Alexander J Keeley1, Nicholas J Beeching2, Katharine E Stott1, Paul Roberts3, Alastair J Watson4, Michael Bj Beadsworth5. 1. Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom. 2. Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom. 3. Department of Infection and Immunity, Royal Liverpool University Hospital, Liverpool, United Kingdom. 4. National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom. 5. Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Abstract
BACKGROUND: Clostridium difficile infection (CDI) causes a high burden of disease in high-resource healthcare systems, with significant morbidity, mortality, and financial implications. CDI is a healthcare-associated infection for which the primary risk factor is antibiotic usage, and it is the leading cause of bacterial diarrhoea in HIV-infected patients in the United States. Little is known about the disease burden of CDI in sub-Saharan Africa, where HIV and healthcare-associated infections are more prevalent and antibiotic usage is less restricted. This article reviews published literature on CDI in sub-Saharan Africa, highlighting areas for future research. METHODS: English language publications since 1995 were identified from online databases (PubMed, Medline, Google Scholar, and SCOPUS), using combinations of keywords "C. difficile", "Africa", and "HIV". RESULTS: Ten relevant studies were identified. There was considerable variation in the methodologies used to assess for carriage of toxigenic C. difficile and its associations. Eight studies reported carriage of toxigenic C. difficile. Three (of three) studies found an association with antibiotic usage. One (of four) studies showed an association with HIV infection. One study showed no association with degree of immunosuppression in HIV. Two (of three) studies showed an association between carriage of toxigenic C. difficile and diarrhoeal illness. CONCLUSIONS: While the carriage of toxigenic C. difficile is well described in sub-Saharan Africa, the impact of CDI in the region remains poorly understood and warrants further research.
BACKGROUND:Clostridium difficile infection (CDI) causes a high burden of disease in high-resource healthcare systems, with significant morbidity, mortality, and financial implications. CDI is a healthcare-associated infection for which the primary risk factor is antibiotic usage, and it is the leading cause of bacterial diarrhoea in HIV-infectedpatients in the United States. Little is known about the disease burden of CDI in sub-Saharan Africa, where HIV and healthcare-associated infections are more prevalent and antibiotic usage is less restricted. This article reviews published literature on CDI in sub-Saharan Africa, highlighting areas for future research. METHODS: English language publications since 1995 were identified from online databases (PubMed, Medline, Google Scholar, and SCOPUS), using combinations of keywords "C. difficile", "Africa", and "HIV". RESULTS: Ten relevant studies were identified. There was considerable variation in the methodologies used to assess for carriage of toxigenic C. difficile and its associations. Eight studies reported carriage of toxigenic C. difficile. Three (of three) studies found an association with antibiotic usage. One (of four) studies showed an association with HIV infection. One study showed no association with degree of immunosuppression in HIV. Two (of three) studies showed an association between carriage of toxigenic C. difficile and diarrhoeal illness. CONCLUSIONS: While the carriage of toxigenic C. difficile is well described in sub-Saharan Africa, the impact of CDI in the region remains poorly understood and warrants further research.
Authors: Christopher R Polage; Clare E Gyorke; Michael A Kennedy; Jhansi L Leslie; David L Chin; Susan Wang; Hien H Nguyen; Bin Huang; Yi-Wei Tang; Lenora W Lee; Kyoungmi Kim; Sandra Taylor; Patrick S Romano; Edward A Panacek; Parker B Goodell; Jay V Solnick; Stuart H Cohen Journal: JAMA Intern Med Date: 2015-11 Impact factor: 21.873
Authors: Amit S Chitnis; Stacy M Holzbauer; Ruth M Belflower; Lisa G Winston; Wendy M Bamberg; Carol Lyons; Monica M Farley; Ghinwa K Dumyati; Lucy E Wilson; Zintars G Beldavs; John R Dunn; L Hannah Gould; Duncan R MacCannell; Dale N Gerding; L Clifford McDonald; Fernanda C Lessa Journal: JAMA Intern Med Date: 2013-07-22 Impact factor: 21.873
Authors: Micah O Oyaro; Kimberly Plants-Paris; Dayna Bishoff; Paul Malonza; Christopher S Gontier; Herbert L DuPont; Charles Darkoh Journal: Int J Infect Dis Date: 2018-06-28 Impact factor: 3.623