Clostridium difficile infection in inflammatory bowel disease

Öz

Background and Aims:A recent rise in Clostridium difficile-associated diarrhea has been observed. A higher incidence of Clostridium difficile-associated diarrhea has also been suggested in patients with inflammatory bowel disease and may be a challenging factor in the differential diagnosis of flares. Prior antibiotic use, older age, prolonged hospital stay, poor immunity, chemotherapy, and acid suppression are the risk factors. Materials and Methods: Between June 2009 and October 2010, 42 patients were admitted with active bloody diarrhea and diarrhea in Ege University, Clinic of Gastroenterology, Inflammatory Bowel Disease Polyclinic. We investigated Clostridium difficile toxin A+B in stool samples (Clostridium difficile toxin A+B, VIDAS, bioMérieux, France) during inflammatory bowel disease flare, and clinical, laboratory and endoscopic findings of the admitted patients were recorded. We queried the patients regarding their use of antibiotic, corticosteroid and azathioprine. Results:Among the inflammatory bowel disease patients, 41 had ulcerative colitis and 1 had Crohn's colitis. Five of the 42 patients were taking corticosteroid and 3 of the 42 were taking azathioprine; none of them was on antibiotic. In 41 patients with inflammatory bowel disease, Clostridium difficile toxin A+B were negative in stool; in one patient, the value was borderline. Conclusions: Recently, Clostridium difficile infection has been suggested frequently in patients with inflammatory bowel disease in the North American and European literature. However, we were unable to demonstrate this infection in our inflammatory bowel disease patients with flare

Anahtar Kelimeler

• Clostridium difficile, toxin A and B, inflammatory bowel disease

İltihabi barsak hastalığında Clostridium difficile infeksiyonu

Öz

Giriş ve Amaç:Son zamanlarda Clostridium difficile bağlı diyarelerde artış gözlenmiştir. Yine Clostridium difficile bağlı diyare iltihabi barsak hastalarında artmış bir insidense sahiptir ve aktivasyonla ayırıcı tanıda karışıklığa yol açabilir. Önceden antibiyotik kullanımı, ileri yaş, uzamış hastanede kalış, bağışıklığın zayışığı kemoterapi ve asid supresyonu risk faktörleridir. Gereç ve Yöntem:Haziran 2009 ve Ekim 2010 arasında Ege Üniversitesi Gastroenteroloji Kliniği İnşamatuvar Barsak Hastalıkları polikliniğine başvuran, aktif kanlı diyaresi ve diyaresi olan 42 hastada dışkıda Clostridium difficile Toksin A+B (Vidas Bio – Merieux France) arandı. İnşamatuvar barsak hastalığı aktivasyonu klinik, laboratuvar ve endoskopik bulgularla tayin edildi. Hastalara antibiyotik kortikosteroid ve azothioprin kullanımı soruldu. Bulgular:Kırkiki inşamatuvar barsak hastasının 41'i Colitis ülseroza ve biri Crohn kolitiydi. Kırkiki hastanın 5'i kortikostreoid, 3'ü azothioprin alıyordu, hiç biri antibiyotik almıyordu. İnşamatuvar barsak hastalığı olanların 41'inde Clostridium difficile toxin A+B gaitada negatifti ve bir hastada sınır değerdeydi. Sonuçlar:Clostridium difficile infeksiyonu Kuzey Amerika ve Avrupa literatüründe inşamatuvar barsak hastalığı'nda sıklıkla ileri sürülmektedir. Fakat biz bu infeksiyonu aktivasyon esnasında inşamatuvar barsak hastalarımızda bulamadık.

Anahtar Kelimeler

• Clostridium difficile, toksin A+B, inflamatuv ar barsak hastalığı

Kaynakça

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