To the Editor—Clostridium difficile is an important cause of diarrhea in hospitals all over the world. It is among the most common organisms related to healthcare-associated infections in the United States and represents a serious public health concern. 1 Clinical manifestations of C. difficile infection (CDI) range from asymptomatic carriage, mild or moderate diarrhea, to fulminant colitis. 2

In the last 20 years, hypervirulent isolates of C. difficile have been increasingly reported, mostly in North America and Europe. 1 The main hypervirulent strain was named ribotype 027 (North American BI, NAP1/027). This epidemic strain was also reported in Asia, providing evidence of worldwide spread. 3 Patients infected with the 027 strain are 3 times more likely to have severe disease than those infected with non-027 strains. 4, 5 This finding was linked to increased production of A, B, and binary toxins, in association with a mutation in the gene regulating of the expression of these toxins, leading to overproduction. However, few studies have investigated the presence of hypervirulent strains of C. difficile in developing countries, particularly in Latin America. 6, 7 Here, we make the first report of the detection of the hypervirulent C. difficile strain in Brazil.