Contrasting incidence of Clostridium difficile and other enteropathogens in AIDS patients in London and Lusaka

Abstract

Diarrhoea is the most common gastrointestinal symptom of AIDS, affecting 50-90% of patients (CHUI &

OWEN, 1994). Common aetiological agents include

protozoa (Cyptosporidium parvum, Zsospora belli, micro- sporidia, Cyclospora cayetanensis, Giardia intestinalis),

bacteria (Mycobacterium avium-intracellulare, Salmonella spp., Shigella spp., Campylobacter jejune) and viruses (cytomegalovirus, adenovirus). Clostridium dz&ile is a Gram-positive spore-forming bacillus which has been identified as a source of exotoxins A and B (BARBLIT et al., 1994; POTHOUUKK, 1996; LYERLY et al., 1998), and which is an important cause ofnosocomial diarrhoea

often affecting debilitated patients (CAPPELL & PHILO- GENE, 1993). The most dramatic manifestation of the

disease is pseudo-membranous colitis but this is the severe end of a spectrum of clinical manifestations. C. difficile represents a threat to HIV-infected patients in

industrialized countries, usually those patients with ad- vanced immunodeficiency receiving multiple antibiotics

(CAPPELL & PHILOGENE, 1993; BARBUT etal., 1994; DEMARAIS et al., 1997; STARR et al., 1997). Whereas the epidemiology of C. d#cile has been well characterized in the Western countries this is not the case for sub-Saharan Africa. There has been only 1 report, from Kenya, in which C. difficile was not detected in stool samples of patients with AIDS-related diarrhoea (MWACHARI et al., 1998). We hypothesized that differences may exist in the

frequency with which C. dzscile and other enteropatho- gens are detected in Africa and industrialized countries.

To test this hypothesis we conducted a prospective study in Lusaka (Zambia) and compared our findings with a retrospective analysis from a London (UK) teaching hospital.