Enterotoxigenic Clostridium perfringens and sporadic diarrhoea: a study from an Indian tertiary care hospital

Abstract

Food-borne diseases present a growing health problem worldwide and over 200 different diseases are known to be transmitted by food (Bryan, 1982). Food safety has always been a very significant public health issue, but its global importance is not fully appreciated by many health authorities even now. In the United States, food-borne pathogens have been reported to cause 76 million cases and 5000 deaths each year (Mead et al., 1999). At present, the conventional means for diagnosing food-borne diarrhoea in the microbiology laboratory relies on the culture of bacteria from stool samples. Because there are many food-borne bacterial pathogens, such investigation is usually concentrated only on facultative bacteria. Analyses of food-borne anaerobic bacteria are not routinely performed due to difficulties in their isolation and identification. The role of Clostridium perfringens and its enterotoxin in food-borne diarrhoea is well known. More recently, C. perfringens enterotoxin has also been implicated as a cause of antibiotic-associated diarrhoea (Borriello et al., 1984), infectious diarrhoea (Larson & Borriello, 1988) and sporadic diarrhoea (Luzzi et al., 1998; Brett et al., 1992). So far no information exists on disease prevalence from our country, even though it is well established in the west. This prompted us to carry out a prospective study to determine the role of enterotoxigenic C. perfringens in patients with sporadic, apparently non-food-related, diarrhoea in the Indian population using a duplex PCR and to type the isolates by multiplex PCR.