diarrhea, suggests that they were asymptomatic carriers of toxigenic strains.
Introduction
The prevalence of
Clostridium difficile
infection is rapidly increasing worldwide, but prevalence is difficult to estimate in developing countries where awareness, diagnostic resources, and surveillance protocols are limited. As diarrhea is the hallmark symptom, we conducted a systematic review and meta-analysis to determine the prevalence and incidence of
C. difficile
infection in patients in these regions who presented with diarrhea.
Methods
We conducted a systematic literature search of MEDLINE/PubMed, Scopus, and Latin-American and Caribbean Health Sciences Literature databases to identify and analyze data from recent studies providing prevalence or incidence rates of
C. difficile
-associated diarrhea in developing countries within four regions: Africa–Middle East, developing Asia, Latin America, and China. Our objectives were to determine the current prevalence and incidence density rates of first episodes of
C. difficile
-associated diarrhea in developing countries.
Results
Within the regions included in our analysis, prevalence of
C. difficile
infection in patients with diarrhea was 15% (95% CI 13–17%) (including community and hospitalized patients), with no significant difference across regions. The incidence of
C. difficile
infection in 17 studies including this information was 8.5 per 10,000 patient-days (95% CI 5.83–12.46). Prevalence was significantly higher in hospitalized patients versus community patients (
p
= 0.0227).
Conclusion
Our prevalence estimate of 15% is concerning; however, low awareness and inconsistent diagnostic and surveillance protocols suggest this is markedly underestimated. Enhanced awareness and management of
C. difficile
infection in patients with diarrhea, along with improvements in infection control and surveillance practices, should be implemented to reduce prevalence of
C. difficile
-associated diarrhea in developing countries.
Funding
Pfizer Inc.
Electronic supplementary material
The online version of this article (10.1007/s40121-019-0231-8) contains supplementary material, which is available to authorized users.
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