HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Samie, A. Articles by Guerrant, R. L. Search for Related Content PubMed PubMed Citation Articles by Samie, A. Articles by Guerrant, R. L. Related Collections Bacterial Infection

PCR Detection of Clostridium difficile Triose Phosphate Isomerase (tpi), Toxin A (tcdA), Toxin B (tcdB), Binary Toxin (cdtA, cdtB), and tcdC Genes in Vhembe District, South Africa

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 (² = 426, P = 0.001), intestinal inflammation in 18 (12.1%) compared with 5 (2.9%) in lactoferrin-negative samples (² = 10.194, P = 0.001), and occult blood in 19 (16%) compared with 4 (2%) in occult blood–negative samples (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 (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.

Received August 6, 2007. Accepted for publication January 3, 2008.

Acknowledgments: The authors thank the officials of the primary schools and hospitals for collaboration in the sample collection.

Financial support: Additional support was provided by an Ellison Medical Foundation grant to the Centre for Global Health, and by the Pfizer Initiative in International Health, University of Virginia, Charlottesville, VA.

Disclosure: R. Guerrant licensed fecal lactoferrin testing to TechLab. This statement is made in the interest of full disclosure and not because the author considers this a conflict of interest.

^* Address correspondence to Amidou Samie, MR-4 Building, Lane Rd, Room 3146, PO Box 801379, Charlottesville, VA 22908. E-mail: samieamidou{at}yahoo.com

Authors’ addresses: Amidou Samie, Jason Franasiak, Laurie Archbald-Pannone, Pascal Bessong, Cirle Alcantara-Warren, and Richard Guerrant, Department of Microbiology, University of Venda, Private Bag X5050, Thohoyandou 0950, Limpopo Province, South Africa, Tel: +27-15-962-8286, Fax: +27-15-962-8648, E-mail: samieamidou{at}yahoo.com. Chikwelu Obi, Academic and Research Directorate, Walter Sisulu University, Nelson Mandela Drive, Eastern Cape, South Africa.

Reprint requests: A. Samie, Department of Microbiology, University of Venda, Private Bag X5050, Thohoyandou 0950, Limpopo Province, South Africa, E-mail: samieamidou{at}yahoo.com.