Epidemiology of Clostridium difficile infection in Asia

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Abstract

While Clostridium difficile infection (CDI) has come to prominence as major epidemics have occurred in North America and Europe over the recent decade, awareness and surveillance of CDI in Asia have remained poor. Limited studies performed throughout Asia indicate that CDI is also a significant nosocomial pathogen in this region, but the true prevalence of CDI remains unknown. A lack of regulated antibiotic use in many Asian countries suggests that the prevalence of CDI may be comparatively high. Molecular studies indicate that ribotypes 027 and 078, which have caused significant outbreaks in other regions of the world, are rare in Asia. However, variant toxin A-negative/toxin B-positive strains of ribotype 017 have caused epidemics across several Asian countries. Ribotype smz/018 has caused widespread disease across Japan over the last decade and more recently emerged in Korea. This review summarises current knowledge on CDI in Asian countries.

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Emerging infectious diseases in southeast Asia: regional challenges to control

Richard Coker, Benjamin Hunter, James W Rudge … (2011)

Summary Southeast Asia is a hotspot for emerging infectious diseases, including those with pandemic potential. Emerging infectious diseases have exacted heavy public health and economic tolls. Severe acute respiratory syndrome rapidly decimated the region's tourist industry. Influenza A H5N1 has had a profound effect on the poultry industry. The reasons why southeast Asia is at risk from emerging infectious diseases are complex. The region is home to dynamic systems in which biological, social, ecological, and technological processes interconnect in ways that enable microbes to exploit new ecological niches. These processes include population growth and movement, urbanisation, changes in food production, agriculture and land use, water and sanitation, and the effect of health systems through generation of drug resistance. Southeast Asia is home to about 600 million people residing in countries as diverse as Singapore, a city state with a gross domestic product (GDP) of US$37 500 per head, and Laos, until recently an overwhelmingly rural economy, with a GDP of US$890 per head. The regional challenges in control of emerging infectious diseases are formidable and range from influencing the factors that drive disease emergence, to making surveillance systems fit for purpose, and ensuring that regional governance mechanisms work effectively to improve control interventions.

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Clinical Clostridium difficile: Clonality and Pathogenicity Locus Diversity

Kate E. Dingle, David W. Griffiths, Xavier Didelot … (2011)

Clostridium difficile infection (CDI) is an important cause of mortality and morbidity in healthcare settings. The major virulence determinants are large clostridial toxins, toxin A (tcdA) and toxin B (tcdB), encoded within the pathogenicity locus (PaLoc). Isolates vary in pathogenicity from hypervirulent PCR-ribotypes 027 and 078 with high mortality, to benign non-toxigenic strains carried asymptomatically. The relative pathogenicity of most toxigenic genotypes is still unclear, but may be influenced by PaLoc genetic variant. This is the largest study of C. difficile molecular epidemiology performed to date, in which a representative collection of recent isolates (n = 1290) from patients with CDI in Oxfordshire, UK, was genotyped by multilocus sequence typing. The population structure was described using NeighborNet and ClonalFrame. Sequence variation within toxin B (tcdB) and its negative regulator (tcdC), was mapped onto the population structure. The 69 Sequence Types (ST) showed evidence for homologous recombination with an effect on genetic diversification four times lower than mutation. Five previously recognised genetic groups or clades persisted, designated 1 to 5, each having a strikingly congruent association with tcdB and tcdC variants. Hypervirulent ST-11 (078) was the only member of clade 5, which was divergent from the other four clades within the MLST loci. However, it was closely related to the other clades within the tcdB and tcdC loci. ST-11 (078) may represent a divergent formerly non-toxigenic strain that acquired the PaLoc (at least) by genetic recombination. This study focused on human clinical isolates collected from a single geographic location, to achieve a uniquely high density of sampling. It sets a baseline of MLST data for future comparative studies investigating genotype virulence potential (using clinical severity data for these isolates), possible reservoirs of human CDI, and the evolutionary origins of hypervirulent strains.

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Meat products and consumption culture in the East.

Ki-Chang Nam, Cheorun Jo, Mooha Lee (2010)

Food consumption is a basic activity necessary for survival of the human race and evolved as an integral part of mankind's existence. This not only includes food consumption habits and styles but also food preparation methods, tool development for raw materials, harvesting and preservation as well as preparation of food dishes which are influenced by geographical localization, climatic conditions and abundance of the fauna and flora. Food preparation, trade and consumption have become leading factors shaping human behavior and developing a way of doing things that created tradition which has been passed from generation to generation making it unique for almost every human niche in the surface of the globe. Therefore, the success in understanding the culture of other countries or ethnic groups lies in understanding their rituals in food consumption customs. Meat consumption culture in the East has not been well developed by its characteristic environment, religion, history, and main food staples. However, recently, the amount of meat production and consumption of the Eastern countries has grown rapidly by the globalization of food industry and rapid economic growth of the countries. This manuscript introduces meat-based products and consumption culture in Asian countries. However, because the environments and cultures within Asia are too diverse to cover all food cultures, this manuscript focused mainly on three northeast Asian countries including China, Japan, and Korea (Republic of) and some southeast Asian countries including Vietnam and Thailand, which have similar environments and cultural interactions historically but retain their own characteristic food culture.

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Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central

ISSN (Electronic): 2047-2994

Publication date Collection: 2013

Publication date (Electronic): 1 July 2013

Volume: 2

Page: 21

Affiliations

[1 ]Microbiology and Immunology, School of Pathology and Laboratory Medicine, the University of Western Australia, Perth, Australia

[2 ]West Midlands Public Health Laboratory, Health Protection Agency, Heart of England NHS Foundation Trust, Birmingham, UK

[3 ]School of Immunity and Infection, University of Birmingham, Birmingham, UK

[4 ]Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine (WA), Perth, Australia

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Publisher ID: 2047-2994-2-21

DOI: 10.1186/2047-2994-2-21

PMC ID: 3718645

PubMed ID: 23816346

SO-VID: 42da8303-c153-4e48-a548-1ff6119e8afc

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Epidemiology of Clostridium difficile infection in Asia

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Most cited references 63

Emerging infectious diseases in southeast Asia: regional challenges to control

Clinical Clostridium difficile: Clonality and Pathogenicity Locus Diversity

Meat products and consumption culture in the East.

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