OBJECTIVE: Clostridium difficile is a major cause of diarrhea in hospitalized patients. Although pseudomembranes are crucial evidence for diagnosis of C. difficile-associated diarrhea (CDAD), some cases do not show any pseudomembranes. The aim of this study was to verify the hypothesis that pseudomembranes are not generated in immunosuppressed patients because of the absence of immunoreactions. MATERIAL AND METHODS: We investigated the endoscopic findings of patients with ulcerative colitis (UC) or who had received hematopoietic stem cell transplantation, and who presented with C. difficile toxin A and had undergone colonoscopy between April 2002 and July 2007 at our institutes. Results. In 4 patients the diagnosis was UC and C. difficile infection, and in another 4 patients the diagnosis was CDAD after hematopoietic stem cell transplantation. None of these cases showed pseudomembranes. Shallow ulcers were found in all four cases with UC. Only non-specific findings were obtained for the CDAD patients after hematopoietic stem cell transplantation. CONCLUSIONS: Pseudomembranes, the typical evidence for CDAD, were not detected in any patients using immunosuppressive agents. Additional bacterial examination is therefore essential when UC becomes exacerbated and when patients present with diarrhea after hematopoietic stem cell transplantation, even in the absence of pseudomembranes.
OBJECTIVE:Clostridium difficile is a major cause of diarrhea in hospitalized patients. Although pseudomembranes are crucial evidence for diagnosis of C. difficile-associated diarrhea (CDAD), some cases do not show any pseudomembranes. The aim of this study was to verify the hypothesis that pseudomembranes are not generated in immunosuppressed patients because of the absence of immunoreactions. MATERIAL AND METHODS: We investigated the endoscopic findings of patients with ulcerative colitis (UC) or who had received hematopoietic stem cell transplantation, and who presented with C. difficile toxin A and had undergone colonoscopy between April 2002 and July 2007 at our institutes. Results. In 4 patients the diagnosis was UC and C. difficileinfection, and in another 4 patients the diagnosis was CDAD after hematopoietic stem cell transplantation. None of these cases showed pseudomembranes. Shallow ulcers were found in all four cases with UC. Only non-specific findings were obtained for the CDAD patients after hematopoietic stem cell transplantation. CONCLUSIONS: Pseudomembranes, the typical evidence for CDAD, were not detected in any patients using immunosuppressive agents. Additional bacterial examination is therefore essential when UC becomes exacerbated and when patients present with diarrhea after hematopoietic stem cell transplantation, even in the absence of pseudomembranes.
Authors: Cord Langner; Fernando Magro; Ann Driessen; Arzu Ensari; Gerassimos J Mantzaris; Vincenzo Villanacci; Gabriel Becheanu; Paula Borralho Nunes; Gieri Cathomas; Walter Fries; Anne Jouret-Mourin; Claudia Mescoli; Giovanni de Petris; Carlos A Rubio; Neil A Shepherd; Michael Vieth; Rami Eliakim; Karel Geboes Journal: Virchows Arch Date: 2014-02-01 Impact factor: 4.064
Authors: Carolyn D Alonso; Suzanne B Treadway; David B Hanna; Carol Ann Huff; Dionissios Neofytos; Karen C Carroll; Kieren A Marr Journal: Clin Infect Dis Date: 2012-03-12 Impact factor: 9.079
Authors: Carolyn D Alonso; Simon F Dufresne; David B Hanna; Annie-Claude Labbé; Suzanne B Treadway; Dionissios Neofytos; Sylvie Bélanger; Carol Ann Huff; Michel Laverdière; Kieren A Marr Journal: Biol Blood Marrow Transplant Date: 2013-08-01 Impact factor: 5.742