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1.
Arq. gastroenterol ; 60(3): 330-338, July-Sept. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1513704

ABSTRACT

ABSTRACT Background: Clostridioides difficile infection (CDI) is a potentially severe disease that can present with refractoriness, recurrence, and evolution to death. In Brazil, the epidemiology of CDI seems to differ from that of the United States and most European countries, with only one ribotype (RT) 027-related case and a high prevalence of RT106. Objective: The aim of this study was to evaluate the outcomes of CDI and its possible association with ribotypes at a university hospital in Brazil. Methods: A total of 65 patients with CDI were included and stool samples were submitted to A/B toxin detection and toxigenic culture, and toxigenic isolates (n=44) were also PCR ribotyped. Results: Patients' median age was 59 (20-87) years and there were 16 (24.6%) deaths. The median Charlson comorbidity index (CCI) was 4 (0-15) and 16.9% of the patients had CCI ≥8. The ATLAS score and non-improvement of diarrhea were related to higher mortality. A longer length of hospitalization was related to the enteral nutrition and use of multiple antibiotics. The period between CDI diagnosis and hospital discharge was longer in those who received new antibiotics after diagnosis, multiple antibiotics, and required intensive care treatment. Recurrence was associated with CCI >7. Twenty ribotypes were identified and RT106 was the most frequently detected strain (43.2%). No relationship was observed between the ribotypes and outcomes. CDI was present in patients with more comorbidities. Conclusion: Risk factors for higher mortality, longer hospital stay and recurrence were identified. A diversity of ribotypes was observed and C. difficile strains were not related to the outcomes.


RESUMO Contexto: A infecção pelo Clostridioides difficile (ICD) é uma doença potencialmente grave que pode se apresentar com refratariedade, recidiva e evoluir para óbito. No Brasil, a epidemiologia da ICD parece diferir da dos Estados Unidos e da maioria dos países europeus, com apenas um caso relacionado ao ribotipo (RT) 027 e alta prevalência do RT106. Objetivo: Avaliar os desfechos da ICD e sua possível associação com ribotipos em um hospital universitário do Brasil. Métodos: Um total de 65 pacientes com ICD foram incluídos e amostras de fezes foram submetidas à detecção de toxina A/B e cultura toxigênica e as cepas toxigênicas isoladas (n=44) também foram ribotipadas por PCR. Resultados: A idade mediana dos pacientes foi de 59 (20-87) anos e houve 16 (24,6%) óbitos. A mediana do índice de comorbidade de Charlson (ICC) foi de 4 (0-15) e 16,9% dos pacientes apresentaram ICC ≥8. O escore ATLAS e a não melhora da diarreia foram relacionados a maior mortalidade. Maior tempo de internação esteve relacionado à nutrição enteral e ao uso de múltiplos antibióticos. O período entre o diagnóstico de ICD e a alta hospitalar foi maior naqueles que receberam novos antibióticos após o diagnóstico, múltiplos antibióticos e necessitaram de tratamento intensivo. A recorrência foi associada com ICC >7. Vinte ribotipos foram identificados e o RT106 foi a cepa mais frequentemente detectada (43,2%). Não foi observada relação entre os ribotipos e os desfechos. ICD esteve presente em pacientes com mais comorbidades. Conclusão: Foram identificados fatores de risco para maior mortalidade, maior tempo de internação e recorrência. Uma diversidade de ribotipos foi observada e cepas de C. difficile não foram relacionadas aos desfechos.

2.
Hist. ciênc. saúde-Manguinhos ; 27(3): 859-878, set. 2020.
Article in Portuguese | LILACS | ID: biblio-1134074

ABSTRACT

Resumo Em 1958, Eiseman e colaboradores publicaram o primeiro artigo científico relatando o uso de transplante de microbiota fecal para tratar casos graves de colite pseudomembranosa. A relevância desse trabalho inovador só foi reconhecida em 1990. A literatura acadêmica sobre o tema caracteriza-se por sucessivas reconstruções. Sugerimos que tais reconstruções foram orientadas por questões de atribuição de prioridade de descoberta científica nos termos propostos por Merton. A retomada do uso de transplantes de microbiota fecal é interpretada como processo de gênese de um fato científico, conforme Fleck: ocorre a mudança de um estilo de pensamento baseado no uso de antibióticos no tratamento de doenças infecciosas para outro que considera as relações ecológicas entre hospedeiros, vetores e agentes etiológicos de doenças.


Abstract In 1958, Eiseman and contributors published the first scientific paper reporting the use of fecal microbiota transplant for treating pseudomembranous colitis. The relevance of this innovative paper was only acknowledged in 1990. The academic literature on the theme is characterized by a narrative that has undergone successive revisions. We suggest that such revisions were based on claims of priority of scientific discoveries, as described by Merton. The revival of fecal microbiota transplants is interpreted as a process of genesis of a scientific fact, as defined by Fleck: there is a switch from a thought style based on the use of antibiotics to treat infectious diseases to another that accepts the ecological relations between hosts, vectors and parasites.


Subject(s)
Humans , History, 20th Century , History, 21st Century , Enterocolitis, Pseudomembranous/history , Fecal Microbiota Transplantation/history , Enterocolitis, Pseudomembranous/microbiology , Enterocolitis, Pseudomembranous/therapy , Gastrointestinal Microbiome , Historiography
3.
Kasmera ; 45(2): 100-106, jul-dic 2017. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1007264

ABSTRACT

Clostridium difficile es un bacilo Gram positivo esporulado, anaerobio estricto, resistente a condiciones adversas y transmitido por vía oral-fecal, se describió por primera vez en 1930; sin embargo, se asoció a enfermedad en humanos en la década de los setenta al identificarse como agente causal de colitis pseudomembranosa. Esta infección se ha relacionado con diversas manifestaciones clínicas que van desde diarrea sin complicaciones hasta sepsis e incluso la muerte. Se presenta un caso clínico de un paciente masculino de 1 año 8 meses, con antecedentes de hipertermia y deposiciones líquidas abundantes, tras varios días de tratamiento antibiótico los síntomas se incrementaron con eliminación de resto membranoso en heces, se refiere a un hospital; donde se realiza el estudio de toxinas de Clostridium difficile, resultando positivo, por lo cual, se establece el diagnostico de colitis pseudomembranosa. Se administra metronidazol y vancomicina por 7 días, con una evolución favorable. El uso de antibióticos es un factor predisponente de colitis pseudomembranosa por la afectación de la microbiota intestinal; además de la estancia hospitalaria y factores intrínsecos. En la literatura se describe un número reducido de estudios sobre esta infección en pacientes pediátricos de allí la importancia del reporte de caso.


Clostridium difficile is a bacillus Gram positive and spore form, anaerobic strictly, resistant to adverse conditions and transmitted by oral - fecal route, it was described by the first time in 1930, nevertheless it's has been associated to disease in human beings in the decade of the seventies it identified as causal agent of pseudomembranous colitis. Its infection has related to diverse clinical manifestations such as diarrhea without complications, which lead to sepsis and inclusive the death. In the following clinical case we have a male infant 1 year old and 18 months patient, with precedents of hyperthermia and liquid depositions, after several days of antibiotics treatment, the symptoms increased with elimination of membranous rest in the faeces; reason why he is transferred to a hospital, in which the Clostridium difficile toxins test is realized, yielding positive results, therefore the diagnosis of pseudomembranous colitis is established metronidazole and vancomycin is given for 7 days having a favorable development. The use of antibiotics is a predisposing factor of pseudomembranous colitis for the affectation of the intestinal microbiota, in addition hospital stays and intrinsic factors. The literature describes a limited number of studies about this infection in pediatric patients, hence the importance of the case report

4.
Med. leg. Costa Rica ; 34(1): 265-271, ene.-mar. 2017. tab
Article in Spanish | LILACS | ID: biblio-841452

ABSTRACT

Resumen:La infección por Clostridium difficile es la principal causa de diarrea infecciosa en pacientes hospitalizados. Los pacientes pueden ser portadores asintomáticos o presentar desde una diarrea leve a una colitis pseudomembranosa, megacolon tóxico, sepsis y muerte. El manejo de esta infección sigue presentando puntos de controversia, tanto en la elección del mejor método diagnóstico como en el tratamiento. En los casos en los cuales la infección por este agente fue confirmada la primera y más efectiva medida es suspender la antibioticoterapia que el paciente este recibiendo, en la medida de lo posible. El tratamiento se basa en tres agentes clásicos: metronidazol, vancomicina y teicoplanina con la más reciente adición de fidaxomicina y ridinilazol. Pacientes con presentación severa muchas veces requieren resolución quirúrgica además de las medidas de soporte y monitoreo. El objetivo de esta revisión es ofrecer información actualizada sobre la patogénesis y estrategias terapéuticas sobre el manejo de la infección por este patógeno.


Abstract:Clostridium difficile infection is the leading cause of hospital acquired diarrhea. The patients can be asymptomatic carriers or present a mild diarrhea, a pseudomembranous colitis, toxic megacolon, sepsis and death. There is controversy in this infection's including the best method of diagnosis and also regarding therapeutic regimen.In cases in which Clostridium infection is confirmed, the first and most effective measure is the withdrawal of any antibiotic treatment the patient is receiving, if possible. The antimicrobial treatment is based on three classic agents: metronidazole, vancomycin and teicoplanin, along with the recent addition of fidaxomicin and ridinilazol.Patients presenting serious symptoms, in addition to appropriate support and monitoring measures, may require surgical treatment. This review's aim is to provide an update on the pathogenesis, and therapeutic strategies on the management of this pathogen.


Subject(s)
Humans , Enterocolitis, Pseudomembranous , Vancomycin/therapeutic use , Clostridioides difficile/virology , Clostridium Infections , Teicoplanin/therapeutic use , Colitis , Diarrhea , Dysentery , Metronidazole/therapeutic use
5.
Med. intensiva ; 34(2): [1-5], 2017. tab, ilus
Article in Spanish | LILACS | ID: biblio-883448

ABSTRACT

La colitis seudomembranosa es una patología relacionada con el uso de antibióticos. En raras ocasiones, evoluciona a megacolon tóxico que podría requerir resolución quirúrgica. Comunicamos el caso de una mujer de 22 años, que recibió amoxicilina/ácido clavulánico unos días antes de la consulta. Presentó diarrea, fiebre y vómitos. Radiografía y tomografía computarizada de abdomen: distensión de colon derecho >6 cm. Toxina para Clostridium: positiva. Comienza con el tratamiento médico y requiere cirugía por megacolon tóxico. El megacolon tóxico es una complicación infrecuente de la colitis seudomembranosa. Es rara en pacientes jóvenes y sin comorbilidades. Se llega al diagnóstico mediante los criterios de Jalan. La tasa de mortalidad se aproxima al 70%. Se debe mantener alto nivel de alerta ante signos de toxicidad sistémica y la dilatación colónica es diagnóstica de la entidad. El uso indiscriminado de antibióticos constituye un serio factor de riesgo.(AU)


Pseudomembranous colitis is a condition associated with the use of antibiotics. On rare occasions, it evolves to toxic megacolon which may require surgical resolution. We report the case of a 22-year-old woman who received amoxicillin/clavulanic acid a few days before the consultation. She referred diarrhea, fever and vomiting. Radiography and computed tomography of abdomen: distension of the right colon >6 cm. Clostridium toxin: positive. Medical treatment is administered and surgery is needed for toxic megacolon. Toxic megacolon is an infrequent complication of pseudomembranous colitis. It is rare in young patients without comorbidities. The diagnosis is reached using the Jalan criteria. The mortality rate approaches 70%. A high level of alertness should be maintained for signs of systemic toxicity and colonic dilation is diagnostic of the entity. Indiscriminate use of antibiotics is a serious risk factor.(AU)


Subject(s)
Humans , Enterocolitis, Pseudomembranous , Megacolon , Intensive Care Units , Anti-Bacterial Agents
6.
Article in English | IMSEAR | ID: sea-156182

ABSTRACT

A 14-year-old child with acute lymphoblastic leukemia who had completed induction chemotherapy presented with fever and diffuse musculoskeletal pains which was thought to be a constellation of myositis, arthralgias and arthritis. Investigations revealed initially showed normal peripheral blood counts but had pancytopenia and pre-terminally blasts were seen in the peripheral blood smear. He had bone marrow necrosis. Disseminated intravascular coagulation was suspected with a positive fungal serology. At autopsy, he had evidence of disease relapsed in lymph nodes, liver, spleen, testes and kidneys. There was extensive pseudomembranous colitis and appendicitis with changes of toxic megacolon.

7.
International Journal of Pediatrics ; (6): 146-148, 2015.
Article in Chinese | WPRIM | ID: wpr-475501

ABSTRACT

Pseudomembranous colitis occurred is closely related to the use of antibiotics and the pathogenic bacteria approximately 100% is clostridium difficile.Diagnosis is mainly based on clinical manifestations,stool culture,toxin detection,colonoscopy and/or histological examination.Once the diagnosis has been confirmed or highly suspected,the initial antibiotic therapy should be discontinued,add with metronidazole and/or vancomycin,supplement by probiotic and nutritional support.The recent years,new treatment options have been proposed.This article presents an review of the related situation of pseudomembranous colitis to improve the comprehension for clinical doctors.

8.
Chinese Journal of Microbiology and Immunology ; (12): 582-586, 2015.
Article in Chinese | WPRIM | ID: wpr-479163

ABSTRACT

Objective To investigate the therapeutic effects and the possible mechanism of fecal transplantation on rats with Clostridium difficile-associated pseudomembranous colitis. Methods A total of 40 Sprague-Dawley rats were divided into four groups including the healthy control group, model group, fecal transplant treatment group and vancomycin treatment group. Rats in three experimental groups were subcuta-neously injected with clindamycin phosphate (10 mg), followed by treatment with toxin producing Clostridi-um difficile (ACTT43255) enema 24 hours later. The rats in fecal transplant treatment group and vancomy-cin treatment group were respectively treated with fecal suspension and vancomycin one day after modeling. The rats were fasted for one day after the last administration and then executed. The levels of potassium ion ( K) , sodium ion ( Na) , albumin ( ALB) , white blood cells ( WBC) , C-reaction protein ( CRP) , interleu-kin-1β ( IL-1β) , interleukin-10 ( IL-10 ) , interleukin-12 ( IL-12 ) and interleukin-17 ( IL-17 ) as well as the percentage of neutrophils ( N%) in serum samples were detected. The colon tissue samples were collect-ed for pathology examination. Results The rat model of pseudomembranous colitis was successfully estab-lished by subcutaneous injection of clindamycin in combination with toxin-producing Clostridium difficile (ACTT43255) enema. The signs of intestinal inflammation including serious weight loss, remarkably short-ened colon length and significantly increased colon wet weight index were observed in rats from the model group (P<0. 05). Compared with the rats from model group, the rats received fecal transplant showed sig-nificantly increased levels of K, ALB, IL-10 and IL-10/IL-12 in serum and decreased levels of WBC, N%, CRP, IL-1β and IL-17 (P<0. 05). Conclusion Fecal transplantation was proved to be an effective ap-proach for the treatment of pseudomembranous colitis. The therapeutic mechanism might due to its impacts on serum inflammatory factors.

9.
The Ewha Medical Journal ; : 54-58, 2015.
Article in English | WPRIM | ID: wpr-57295

ABSTRACT

Pseudomembranous colitis (PMC) is a frequent cause of morbidity and mortality among hospitalized patients. Although diarrhea is the most common manifestation, PMC may be associated with intraperitoneal fluid accumulation in the severe cases. And a few cases showing both ascites and pleural effusion have been reported in patients with PMC. We report a case of PMC who showed elevated serum and ascites levels of carcinoembryonic antigen (CEA) with a normal CEA level in pleural effusion and who successfully recovered after oral administration of metronidazole. After treatment, the serum CEA level returned to the reference range.


Subject(s)
Humans , Administration, Oral , Ascites , Carcinoembryonic Antigen , Diarrhea , Enterocolitis, Pseudomembranous , Metronidazole , Mortality , Pleural Effusion , Reference Values
10.
Rev. Soc. Bras. Med. Trop ; 47(4): 447-450, Jul-Aug/2014. tab
Article in English | LILACS | ID: lil-722303

ABSTRACT

Introduction Despite the known importance of Clostridium difficile as a nosocomial pathogen, few studies regarding Clostridium difficile infection (CDI) in Brazil have been conducted. To date, the diagnostic tests that are available on the Brazilian market for the diagnosis of CDI have not been evaluated. The aim of this study was to compare the performances of four commercial methods for the diagnosis of CDI in patients from a university hospital in Brazil. Methods Three enzyme immunoassays (EIAs) and one nucleic acid amplification test (NAAT) were evaluated against a cytotoxicity assay (CTA) and toxigenic culture (TC). Stool samples from 92 patients with suspected CDI were used in this study. Results Twenty-five (27.2%) of 92 samples were positive according to the CTA, and 23 (25%) were positive according to the TC. All EIAs and the NAAT test demonstrated sensitivities between 59 and 68% and specificities greater than 91%. Conclusions All four methods exhibited low sensitivities for the diagnosis of CDI, which could lead to a large number of false-negative results, an increased risk of cross-infection to other patients, and overtreatment with empirical antibiotics. .


Subject(s)
Humans , Clostridioides difficile , Clostridium Infections/diagnosis , Diarrhea/microbiology , Immunoenzyme Techniques/methods , Nucleic Acid Amplification Techniques , Brazil , Bacterial Toxins/genetics , Bacterial Toxins/isolation & purification , Clostridioides difficile/genetics , Clostridioides difficile/immunology , Clostridioides difficile/isolation & purification , Feces/microbiology , Hospitals, University , Sensitivity and Specificity
11.
Ciênc. rural ; 44(5): 841-846, maio 2014. tab
Article in English | LILACS | ID: lil-707030

ABSTRACT

The objective of this study was to evaluate antimicrobial susceptibility in Clostridium difficile strains isolated from animals and humans in Brazil. The 54 C. difficile strains used were isolated from stool samples from piglets (n=16), dogs (n=13), humans (n=13), foals (n=8) calves (n=2), an ocelot (n=1) and a maned wolf (n=1). Antimicrobial susceptibility was determined using the serial plate agar dilution method for penicillin, florfenicol, oxytetracycline, erythromycin, vancomycin, metronidazole and tylosin. The C. difficile strains assessed were susceptible to metronidazole and vancomycin. Florfenicol resistance was rarely observed; 52 (96.4%) strains were sensitive to this antimicrobial. Five (9.3%), five (9.3%), 14 (25.9%) and 20 (37.0%) strains were resistant to oxytetracycline, penicillin, tylosin and erythromycin respectively.


O objetivo do presente trabalho foi avaliar a sensibilidade antimicrobiana de estirpes de Clostridium difficile isoladas de animais e humanos no Brasil. Foram utilizados 54 estirpes de C. difficile isoladas de fezes de leitões (n=16), cães (n=13), seres humanos (n=13), potros (n=8), bezerros (n=2), jaguatirica (n=1) e um lobo-guará (n=1). A sensibilidade antimicrobiana foi determinada pelo método de diluição seriada em ágar para penicilina, florfenicol, oxitetraciclina, eritromicina, vancomicina, metronidazol e tilosina. Todos os isolados foram sensíveis ao metronidazol e á vancomicina. Resistência ao florfenicol foi rara, sendo que 52 (96,4%) das estirpes foram sensíveis a esse antimicrobiano. Cinco (9,3%), cinco (9,3%), 14 (25,9%) e 20 (37,0%) foram resistentes a oxitetraciclina, penicilina, tilosina e eritromicina, respectivamente.

12.
Asian Pacific Journal of Tropical Medicine ; (12): S6-S13, 2014.
Article in Chinese | WPRIM | ID: wpr-951690

ABSTRACT

Clostridium difficile is a Gram-positive, strictly anaerobic, spore-forming bacterium. It is the most common cause of antibiotic-associated diarrhea in hospitals and other healthcare facilities and is of significant concern because of the increasing morbidity and mortality rates as well as increased health care costs. Spectrum of presentation of Clostridium difficile infection ranges from mild, self-limiting diarrhea, to serious diarrhea, pseudomembranous colitis and life-threatening fulminant colitis, which may result in death. Prompt identification of patients with symptomatic Clostridium difficile infection is essential as the majority of patients respond quickly to antimicrobial therapy. Prevention is best accomplished by implementation of infection-control measures and by judicious use of antimicrobial agents.

13.
Journal of Biomedical Research ; : 44-48, 2014.
Article in English | WPRIM | ID: wpr-70419

ABSTRACT

Pseudomembranous colitis (PMC) is known to be associated with the long-term administration of antibiotics, which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. However, antituberculosis agents are rarely reported as a cause of this disease. Besides, most cases of antituberculosis agent-induced PMC have been observed in patients with pulmonary tuberculosis but not with tuberculous meningitis. This report presents a case of PMC associated with antituberculosis therapy in a patient with tuberculous meningitis. A 29-year-old female patient was admitted due to headaches and diplopia that had lasted for 2 weeks. She had not recently received antimicrobial therapy. She was diagnosed with tuberculous meningitis by cerebrospinal fluid findings and neurologic examination, including brain imaging study. She was treated with standard antituberculosis agents (HERZ regimen: isoniazid, ethambutol, rifampicin, and pyrazinamide). After 11 days of HERZ, she developed a fever, sudden widespread skin eruption, and elevation of liver enzymes. Considering adverse drug reactions, antituberculosis agents were stopped. One week later, her symptoms were relieved. Thus, antituberculosis agents were reintroduced one at a time after liver function returned to normal. However, she presented with frequent mucoid, jelly-like diarrhea, and lower abdominal pain. Sigmoidscopy revealed multiple yellowish plaques with edematous mucosa, which were compatible with PMC. She was treated with oral vancomycin considering drug interactions. Symptoms were relieved and did not recur when all antituberculosis agents except pyrazinamide were started again. Therefore, when a patient complains of abdominal pain or diarrhea after initiation of antituberculosis therapy, the physician should consider the possibility of antituberculosis agent-associated PMC.


Subject(s)
Adult , Female , Humans , Abdominal Pain , Anti-Bacterial Agents , Cerebrospinal Fluid , Clostridioides difficile , Diarrhea , Diplopia , Drug Interactions , Drug-Related Side Effects and Adverse Reactions , Enterocolitis, Pseudomembranous , Ethambutol , Fever , Headache , Isoniazid , Liver , Mucous Membrane , Neuroimaging , Neurologic Examination , Pyrazinamide , Rifampin , Skin , Tuberculosis, Meningeal , Tuberculosis, Pulmonary , Vancomycin
14.
Keimyung Medical Journal ; : 136-137, 2014.
Article in English | WPRIM | ID: wpr-24563

ABSTRACT

Among the complications of Clostridium difficile (C. difficile) infection, rectal prolapse has been very rarely reported in children. We report a 29-month-old girl who presented with rectal prolapse complicated with C. difficile-associated pseudomembranous colitis following 3-week course of oral amoxicillin/clavulanic acid for treatment of acute otitis media. The patient complained of fever, abdominal pain and mucoid bloody diarrhea. She also showed a protruded and everted rectal mucosa with discrete white-yellowish exudative plaques. Abdominal CT scan revealed a diffuse wall thickening with mucosal enhancement of the rectosigmoid colon. Both stool culture and toxin assay for C. difficile were positive. Her symptoms were completely improved with oral metronidazole treatment. C. diffile-associated pseudomembranous colitis should be considered as a rare but possible cause of rectal prolapse in children who have recently received antibiotic therapy.


Subject(s)
Child , Child, Preschool , Female , Humans , Abdominal Pain , Clostridioides difficile , Colon , Diarrhea , Enterocolitis, Pseudomembranous , Fever , Metronidazole , Mucous Membrane , Otitis Media , Rectal Prolapse , Tomography, X-Ray Computed
15.
Asian Pacific Journal of Tropical Medicine ; (12): S6-S13, 2014.
Article in English | WPRIM | ID: wpr-820157

ABSTRACT

Clostridium difficile is a Gram-positive, strictly anaerobic, spore-forming bacterium. It is the most common cause of antibiotic-associated diarrhea in hospitals and other healthcare facilities and is of significant concern because of the increasing morbidity and mortality rates as well as increased health care costs. Spectrum of presentation of Clostridium difficile infection ranges from mild, self-limiting diarrhea, to serious diarrhea, pseudomembranous colitis and life-threatening fulminant colitis, which may result in death. Prompt identification of patients with symptomatic Clostridium difficile infection is essential as the majority of patients respond quickly to antimicrobial therapy. Prevention is best accomplished by implementation of infection-control measures and by judicious use of antimicrobial agents.

16.
Indian J Pathol Microbiol ; 2013 Oct-Dec 56 (4): 413-415
Article in English | IMSEAR | ID: sea-155929

ABSTRACT

A 71-year-old female patient was admitted with intractable diarrhea and abdominal distention following several courses of broad spectrum antibiotic therapy. Colonic biopsy revealed pseudomembranous colitis with foci of signet ring cell (SRC) change. The SRCs possessed bland nuclei and were confi ned to the basement membranes of the crypts with no infi ltration into the lamina propria. Benign SRCs in pseudomembranous colitis is an uncommon phenomenon. Awareness of this rare, but potential pitfall is of utmost importance to avoid a misdiagnosis of SRC carcinoma.

17.
Article in English | IMSEAR | ID: sea-182643

ABSTRACT

In the last few decades, increasing use of antibiotics has dramatically increased incidences of antibiotic associated diarrhea. An unopposed homing of Clostridium difficile in ICU and wards put forward new challenges for physicians. Development of diarrhea during or just after hospital stay especially in old patients is a typical clinical presentation of C. difficile diarrhea. Cytotoxin assay from tissue culture is a gold standard diagnostic test but its poor availability, high cost, time bound results and rapidly development of life-threatening complications made us to think of a screening test. Demonstration of pathognomonic summit lesions and pseudomembrane with colonoscopy or sigmoidoscopy is relatively inexpensive, easily available and diagnosis is prompt. Our experience in few patients with colonoscopy makes us to recommend it as a screening test for all clinically suspected patients. Till today, it is refuted as first-line investigation because of good number of false negative results but demonstration of pathognomonic lesions even in few patients saves the life with minimal expenditure and least time wastage before initiation of definitive treatment.

18.
Acta méd. colomb ; 38(3): 177-181, jul.-sep. 2013. ilus, graf, tab
Article in Spanish | LILACS, COLNAL | ID: lil-689547

ABSTRACT

Resumen La infección por Clostridium difficile (cd) es una de la causas más comunes de diarrea adquirida en el ámbito hospitalario, y su espectro clínico puede ir desde casos leves, autolimitados, hasta situaciones como colitis de muy difícil manejo que pueden poner en riesgo la vida del paciente (1). Generalmente se ha asociado al uso crónico de antibióticos de amplio espectro (2). La incidencia de la enfermedad ha aumentado en los últimos años, haciendo que aparezcan nuevas opciones terapéuticas y diagnósticas a las ya conocidas. El objetivo de este artículo es hacer la revisión de un caso de un paciente con infección por cd documentada de difícil manejo, que respondió satisfactoriamente al manejo con rifaximine. (ActaMed Colomb 2013; 38: 177-181).


Abstract Infection with Clostridium difficile (CD) is one of the most common causes of diarrhea acquired in the hospital, and its clinical spectrum can range from mild, self-limiting cases to situations like colitis with difficult management that can put at risk the life of the patient (1). It has been generally associated with chronic use of broad spectrum antibiotics (2). the incidence of the disease has increased in recent years, causing the emergence of new therapeutic and diagnostic options different to those already known. the aim of this article is to review the case of a patient with documented cd infection with difficult management, that responded successfully to treatment with rifaximine. (Acta Med Colomb 2013; 38: 177-181).


Subject(s)
Humans , Male , Aged , Clostridium Infections , Enterocolitis, Pseudomembranous , Clostridioides difficile , Colitis , Diarrhea , Anti-Bacterial Agents
19.
Gastroenterol. latinoam ; 24(supl.1): S29-S32, 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-763716

ABSTRACT

Clostridium difficile has become an important healthcare-associated infection due to increased frequency, mortality and recurrence rate. These facts, associated in part to the appearance of epidemic strains have driven changes in diagnostic and therapeutic approaches. The clinical spectrum of C. difficile infection (CDI) ranges from mild diarrhea without systemic compromise to life-threatening pseudomembranous colitis. Metronidazole is the first line treatment in mild CDI; however, the response rate is lower in severe disease, therefore in patients with clinical markers of unfavorable outcome, the first line treatment is oral vancomicin. On the other hand, the increased recurrence rate seen in the last decade with its clinical and economic consequences has forced the development of new therapies that allow change the course of this disease. In this line, the fecal microbiota transplantation and new antibiotics as fidaxomicin has proved to decrease the recurrences.


Clostridium difficile es actualmente una de las principales infecciones asociadas a la atención de salud debido al aumento de su frecuencia, letalidad y capacidad de recurrencia. Estos hechos en parte asociados al surgimiento de cepas conocidas como epidémicas han determinado grandes cambios en el enfrentamiento diagnóstico y terapéutico. El espectro clínico de la infección por C. difficile (ICD) abarca desde una diarrea leve sin compromiso sistémico hasta cuadros de colitis pseudomembranosa que pueden ocasionar la muerte. Metronidazol es el tratamiento de elección de la ICD leve; sin embargo, la tasa de respuesta es inferior en cuadros graves, por lo tanto, en pacientes con marcadores de mal pronóstico vancomicina oral es la terapia de primera elección. Por otro lado, la mayor tasa de recurrencia observada en la última década con sus consecuencias clínicas y económicas ha obligado al desarrollo de nuevas terapias que permitan alterar el curso de la enfermedad. En esta línea, el trasplante de microbiota fecal y nuevos antibióticos como fidaxomicina han mostrado efectividad en reducir las recurrencias.


Subject(s)
Humans , Clostridium Infections/complications , Clostridium Infections/therapy , Aminoglycosides/therapeutic use , Clostridioides difficile , Enterocolitis, Pseudomembranous/microbiology , Feces/microbiology , Recurrence , Vancomycin/therapeutic use
20.
Korean Journal of Medicine ; : 395-399, 2013.
Article in Korean | WPRIM | ID: wpr-225749

ABSTRACT

The incidence, recurrence, and mortality of Clostridium difficile infection are increasing and the standard therapy is oral metronidazole or vancomycin. Since treatment failure with standard therapy is increasing, an alternative therapy is needed. Fecal microbiota transplantation is one effective method in patients with refractory or recurrent C. difficile infection, including pseudomembranous colitis. Here, we report two cases of refractory pseudomembranous colitis treated with fecal microbiota transplantation.


Subject(s)
Humans , Clostridioides difficile , Enterocolitis, Pseudomembranous , Incidence , Metagenome , Metronidazole , Recurrence , Transplants , Treatment Failure , Vancomycin
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