ABSTRACT
Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence.
Subject(s)
Aged , Female , Humans , Abdominal Pain , Anti-Bacterial Agents , Clostridioides difficile , Colon , Colonoscopes , Colonoscopy , Diarrhea , Dysbiosis , Enterocolitis, Pseudomembranous , Feces , Follow-Up Studies , Metronidazole , Microbiota , Mortality , Opportunistic Infections , Recurrence , Tissue Donors , VancomycinABSTRACT
BACKGROUND: Cancer is the second cause of childhood death following accident, and leukemia is the most frequent childhood cancer in Korea. For the desirable control of childhood leukemia, of which the mortality is still high, the basic data for the incidence has a great importance. This is the second report from the data during 1991~1995 following the first one that analyzed the data from 328 cases of childhood leukemia during 1981~1990 in the same area, Pusan city, Korea. METHODS: The data were obtained from 138 new cases(84 males and 54 females from 0 to 15 years old) of childhood leukemia who had been living in the city of Pusan and were admitted to the 4 university hospitals and 11 general hospitals from 1991 to 1995. The cases were confirmed by CBC and bone marrow examination. RESULTS: The crude annual incidence rate per 100,000 population varied 1.50~5.30, 2.59~6.00 and 1.58~2.61 in the age group of 0~4 years, 5~9 years and 10~14 years, respectively. The standardized annual incidence rate per 100,000 population varied from 2.05 to 3.46(male 2.96~4.89, female 0.98~3.57). Sex ratio(male to female) was 1.58:1, 1.44:1, and 1.82:1 in total cases, ALL and AML, respectively, while incalculable in CML. By the major types of childhood leukemia, the cases were composed of 105 ALL (76.1%), 31 AML(22.5%), 2 CML(1.4%). CONCLUSION: It was concluded that the annual incidence rate of childhood leukemia per 100,000 population in Pusan city during 1991~1995 was similar to that of previous report during 1981~1990, while the proportion of ALL had tendency to increase up to that of United States, in contrast to the low proportions of ALL in the previous reports.
Subject(s)
Female , Humans , Male , Bone Marrow Examination , Hospitals, General , Hospitals, University , Incidence , Korea , Leukemia , Mortality , United StatesABSTRACT
Clinical analysis of 170 patients with childhood leukemia was made, who were admitted to the department of Pediatrics, Pusan Paik Hospital, Inje University, College of Medicine during 10 years from 1981 to 1990. The results were as follows: 1) The annual number of the patients with childhood leukemia was in the range of 6~25 cases. And the annual rate of the number of the patients in the department of the Pediatrics was 0.37~1.60% with the average of 1.06%. 2) Of the 170 patients, 72 cases(42.3%) were in the range of 0~5 years of age, which was the largest age group. In male, of the 97 patients, the largest age group was the age group of 0~5 years, which included 45 cases (46.4%), while in female, the largest was that of 6~10 years, which included 29 cases of 73 patients (39.8%). 3) Of the 170 patients, sex ratio was 1.33:1 with male dominance in all age groups except 1:1.6 with female dominance in the age group of 6~10 years. 4) Of the 170 patients, 113 cases were ALL (66.5%), 50 cases AML (29.4%), and 7 cases CML (4.1%). 5) In ALL, 51 cases of the 113 patients (45.1%), were in the age group of 0~5 years, 35 cases (31%) in the age group of 6~10 years, and 27 cases (23.9%) in the age group of 11~15 years. In AML, 19 cases of the 50 patients (38.0%) were in the age group of 0~5 years, 17 cases (34%) in the age group of 6~10 years, and 14 cases (28%) in the age group of 11~15 years. 6) In ALL, the sex ratio of male: female was 1.21:1, 1,50:1 in AML, and 2.5:1 in CML. 7) According to the FAB classification in ALL, of the 113 patients, 72 cases (63,7%) were in L1 type, 34 cases (30.0%) in L2 type, and only 3 cases in L3 type. In AML, of the 50 patients, 19 cases (38%) were in M2 type, 16 cases (32%) in M1 type, and 6 cases (12%) in M4 type, in order. 8) In CML, of the 7 patients, 4 cases were juvenile type, who were all under 10 years old, while 3 cases were adult type, who were all male above 11 years old. 9) Of the 170 patients, clinical symptoms on admission were pallor in 112 cases (65.9%), fever in 84 cases (49.4%), hemorrhage in 78 cases (45.9%), weakness in 40 cases (25.3%), bone pain in 32 cases (18.8%) in order. 10) Of the 170 patients, physical findings on admission were hepatomegaly in 113 cases (66.5%), lymphnode swelling in 84 cases (49.4%), splenomegaly in 78 cases (45,9%)in order. 11) Of the 170 patients, the hemoglobin level on admission were 4~7gm/dl in 95 cases (55.9%), 8~10gm/dl in 42 cases (24.7%), and 0~3gm/dl in 22 cases (12.9%) in order. 12) Of the 170 patients, the WBC count on admission were 10,000~50,000/mm3 in 58 cases (34.1%), below, 5,000/mm3 in 49 cases (28.8%), and 5,5000~100,000/mm3 in 24 cases (14.1%) in order. 13) Of the 170 patients, the platelet count on admission were below 50,000/mm3 in 93 cases (54,7%), above 100,000/mm3 in 48 cases (28.2%), 20,000~50,000/mm3 in 43 (25,3%), 43 cases (25,3%), and 50,000~100,000/mm3 in 29 cases (17.1%) in order.