Abstract
Clostridium difficile-associated disease (CDAD) is caused by a spore-forming bacterium and can result in highly variable disease, ranging from mild diarrhoea to severe clinical manifestations. Infections are most commonly seen in hospital settings and are often associated with on-going antibiotic therapy. Incidences of CDAD have shown a sustained increase worldwide over the last ten years and a hypervirulent C. difficile strain, PCR ribotype 027/REA type BI/North American pulsed-field (NAP) type 1 (027/BI/NAP-1), has caused outbreaks in North America and Europe. In contrast, only a few reports of cases in Latin America have been published and the hypervirulent strain 027/BI/NAP-1 has, so far, only been reported in Costa Rica. The potential worldwide spread of this infection calls for epidemiological studies to characterize currently circulating strains and also highlights the need for increased awareness and vigilance among healthcare professionals in currently unaffected areas, such as Latin America. This review attempts to summarize reports of C. difficile infection worldwide, especially in Latin America, and aims to provide an introduction to the problems associated with this pathogen for those countries that might face outbreaks of epidemic strains of C. difficile for the first time in the near future.
Highlights
Clostridium difficile-associated disease (CDAD) is caused by a spore-forming bacterium and can result in highly variable disease, ranging from mild diarrhoea to severe clinical manifestations
After this pioneering description of the presence of C. difficile infection in Costa Rica, Quesada-Gomez et al (2010) published one of the most important articles about this subject in Latin America. They described, for the first time, the isolation of 027/BI/North American pulsed-field (NAP)-1 strains from patients with CDAD in a Costa Rican hospital
When the worldwide scenario of C. difficile infection was examined by studying the epidemiology of the microorganism, it was observed that, after 2002, the United States and Canada started to have problems with CDAD, especially considering the increase in cases of severe infections that progressed to toxic megacolon, resulting in high rates of mortality among elderly people
Summary
The first study reporting the presence of C. difficile among adults in Costa Rica was published in 2008 by ZumbadoSalas et al (2008). The frequency of CDAD in these patients was 30 % (31/104), which is similar to previously reported detection rates in Ireland (27 %) and Sweden (20 %), suggesting that C. difficile infections are not governed by the socioeconomic factors that distinguish high- and low-income countries After this pioneering description of the presence of C. difficile infection in Costa Rica, Quesada-Gomez et al (2010) published one of the most important articles about this subject in Latin America. The authors concluded that, toxic megacolon due to this micro-organism is a rare complication in patients with ulcerative colitis, it should be suspected in those under antibiotic therapy that present relapses Another case report was published by Sanchez-Perez et al (2010), describing a 63-year-old woman who was suffering from abdominal pain, bloating and diarrhoea for over 3 days. The authors highlighted that in AIDS patients who develop PMC and do not respond to treatment for C. difficile infection, CMV should be considered as a possible contributing factor in differential diagnoses
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