Clostridium difficile toxin in adult inpatients in an urban hospital in Malawi: Associations with HIV status, CD4 count and diarrhoea

Clostridium difficile Infection (CDI) is the cause of substantial morbidity and mortality in the developed world. However, very little is known about the burden of CDI in sub-Saharan Africa where less antibiotic restriction, high HIV prevalence and greater impact from nosocomial infection mean the potential for a significant disease burden is great. Researchers investigated the prevalence of Clostridium difficile Toxin (CDT), assessing association with HIV, CD4 count and diarrhoea in medical in-patients in Malawi. In 206 patients tested for CDT, 28 (13.6%) were positive. No significant associations were seen with either diarrhoea or HIV. There was a non-statistically significant (p = 0.056) association between CD4 counts of <50 and CDT. The frequency and the clinical implications of CDI in both HIV positive and negative patients in sub-Saharan Africa, requires further assessment.