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High Prevalence of Toxigenic and Nontoxigenic Clostridium difficile Strains in Malaysia

Thomas V Riley1,2,3, Deirdre A Collins4, Rina Karunakaran5

  • 1School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia thomas.riley@uwa.edu.au.

Journal of Clinical Microbiology
|March 23, 2018
PubMed

Insights

Clostridium difficile infection (CDI) is common in Southeast Asia, though severe cases are rare. This study identified prevalent strains in Malaysia, suggesting regional localization and impact on the CDI burden.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Epidemiology

Background:

  • Clostridium difficile is prevalent in Southeast Asia, presenting with various clinical symptoms.
  • Severe Clostridium difficile infections (CDI) are infrequently documented in the region.

Purpose of the Study:

  • To investigate the prevalence and characteristics of Clostridium difficile infection (CDI) in Malaysia.
  • To identify specific Clostridium difficile strains and toxin gene presence in Malaysian hospitals.

Main Methods:

  • Collected 437 diarrheal stool specimens from patients in Kuala Lumpur and Kota Bharu hospitals (2015-2016).
  • Utilized enzyme immunoassays for glutamate dehydrogenase (GDH) and toxin A/B detection.
  • Employed bacterial culture, PCR ribotyping, and toxin gene analysis for C. difficile isolates.

Main Results:

  • Fecal toxin was detected in 3.0% of specimens; 16.2% were GDH positive and toxin negative.
  • Toxigenic C. difficile strains were isolated from 10.3% and non-toxigenic strains from 12.4% of specimens.
  • PCR ribotypes 017 (20.0%) and 043 (10.0%) were the most prevalent in Malaysia.

Conclusions:

  • The high prevalence of specific C. difficile strains (RT 017) and non-toxigenic strains in Malaysia suggests regional adaptation.
  • These findings imply a significant role for these localized strains in the overall burden of CDI in Southeast Asia.
Keywords:
Clostridium difficileMalaysiaepidemiologyprevalence

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