Environmental Sources Clostridium difficile in Lagos State, Nigeria

Abstract

Clostridium difficile is the pathogen responsible for antibiotic-associated pseudo-membraneous colitis (diarrhea), which can be as a result of the use of broad spectrum antibiotics (such as ampicillin, clindamycin and the cephalosporins). These antibiotics can wipe away part of the normal intestinal flora allowing the pathogenic Clostridium difficile that is sometimes present to super infect the colon. When it grows in abundance, it releases its exotoxins. Toxin A causes diarrhea, and Toxin B is cytotoxic to the colonic cells. Clostridium difficile is known to cause severe diarrhea, abdominal cramping and fever. In this study, a total of 480 environmental samples were collected. Soil (100), Water (100), Vegetables (100), Animal Faeces (100) and the Hospital environment (80). Using Brazier CCEY Agar, Clostridium difficile spores were only found in the hospital setting examined. Seven (7) out of the Sixty (60) samples examined from the Medical Wards as well as three (3) out of the twenty (20) Intensive Care Unit (ICU) samples were C. difficile positive. In the medical wards, the areas examined are the patient bed sheet, bed railings, table top, toilets and windows. From the ICU, the spores were found on the drip stand, table tops and patient beds. Clostridium difficile was not isolated from Soil, Water, Vegetables and Animal Faeces but other species was isolated from them. This suggests that C. difficile is more easily isolated in the hospital environment than the community. Therefore, more samples are still needed to be examined in more locations and other sources within the hospital as well as the community so as to improve our understanding about the ecology of C. difficile transmission.