ABSTRACT
Clostridium difficile diarrhea is one of the most important health carerelated infections in the world, and is associated with significant morbidity and mortality with high economic costs. Treatment consists basically on the use of antibiotics. Metronidazole is the first-line agent. Vancomycin is reserved for more serious cases, or for patients who do not respond to treatment with metronidazole; however, there is a significant percentage of patients that can be refractory to the initial treatment or can have recurrences. For these cases a treatment option is fidaxomicin, but its use is limited due to high costs. In this context, an alternative treatment option is fecal transplant, which has proven to be highly effective in treatment of recurrent condition nonresponsive to traditional management. We present a case of a young female patient with a chronic renal failure in hemodialysis, with chronic diarrhea due to Clostridium difficile. This patient was treated at a public health facility in the south of Chile; in a site with difficult access to complex diagnostic techniques and new treatments. After non-response to management with traditional antibiotics and several months with diarrhea; the fecal transplantation was perform with a rapid and symptomatic improvement.
La diarrea por Clostridium difficile es una de las infecciones asociadas a atención en salud más importantes a nivel mundial, y está asociada a importante morbimortalidad y a elevados costos económicos. El tratamiento se basa en el uso de antibióticos, para lo que se utiliza metronidazol como agente de primera línea, y vancomicina, que se reserva para casos más graves, o pacientes que no responden al tratamiento con metronidazol; no obstante, existe un importante porcentaje de pacientes que pueden ser refractarios al tratamiento inicial o tener recurrencias. Para estos casos una opción de tratamiento es fidaxomicina, sin embargo, su uso está limitado por su elevado costo. En este contexto surge como alternativa el trasplante fecal, nueva alternativa que ha probado ser altamente eficaz en tratamientos de recidivas que no responden al manejo tradicional. A continuación se describe el caso de una paciente joven portadora de insuficiencia renal crónica en hemodiálisis, con diarrea crónica por Clostridium difficile, tratada en un centro del sistema público de salud del sur de Chile, centro con dificultades tanto para acceder a técnicas diagnósticas complejas, como a tratamientos de última generación. Luego de no responder al manejo antibiótico tradicional, tras meses con diarrea crónica, es sometida a trasplante fecal con rápida mejoría sintomática.
Subject(s)
Humans , Adult , Female , Feces/microbiology , Clostridium Infections/therapy , Transplantation , Biological Therapy , Clostridioides difficile , Microbiota , Metronidazole/therapeutic use , Vancomycin/therapeutic useABSTRACT
Mycophenolate mofetil (MMF) is an immunosupressor agent frequently used in patients after bone marrow or solid organ transplants. The most common adverse reactions of the drug are gastrointestinal, specially diarrhea and vomiting. We report a 53-year-old male, that received a heart transplant receiving immunosuppression with cyclosporine, mycophenolate mofetil and prednisone. Six months after the transplant, the patient started with diarrhea, anorexia and weight loss. A duodenal biopsy showed villous atrophy. Celiac disease and the presence of parasites were discarded. Mycophenolate mofetil was discontinued and one week later, diarrhea subsided. Two months later the patient was asymptomatic and recovered weight. A new duodenal biopsy showed absence of villous atrophy.
Subject(s)
Humans , Male , Middle Aged , Duodenum/pathology , Immunosuppressive Agents/adverse effects , Microvilli/pathology , Mycophenolic Acid/analogs & derivatives , Atrophy , Biopsy , Heart Transplantation/immunology , Kidney Transplantation/immunology , Mycophenolic Acid/adverse effectsABSTRACT
We report 4 episodes of mushroom poisoning that ocurred before 1986 and 1990 in the province of Malleco. 25 of 36 individuals who ingested the mushroom became ill; they had an acute gastroenteritis that was followed in 7 by an acute hepatitis and in 1 by a massive upper gastrointestinal bleeding. Three subjects with fulminant hepatic failure and the subject with the massive bleeding died. Amanita gemmata (strain described as toxic in Chile since 1967) was found in 2 episodes and Amanita sp in 1. The clinical picture is similar to that described for Amanita phaloides. The treatment is symptomatic but penicillin and silymarin may have an antitoxic action. The importance of warning the population about the existence of toxic mushrooms in Chile is emphasized