ABSTRACT
BACKGROUND: Adults with inflammatory bowel disease (IBD) have a high prevalence of Clostridium difficile carriage, but little data exist regarding pediatric patients with IBD. Serum antibody responses to C. difficile toxins in correlation with organism carriage are not described in IBD. This study determines the prevalence of C. difficile carriage and compares serum antibody responses to C. difficile toxins in pediatric outpatients with IBD and controls. METHODS: Fecal and serum samples were prospectively collected from pediatric outpatients with IBD (n = 85) and age-matched controls (n = 78). Initial and follow-up stool samples were tested using cytotoxigenic C. difficile culture and PCR to detect the toxin B gene. Pulsed-field gel electrophoresis determined the strain type. Enzyme-linked immunosorbent assay determined serum immunoglobulin responses to C. difficile toxins. RESULTS: Asymptomatic C. difficile carriage was significantly greater in IBD (17%) versus controls (3%) (P = 0.012). IBD type, disease severity, IBD therapy, recent antibiotics, and hospitalizations were not associated with carriage. Proton pump inhibitor use was significantly higher in patients with C. difficile carriage (54% versus 25%, P < 0.05). North American pulsed-field (NAP) strain carriage varied over time in patients colonized with C. difficile. A significantly greater proportion of patients with IBD had a positive serum antibody response to toxin A (69%) compared with controls (53%) (P < 0.05). CONCLUSIONS: Asymptomatic toxigenic C. difficile carriage was increased in pediatric outpatients with IBD compared with controls. Proton pump inhibitor use was associated with increased carriage. Antibody responses to C. difficile toxins were increased in IBD, potentially promoting asymptomatic colonization. Future studies should identify the risk factors for symptomatic C. difficile in pediatric IBD.
Subject(s)
Antibodies, Bacterial/blood , Bacterial Proteins/immunology , Bacterial Toxins/immunology , Clostridioides difficile/isolation & purification , Enterocolitis, Pseudomembranous/microbiology , Feces/microbiology , Inflammatory Bowel Diseases/microbiology , Adolescent , Adult , Case-Control Studies , Child , Child, Preschool , Clostridioides difficile/immunology , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Enterocolitis, Pseudomembranous/drug therapy , Enzyme-Linked Immunosorbent Assay , Female , Follow-Up Studies , Humans , Inflammatory Bowel Diseases/drug therapy , Male , Polymerase Chain Reaction , Prevalence , Prognosis , Prospective Studies , Proton Pump Inhibitors/therapeutic use , Young AdultABSTRACT
BACKGROUND: Mesalamine or 5-aminosalicylic acid (5-ASA) has proven efficacy in treating patients with ulcerative colitis (UC). Although mesalamine is considered safe, it has been associated with acute interstitial nephritis and renal failure. METHODS: Herein we present a case of a child with UC who developed acute renal failure on mesalamine therapy. RESULTS: A 15-year-old African-American girl with well-controlled UC presented to the Johns Hopkins Hospital with a four-day history of high fever, malaise, generalized body aches, and productive non-bloody cough. Over the next three days, she developed acute renal failure with fluid retention, and elevated serum creatinine and blood urea nitrogen. A kidney biopsy showed drug induced acute interstitial nephritis and focal segmental glomerulosclerosis with viral inclusion bodies likely secondary to cytomegalovirus. CONCLUSION: When treating UC patients with a history of underlying renal disease, it is advised to carefully monitor renal function while on mesalamine therapy.
