Clostridioides difficile infection in Africa: A narrative review

Kullin, Brian; Abratt, Valerie R.; Reid, Sharon J.; Riley, Thomas V.

doi:10.1016/j.anaerobe.2022.102549

Cited by 13 publications

(5 citation statements)

References 102 publications

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“…This study also reported a 2.6% prevalence of RT053-163 as well as the emergence of a novel ribotype 255 strain [32]. Interestingly, RT027 and RT078 are not commonly reported in lower-middle-income countries such as India or Africa [12].…”

Section: Discussionsupporting

confidence: 50%

“…Despite its prominence in causing antibiotic-associated diarrhoea in nosocomial and community populations in the US and Europe, there are a lack of studies describing the molecular epidemiological burden of CDI in India and other lower-middle-income countries (LMICs) [10][11][12]. The available data from a small number of Indian studies indicate the prevalence of ribotypes 001, 017, and 106, 045, 126 and 019 [13,14].…”

Section: Introductionmentioning

confidence: 99%

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The Molecular Epidemiology of Clostridioides difficile Infection in Central India: A Prospective Observational Cohort Study

Biswas,

Pinkham,

Walk

et al. 2023

Microbiology Research

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This prospective observational cohort study aimed to establish and compare baseline rates of Clostridioides difficile infection (CDI) in community and hospitalized patients in Nagpur and rural Melghat Maharashtra, including adults aged ≥18 years with a diagnosis of diarrhoea as defined as 3 or more loose stools in a 24 h period. All diarrhoeal samples were tested for CDI using the C. diff Quik Chek Complete enzyme immunoassay. C. difficile-positive stool samples were characterised by toxigenic culture, antimicrobial susceptibility testing and PCR ribotyping. C. difficile testing was performed on 1683 patients with acute diarrhoea. A total of 54 patients (3.21%; 95% CI: 2.42–4.17) tested positive for both the GDH antigen and free toxin. The risk factors for CDI included the presence of co-morbidities, antibiotic usage, and immunosuppression. The detected PCR ribotypes included 053-16, 017, 313, 001, 107, and 216. Our findings show that toxigenic C. difficile is an important but neglected aetiologic agent of infective diarrhoea in Central India. These results underscore the need to enhance the awareness and testing of patients with diarrhoea in India regarding the presence of toxigenic C. difficile, particularly in high-risk individuals with multiple co-morbidities, immunosuppression, and recent or ongoing antibiotic exposure or hospitalization.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

The Molecular Epidemiology of Clostridioides difficile Infection in Central India: A Prospective Observational Cohort Study

Biswas,

Pinkham,

Walk

et al. 2023

Microbiology Research

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“…For example, as regards the African continent, CDI patients are often younger than in European and North American contexts, but typing data are rarely reported [ 168 ]. Furthermore, co-infection with the causative agents of tuberculosis or malaria has been reported to affect the virulence of C. difficile RTs [ 169 ], although the underlying mechanisms are unknown. Finally, the low availability of antimicrobials in some Asian and African countries and the suggested reduction in their use by international agencies [ 170 , 171 ] could certainly be linked to lower selective pressure on circulating C. difficile strains, potentially helping to foster the emergence of non-hypervirulent RTs.…”

Section: Discussionmentioning

confidence: 99%

Make It Less difficile: Understanding Genetic Evolution and Global Spread of Clostridioides difficile

Mengoli

Barone

Fabbrini

et al. 2022

Genes

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Clostridioides difficile is an obligate anaerobic pathogen among the most common causes of healthcare-associated infections. It poses a global threat due to the clinical outcomes of infection and resistance to antibiotics recommended by international guidelines for its eradication. In particular, C. difficile infection can lead to fulminant colitis associated with shock, hypotension, megacolon, and, in severe cases, death. It is therefore of the utmost urgency to fully characterize this pathogen and better understand its spread, in order to reduce infection rates and improve therapy success. This review aims to provide a state-of-the-art overview of the genetic variation of C. difficile, with particular regard to pathogenic genes and the correlation with clinical issues of its infection. We also summarize the current typing techniques and, based on them, the global distribution of the most common ribotypes. Finally, we discuss genomic surveillance actions and new genetic engineering strategies as future perspectives to make it less difficile.

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“…Interestingly, these isolates were moxifloxacin susceptible, suggesting that Japanese RT027 represents the pre-epidemic RT027 genetic background [67]. Data from Africa show that CDI patient populations are often younger than those in Europe, probably due to the high prevalence of co-morbid conditions such as tuberculosis, particularly in sub-Saharan Africa, the main ribotypes are RT012, RT084 and RT014/020 [68]. Another country that reported the prevalence of ST37 (RT017, clade4) is China.…”

Section: Epidemiologymentioning

confidence: 99%

Clostridioides difficile, a New “Superbug”

et al. 2023

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Clostridioides difficile is a Gram-positive, spore-forming, anaerobic bacterium. The clinical features of C. difficile infections (CDIs) can vary, ranging from the asymptomatic carriage and mild self-limiting diarrhoea to severe and sometimes fatal pseudomembranous colitis. C. difficile infections (CDIs) are associated with disruption of the gut microbiota caused by antimicrobial agents. The infections are predominantly hospital-acquired, but in the last decades, the CDI patterns have changed. Their prevalence increased, and the proportion of community-acquired CDIs has also increased. This can be associated with the appearance of hypervirulent epidemic isolates of ribotype 027. The COVID-19 pandemic and the associated antibiotic overuse could additionally change the patterns of infections. Treatment of CDIs is a challenge, with only three appropriate antibiotics for use. The wide distribution of C. difficile spores in hospital environments, chronic persistence in some individuals, especially children, and the recent detection of C. difficile in domestic pets can furthermore worsen the situation. “Superbugs” are microorganisms that are both highly virulent and resistant to antibiotics. The aim of this review article is to characterise C. difficile as a new member of the “superbug” family. Due to its worldwide spread, the lack of many treatment options and the high rates of both recurrence and mortality, C. difficile has emerged as a major concern for the healthcare system.

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Clostridioides difficile infection in Africa: A narrative review

Cited by 13 publications

References 102 publications

The Molecular Epidemiology of Clostridioides difficile Infection in Central India: A Prospective Observational Cohort Study

The Molecular Epidemiology of Clostridioides difficile Infection in Central India: A Prospective Observational Cohort Study

Make It Less difficile: Understanding Genetic Evolution and Global Spread of Clostridioides difficile

Clostridioides difficile, a New “Superbug”

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