Abstract
Clostridium difficile ; a group of spore forming, toxin forming, gram positive anerobel is implicated in hospital associated diarrhea and is the causative agent of infectious diarrhea. It is the most common hospital associated infection in Europe and North America, and is presumed to be as prevalent in the rest of the world.There has been emergence of new virulent strain of C. difficile, identified as BI, NAP1, and toxinotype III and ribotype 027 (subsequently known as BI/NAP1/027) by various typing method in recent years, implicated in dramatic increase in C. difficile infections.Diagnosis is established by presence of C. difficile toxin or C. difficile toxin gene in stool. Lab testing does not distinguish C. difficile infection and asymptomatic carriage. Clinical suspicion and positive stool study confirms a diagnosis.Clostridium Difficile infection, is most common health care associated infection in Europe and North America, and the available studies show it may have similar prevalence in Nepal. Literature review does not reveal any significant study being conducted in Nepal as of now. It warrants further study to exactly determine the incidence/prevalence and its impact in current health care in Nepal. Clinicians need increased awareness and prompt diagnosis to reduce morbidity and further prevention of transmission.Nepalese Medical Journal, vol.1, No. 1, 2018, page: 43-47
Highlights
MICROBIOLOGY, PATHOGENESIS AND EPIDEMIOLOGYClostridium difficile is group of spore forming, toxin forming, gram positive anerobe that is implicated in hospital associated diarrhea and is the causative agent of infectious diarrhea in hospitalized patients
A meta analytical study from 2017 suggest, the prevalence of Clostridium difficile infection in Asia to be similar to Europe and North America implicating immediate need of proper clinical and microbiological diagnosis and treatment to further reduce morbidity and mortality
But is only recommended to be tested on unformed strain, as it cannot distinguish asymptomatic carriage of toxin producing C. difficile strain.[23,24]
Summary
Clostridium difficile is group of spore forming, toxin forming, gram positive anerobe that is implicated in hospital associated diarrhea and is the causative agent of infectious diarrhea in hospitalized patients. There has been emergence of new virulent strain of C. difficile, identified as BI, NAP1, and toxinotype III and ribotype 027 (subsequently known as BI/NAP1/027) by various typing method in recent years, implicated in dramatic increase in C. difficile infections.[8] This particular strain is characterized by effective spore formation, high toxin production, higher mortality rate, and resistance to fluoroquinolones. This strain is presumed to have a global reach and is found in diverse hospital settings.[9]. It tends to occur mostly in younger individual and the pathogenesis is not clearly defined as they have not had exposure to antibiotics or have other risk factors.[10]
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