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Journal of Clinical Microbiology
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Epidemiology

High Prevalence of Toxigenic and Nontoxigenic Clostridium difficile Strains in Malaysia

Thomas V. Riley, Deirdre A. Collins, Rina Karunakaran, Maria Abdul Kahar, Ariza Adnan, Siti Asma Hassan, Nadiah Hanim Zainul, F. R. Mohammed Rustam, Z. Abd Wahab, Ramliza Ramli, Yeong Yeh Lee, Hamimah Hassan
Andrew B. Onderdonk, Editor
Thomas V. Riley
aSchool of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
bDepartment of Microbiology, PathWest Laboratory Medicine, Nedlands, Australia
cSchool of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
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Deirdre A. Collins
aSchool of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
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Rina Karunakaran
dDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Maria Abdul Kahar
dDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Ariza Adnan
dDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Siti Asma Hassan
eSchool of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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Nadiah Hanim Zainul
eSchool of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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F. R. Mohammed Rustam
fFaculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
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Z. Abd Wahab
gSungai Buloh Hospital, Sungai Buloh, Malaysia
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Ramliza Ramli
hDepartment of Microbiology and Immunology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Yeong Yeh Lee
eSchool of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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Hamimah Hassan
dDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Andrew B. Onderdonk
Brigham and Women's Hospital
Roles: Editor
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DOI: 10.1128/JCM.00170-18
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ABSTRACT

Accumulating evidence shows a high prevalence of Clostridium difficile in Southeast Asia associated with a range of clinical presentations. However, severe infections are rarely reported. We investigated C. difficile infection (CDI) across four hospitals in Kuala Lumpur and Kota Bharu, Malaysia. Enzyme immunoassays for glutamate dehydrogenase (GDH) and toxin A or B were performed on diarrheal stool specimens collected from patients in 2015 and 2016. Specimens were also cultured and isolates of C. difficile characterized by PCR ribotyping and detection of toxin genes. In total, 437 specimens were collected and fecal toxin was detected in 3.0%. A further 16.2% of specimens were GDH positive and toxin negative. After culture, toxigenic strains were isolated from 10.3% and nontoxigenic strains from 12.4% of specimens. The most prevalent PCR ribotypes (RTs) were RT 017 (20.0%) and RT 043 (10.0%). The high prevalence of RT 017 and nontoxigenic strains in Malaysia and in neighboring Thailand and Indonesia suggests that they localize to the region of Southeast Asia, with an implication that they may mediate the burden of CDI in the region.

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High Prevalence of Toxigenic and Nontoxigenic Clostridium difficile Strains in Malaysia
Thomas V. Riley, Deirdre A. Collins, Rina Karunakaran, Maria Abdul Kahar, Ariza Adnan, Siti Asma Hassan, Nadiah Hanim Zainul, F. R. Mohammed Rustam, Z. Abd Wahab, Ramliza Ramli, Yeong Yeh Lee, Hamimah Hassan
Journal of Clinical Microbiology May 2018, 56 (6) e00170-18; DOI: 10.1128/JCM.00170-18

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High Prevalence of Toxigenic and Nontoxigenic Clostridium difficile Strains in Malaysia
Thomas V. Riley, Deirdre A. Collins, Rina Karunakaran, Maria Abdul Kahar, Ariza Adnan, Siti Asma Hassan, Nadiah Hanim Zainul, F. R. Mohammed Rustam, Z. Abd Wahab, Ramliza Ramli, Yeong Yeh Lee, Hamimah Hassan
Journal of Clinical Microbiology May 2018, 56 (6) e00170-18; DOI: 10.1128/JCM.00170-18
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KEYWORDS

Clostridium difficile
Malaysia
epidemiology
prevalence

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