Samie Amidou, Obi Chikwelu L, Franasiak Jason, Archbald-Pannone Laurie, Bessong Pascal O, Alcantara-Warren Cirle, Guerrant Richard L
AIDS Virus Research Laboratory, Department of Microbiology, University of Venda, Thohoyandou, South Africa.
Am J Trop Med Hyg. 2008 Apr;78(4):577-85.
Specific polymerase chain reaction (PCR) protocols were used to determine the prevalence of toxigenic Clostridium difficile in Vhembe, South Africa. Of 322 stool samples collected, toxigenic C. difficile was found in 23 (7.1%) cases and was significantly associated with diarrhea 20 (11.4%) compared with 3 (2%) in non-diarrheal samples (chi(2) = 426, P = 0.001), intestinal inflammation in 18 (12.1%) compared with 5 (2.9%) in lactoferrin-negative samples (chi(2) = 10.194, P = 0.001), and occult blood in 19 (16%) compared with 4 (2%) in occult blood-negative samples (chi(2) = 22.157, P < 0.001). Toxigenic C. difficile was more common among individuals > 50 years of age (20%), followed by those between 30 and 39 years of age (19%) and was not associated with HIV infections (chi(2) = 0.289, P = 0.591). Co-infection with other pathogens was common. Multivariate analysis indicated that toxigenic C. difficile was associated with E. bieneusi (P = 0.028), C. parvum (P = 0.007), and Enteroaggregative Escherichia coli (EAEC) (P = 0.007) in diarrheal samples. This study confirms the usefulness of PCR methodologies in the detection of toxigenic C. difficile and suggests that C. difficile is responsible for a small, but underappreciated, proportion of diarrheal cases in the region, and further study is warranted in this area.
采用特定的聚合酶链反应（PCR）方案来确定南非万贝地区产毒艰难梭菌的流行情况。在收集的322份粪便样本中，23例（7.1%）检测出产毒艰难梭菌，且与腹泻显著相关，腹泻样本中有20例（11.4%）检测出产毒艰难梭菌，而非腹泻样本中仅有3例（2%）（卡方检验χ(2)=426，P = 0.001）；与乳铁蛋白阴性样本中5例（2.9%）相比，产毒艰难梭菌在18例（12.1%）有肠道炎症的样本中被检测到（卡方检验χ(2)=10.194，P = 0.001）；与潜血阴性样本中4例（2%）相比，产毒艰难梭菌在19例（16%）潜血阳性样本中被检测到（卡方检验χ(2)=22.157，P < 0.001）。产毒艰难梭菌在50岁以上个体中更为常见（20%），其次是30至39岁年龄段的个体（19%），且与HIV感染无关（卡方检验χ(2)=0.289，P = 0.591）。与其他病原体的合并感染很常见。多变量分析表明，在腹泻样本中，产毒艰难梭菌与微小隐孢子虫（P = 0.028）、微小隐孢子虫（P = 0.007）和聚集性大肠杆菌（EAEC）（P = 0.007）有关。本研究证实了PCR方法在检测产毒艰难梭菌方面的有效性，并表明艰难梭菌在该地区腹泻病例中所占比例虽小但未得到充分认识，该领域有必要进一步开展研究。
