Clostridium perfringens type A & antibiotic associated diarrhoea.

ABSTRACT

BACKGROUND & OBJECTIVE: Clostridium perfringens type A (CPA) isolates produce lethal necrotizing antigens and the heat resistant forms of the organism are associated with pathogenic outcome in humans. CPA has also been implicated in antibiotic associated diarrhoea (AAD). We therefore undertook this study to investigate the presence of CPA in stool samples of patients with AAD in a tertiary care setting in north India. METHODS: A total of 285 stool samples obtained from patients suspected for Clostridium difficile aetiology were examined for the presence of CPA antigens. Four sets of reagents (CP-I, CP-II, CP-III and CP- IV) comprising latex beads coated with polyvalent immune sera to 17 serotypes of heat resistant CPA were used in the study. Agglutination reaction was carried out using the reagents with the stool supernatants. RESULTS: Of the 285 stool samples tested, 25 (8.77%) were positive for at least one or more of the four polyvalent sets. Briefly, 48 per cent were positive for all the four sets, 12 per cent for 3 sets, 28 per cent for 2 sets and 12 per cent for only one set, indicating the prevalence of multiple serotypes of CPA. Twenty three (92%) of the 25 positive samples came from patients who were on antibiotics. C. difficile toxin was also present in 9 of 25 (36%) of the samples positive for CPA antigens. INTERPRETATION & CONCLUSION: In our setting, CPA could thus be associated with AAD either by itself or in synergy with C. difficile infection. Assessment of true burden of CPA associated AAD would be required to take appropriate steps for its control in our country.