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An Unusual Case of Clostridium difficile Infection in Trinidad and Tobago

Lemar Blake, Patrick Eberechi Akpaka, Adash Ramsubahag, Renea Ali and Asongna T. Folefoc

Clostridium difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. Psuedomembraneous colitis is a major complication of CDI and its outbreaks with increased severity and mortality has been reported. In this study we report the first fatal case of a toxin A and B gene positive strain of C. difficile associated with pseudomembraneous colitis in a patient from Trinidad and Tobago. Patients admitted to tertiary hospitals with history of diarrhea were investigated and reviewed. A fatal case of a 47-year old Trinidadian of African descent who presented with diarrheal stool at a public hospital in Trinidad and Tobago was reviewed and is being reported. The identified patient had his stool sample analyzed using conventional and molecular microbiology procedures to identify the C. difficile bacteria, toxins and genes. The antimicrobial susceptibility profile was also determined using agar dilutions according to CLSI guidelines.This patient’s stool sample was positive for Clostridium difficile toxin and the enzyme glutamate dehydrogenase which were demonstrated using the Quick Check Complete® kit. The antimicrobial susceptibility test produced an unusual profile - being resistant to meropenem, ampicillin, ceftriaxone, cefotaxime and ciprofloxacin. PCR analysis demonstrated that the strain produced a 1266bp and 204bp DNA fragment corresponding to the toxin A and B gene respectively, based on the primers used. This organism was noted to be responsible for the development of psuedomembranous colitis that led to the demise of this patient. Surveillance work need to be instituted as well as antibiotics stewardship so as to prevent any more case of inflammatory bowel diseases prevalence in our country.