Abstract:

AIM: To report the first fatal case of a toxin A positive toxin B gene positive strain of Clostridium difficile that caused pseudomembraneous colitis in a patient living in Trinidad & Tobago.

Presentation of case: Patients admitted in a tertiary hospital with history of diarrhea were being investigated and reviewed. A case of a 47-year old Trinidadian of African descent presenting with diarrheal stool at a public hospital in Trinidad and Tobago. The identified patient had his stool sample analyzed using conventional and molecular microbiology procedures to identify the bacteria, toxins and genes produced by the microorganism. The antimicrobial susceptibility was also determined using agar dilutions according to CLSI guidelines.

DISCUSSION: The patient‘s stool sample produced positive results for Clostridium difficile toxin. The Quick Check Complete® kit demonstrated the production of toxin and the glutamate dehydrogenase enzyme. This strain exhibits the toxin A and B gene.

CONCLUSION: Clostridium difficile isolated from this patient revealed the presence of toxin A and B gene. This gave a 1266bp and 204bp DNA fragment corresponding to the toxin A and B gene respectively, based on the primers used. The isolated strain was resistant to meropenem, ampicillin, ceftriaxone, cefotaxime and ciprofloxacin. This organism seems to have been responsible for the formation of psuedomembranous colitis in the studied patient. Further research is needed on similarly detected strains, to better understand their significance in Inflammatory Bowel Diseases and their prevalence in our geographical location. 

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