PREVALENCE OF CLOSTRIDIUM-DIFFICILE AND T OXIN-A IN FECAL SAMPLES OF HIV-INFECTED PATIENTS

Patients with AIDS are immunodeficient, receive multiple antibiotic tr eatments, occasionally anti-cancer chemotherapy and are often hospital ised ; thus they are susceptible to develop a Clostridium difficile in fection. The aim of this study was to evaluate the role of C. difficil e in diarrhoea in this patient population. Therefore, C. difficile and toxin A which plays a major role in pathogenicity were examined in fa ecal samples of HIV infected patients. Between January 1991 and June 1 992, 102 stool samples from 67 patients were studied. Ninety p. cent o f these patients were hospitalised (length > 3 days), 80 % had a diagn osis of AIDS stage IV, and 66 % had diarrhoea. Nineteen point four p. cent of the patients were carriers of C. difficile. Different associat ions were found : 1) presence of non toxigenic strains and absence of toxin A in stool samples (6 patients), 2) presence of toxigenic strain s and absence of toxin A in stool samples (6 patients), 3) presence of toxigenic strains and toxin A in stool samples (2 patients). None of the patients developed a colitis or pseudomembranous colitis. The carr ier rate was identical to those found in other hospitalised population s without AIDS. The prevalence of C. difficile diarrhoea or colitis is low. In this study, AIDS patients do not seem to constitute a risk gr oup for C. difficile intestinal pathology. However, carriers of C. dif ficile were subjected to strict hygiene rules to prevent nosocomial sp read.