Clostridium difficile Associated Disease Clinical and Molecular Data

Introduction. A balanced microflora of the gastrointestinal tract plays a significant role in the protection of an organism. Dramatic changes may take place in the composition of normal microflora during antibacterial therapy, because part of sensitive microorganisms die and microflora detrimental to an organism proliferates there causing gastrointestinal tract disorders (7). C. difficile is an important agent causing gastrointestinal tract disorders. It may induce manifestations ranging from asymptomatic colonization of the gastrointestinal tract to severe diarrhea, pseudomembranous colitis, toxic megacolon, intestinal perforation, and death. All these severity levels are included in the term Clostridium difficile associated disease (CDAD). A patient at risk for C. difficile is an elderly person with a severe principal disease, who receives long-term inpatient treatment, has been receiving antibiotics, antacid and antiulcer agents for a long time, has had a gastrointestinal surgical intervention or any organ transplantation, which is always related to immune suppression (11). Aim of the study. Molecular typing of Latvian strains of C. difficile and clinical data analysis. Materials and methods. The research includes data collected during the time period from August 2006 to the end of 2008 from three Latvian hospitals. A pure culture of C. difficile bacteria was isolated and cultured from fecal material. Ribotyping was done by amplification of specific regions of the 16S and 23S RNA genes and amplification products were separated in 1.5% agarose gel. Results. Fecal samples of 500 patients having manifestations of clinical symptoms of CDAD were microbiologically and molecularly studied from August 2006 to the end of 2008. 130 samples were tcdA + tcdB + toxin-positive. Conclusions. All samples were cultured on agar in anaerobic conditions. As a result, 55 pure cultures were obtained. The average age of patients is 65 years. Women get infected more frequently than men. In 95% patients CDAD was induced by antibacterial therapy. In 86% cases, having received a positive response for C.difficile antibacterial therapy is changed. Disease development risk factors are previous antibacterial therapy, previous hospitalization, GIT manipulations and C.difficile infection in anamnesis. The biggest number of CDAD patients was found in Nephrology Department of P. Stradins Clinical University Hospital. A hypervirulent Cl.difficile ribotype 027 was not found in Latvia yet, bat 16 different ribotypes were determined using Bionumerics software. 4 of them are domineering ribotypes with 17, 14, 5 and 4 isolates in every group.