Prevalence of Clostridium difficile infections among Kenyan children with diarrhea

Abstract

Clostridium difficile infections in Africa C. difficile pathogenesis C. difficile epidemiology CDI in young children CDI in infants C. difficile co-infection A B S T R A C TBackground: Diarrhea causes significant morbidity and mortality among children worldwide. Regions most affected by diarrhea include Sub-Saharan Africa and Southeast Asia, where antibiotics are in common use and can make children more vulnerable to Clostridium difficile and pathogens that are not affected by these drugs. Indeed, C. difficile is a major diarrhea-associated pathogen and poses a significant threat to vulnerable and immunocompromised populations. Yet, little is known about the role and epidemiology of C. difficile in diarrhea-associated illness among young children. As a result, C. difficile is often neglected in regions such as Sub-Saharan Africa that are most impacted by childhood diarrhea. The purpose of this study was to establish the frequency of C. difficile in young children (<5 years) with diarrhea. Methods: Children presenting with diarrhea at a national hospital in Kenya from 2015 to 2018 were enrolled consecutively. Following informed consent by a parent or legal guardian, stool samples were obtained from the children and demographic data were collected. The stools were examined for the presence of four common pathogens known to cause diarrhea: C. difficile, rotavirus, Cryptosporidium parvum, and Giardia lamblia. C. difficile was verified by toxigenic culture and PCR. The presence of C. parvum and/or G. lamblia was determined using the ImmunoCard STAT! Crypto/Giardia Rapid assay. Rotavirus was detected by ELISA. Results: The study population comprised 157 children; 62.4% were male and 37.6% were female and their average age was 12.4 months. Of the 157 stool specimens investigated, 37.6% were positive for C. difficile, 33.8% for rotavirus, 5.1% for Cryptosporidium, and 5.1% for Giardia. PCR analysis identified at least one of the C. difficile-specific -genes (tcdA, tcdB, or tcdC). Further, 57.6% of the stools had C. difficile colonies bearing a frame-shift deletion in the tcdC gene, a mutation associated with increased toxin production. The frequency of C. difficile was 32.6% in children 12 months old and increased to 46.6% in children 12-24 months old. Conclusions: In Kenyan children presenting with diarrhea, C. difficile is more prevalent than rotavirus or Cryptosporidium, two leading causes of childhood diarrhea. These findings underscore the need to better understand the role of C. difficile in children with diarrhea, especially in areas with antibiotic overuse. Understanding C. difficile epidemiology and its relationship to co-infecting pathogens among African children with diarrhea will help in devising ways of reducing diarrhea-associated illness.

Postbiotics against Pathogens Commonly Involved in Pediatric Infectious Diseases

“…Postbiotics may also be a new alternative to prevent or treat Clostridioides difficile (formerly known as Clostridium difficile ) infections (CDI). Although considered extremely rare in neonates and infants, further studies report the occurrence of diarrhea in this specific population [ 91 , 92 ]. Routine testing for CDI in infants is currently not recommended due to the high asymptomatic colonization in this group and should be performed only when other causes of diarrhea, such as rotavirus, have been excluded [ 93 , 94 ].…”

“…Routine testing for CDI in infants is currently not recommended due to the high asymptomatic colonization in this group and should be performed only when other causes of diarrhea, such as rotavirus, have been excluded [ 93 , 94 ]. However, toxigenic C. difficile has been identified alone or in co-infection with rotavirus, suggesting that it could be a contributing factor to diarrhea in infants [ 92 , 95 ]. New evidence shows that CFS from various lactic acid bacteria (LAB) cocultured with multi-resistant C. difficile can reduce the cytotoxic effects of clostridial toxins on different cell lines compared to pure C. difficile CFS.…”

Evaluation of inpatients Clostridium difficile prevalence and risk factors in Cameroon

“…There are scarcity of data published and information sharing platforms on CDI epidemiology in sub-Sahara Africa [6,7]. Little is documented on the risk factors and prevalence of C. difficile in hospitals and community health care settings in Cameroon.…”

Performance of three rapid diagnostic tests for the detection of Cryptosporidium spp. and Giardia duodenalis in children with severe acute malnutrition and diarrhoea

“…Other studies also found lower Cryptosporidium spp. prevalence in Kenyan children with diarrhoea of 5.1% [26] or 11.0% [27], respectively. In contrast, the prevalence found in the present study was much lower than that previously reported (34.1%) in HIV infected individuals [9].…”