High Clostridium difficile Infection among HIV-Infected Children with Diarrhea in a Tertiary Hospital in Mwanza, Tanzania

Clostridium difficilecauses a million of illnesses each year worldwide and can affect people of all ages. Limited data exist on the prevalence ofC.difficileinfections (CDI) among children below five years of age in developing countries. This study is aimed at determining the prevalence, associated factors, and outcome of theClostridium difficileinfection among children with diarrhea attending a tertiary hospital in Mwanza, Tanzania. Stool samples were collected and cultured anaerobically to isolateClostridium difficile, followed byC.difficiletoxin A and B assay and ribotyping. A total of 301 children with diarrhea were enrolled. A total of 22 (7.31%, 95% CI: 0.89-0.95) nonrepetitive stool samples were positive forClostridium difficile. Eighteen (81%) ofC.difficileisolates were toxigenic, and 16 (72.7%) had unknown ribotypes. Independent predictors of positiveC.difficilewere as follows: positive HIV status, hospital stay of more than four days, high stool leukocyte count, and watery stool.Clostridium difficile-positive children had significantly higher median duration of the diarrhea than those withoutC.difficile. Clinicians should considerC.difficileas a possible cause of diarrhea in children living in developing countries and institute appropriate management to prevent associated morbidities and mortalities. Furthermore, there is a need of joint effort to improveC.difficilediagnosis and surveillance in developing countries to establish the unknown epidemiology of CDI in these countries.