Abstract
Clostridium difficile causes a million of illnesses each year worldwide and can affect people of all ages. Limited data exist on the prevalence of C. difficile infections (CDI) among children below five years of age in developing countries. This study is aimed at determining the prevalence, associated factors, and outcome of the Clostridium difficile infection among children with diarrhea attending a tertiary hospital in Mwanza, Tanzania. Stool samples were collected and cultured anaerobically to isolate Clostridium difficile, followed by C. difficile toxin A and B assay and ribotyping. A total of 301 children with diarrhea were enrolled. A total of 22 (7.31%, 95% CI: 0.89-0.95) nonrepetitive stool samples were positive for Clostridium difficile. Eighteen (81%) of C. difficile isolates were toxigenic, and 16 (72.7%) had unknown ribotypes. Independent predictors of positive C. difficile were as follows: positive HIV status, hospital stay of more than four days, high stool leukocyte count, and watery stool. Clostridium difficile-positive children had significantly higher median duration of the diarrhea than those without C. difficile. Clinicians should consider C. difficile as a possible cause of diarrhea in children living in developing countries and institute appropriate management to prevent associated morbidities and mortalities. Furthermore, there is a need of joint effort to improve C. difficile diagnosis and surveillance in developing countries to establish the unknown epidemiology of CDI in these countries.
Highlights
C. difficile is a gram-positive, cytotoxin-producing anaerobic bacterium commonly existing in the large intestines of humans and animals without causing disease [1, 2]
We identified C. difficile significantly more often in patients who had a prolonged median hospital stay before diarrhea started than in those with a shorter median hospital stay (4.5 [4,5,6,7,8] days vs. 3 [1,2,3,4,5,6,7] days, P = 0:026)
This study has observed the prevalence of Clostridium difficile infection (CDI) to be 7.3% among children with diarrhea which is comparable with previous studies in Tanzania (6.4%), Zimbabwe (8.6%), South Africa (7.1%), and Brazil (6.7%) [6, 7, 9, 28]
Summary
C. difficile is a gram-positive, cytotoxin-producing anaerobic bacterium commonly existing in the large intestines of humans and animals without causing disease [1, 2]. Clostridium difficile is one of the known causes of the antibioticassociated diarrhea [3, 4]. Few studies exist in Africa regarding the magnitude of CDI; these studies have documented the prevalence to range from 4.9 to 8.6% [6,7,8,9,10]. The prevalence of CDI among adults and children with diarrhea in Mwanza has been documented to be 6.4% [9]. Colonization of C. difficile among healthy children has been reported in a number of surveys and has been found to range from 2 to 64%, with more colonization being reported in neonates and infants [11,12,13]
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