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A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
Analysis of Clostridioides difficile Infection in Children with Diarrhea in Two Hospitals in Southern Brazil
Adriane C Maestri1,2, Dany Mesa3, Thais M Vasconcelos3
1Laboratório de Bacteriologia, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Rua Padre Camargo, 280 - Alto da Glória, CEP: 80.062-240, Curitiba, Paraná, Brazil.
Insights
Clostridioides difficile infection (CDI) affects 13.3% of children with diarrhea in Brazil, with high recurrence rates. Molecular analysis revealed diverse strains with various virulence and resistance factors, underscoring the need for further research.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Clostridioides difficile infection (CDI) is increasingly prevalent in pediatric populations.
- Limited epidemiological and molecular data exist for pediatric CDI in Latin America.
- Antimicrobial-associated diarrhea (AAD) in children warrants investigation for underlying CDI.
Purpose of the Study:
- To determine the prevalence and molecular characteristics of CDI in children with diarrhea in southern Brazil.
- To identify risk factors and recurrence patterns of pediatric CDI.
- To analyze virulence factors and antimicrobial resistance in C. difficile isolates.
Main Methods:
- Prospective cohort study of 105 children with AAD.
- Diagnostic testing included enzyme immunoassay for GDH and toxins, real-time PCR, and toxigenic culture.
- Whole genome sequencing was performed on toxigenic C. difficile isolates.
Main Results:
- CDI was diagnosed in 13.3% of the children.
- Previous CDI history and stool mucus were associated with higher CDI likelihood.
- Metronidazole was the primary treatment, with a 23.1% recurrence rate (rCDI).
- Sequenced isolates showed genetic diversity, toxin genes (tcdA, tcdB, cdtA, cdtB), adhesion factors, immune evasion factors, and antimicrobial resistance genes.
Conclusions:
- CDI is a significant concern in hospitalized children with diarrhea in Brazil, characterized by prevalence and recurrence.
- The genetic diversity and presence of virulence and resistance factors highlight the complexity of pediatric CDI.
- Further longitudinal studies are essential to understand CDI's impact on the pediatric healthcare system in this region.
Abstract:
Clostridioides difficile infection (CDI) has been increasingly observed in children, but there is a lack of epidemiological and molecular data on CDI in Latin America. This prospective cohort study aimed to investigate the role of CDI in children with diarrhea. It included 105 children with antimicrobial-associated diarrhea (AAD) and analyzed the molecular characteristics of strains isolated from two hospitals in southern Brazil between 2017 and 2020. Fecal samples from the participants were tested for glutamate dehydrogenase (GDH) and A/B toxins using a rapid enzyme immunoassay. GDH-positive samples underwent automated real-time polymerase chain reaction and toxigenic culture. Toxigenic C. difficile isolates were selected for whole genome sequencing. Out of the 105 patients, 14 (13.3%) met the criteria for CDI. Children with a history of previous CDI and the presence of mucus in their stool were more likely to have CDI. Metronidazole was the most used treatment (71.4%), and three patients (23.1%) experienced CDI recurrence (rCDI). Although the number of sequenced isolates was limited, a wide diversity of sequence types (ST) was observed. In addition to toxin genes (tcdA, tcdB, cdtA, and cdtB), the isolates also exhibited virulence factors involved in adhesion (cwp66, groEL, slpA, fbpA/fbp68) and immune evasion (rmlA, rmlB, rmlC, gnd, rfbA-1), along with multiple resistance factors (gyrA mutation, norA, ermB, dfrF, and vanG). These findings highlight the prevalence and recurrence of CDI among hospitalized children. Longitudinal studies are needed to better understand the characteristics of CDI-associated diarrhea and its impact on the healthcare system in this population.
