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 531 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most frequent cause of antibiotic-associated colitis is Clostridium difficile. This gram-positive, spore-forming anaerobic bacillus releases toxins, which produce diarrhea and damage the colonic mucosa. Endoscopy shows a wide range of alterations, "unspecific colitis" with reddening or edema, ulcerations or at the worst pseudomembranous colitis. Nearly all antibiotics are able to trigger Clostridium difficile colitis. An enhanced risk is exerted by broad spectrum substances, which act also on the anaerobic flora protecting the gastrointestinal tract from unphysiological colonization. Clusters of cases were observed in hospitalized patients. The patients risk factors coincide with the administration of antibiotics. Furthermore Clostridium difficile is likely to be spread as a nosocomial infection in many instances. Less often colitis is observed in connection with oral antibiotics outside the hospital. However, substantial underreporting of cases has to be considered. Clinical symptoms usually start 4 to 10 days after first administration of the antibiotic. Leading symptoms are frequent profuse watery stools. Abdominal cramps and tenderness as well as fever and leukocytosis are common. Intense symptoms can simulate serious conditions like perforation. Upon clinical suspicion the diagnosis is made by endoscopy, stool culture and possibly demonstration of toxin. The predictive value of the stool culture equals that of toxin detection. In adult patients there is a good correlation between positive stool culture and clinical presentation. Infants can carry Clostridium difficile as part of their normal flora, therefore positive stool culture or toxin detection in an infant cannot necessarily be linked to clinical symptoms. In some cases Clostridium difficile has to be regarded as etiologic organism also in infants.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Diarrhea induced by antibiotics]. 266 16

Most gastrointestinal infections secondary to the use of antimicrobial agents that have been documented are related to overgrowth of Clostridium difficile which produces a spectrum from severe pseudomembranous colitis to mild diarrhea or asymptomatic carriage. The most common inducers of pseudomembranous colitis or antimicrobial agent-associated diarrhea are ampicillin, clindamycin, and various cephalosporins, but almost all antimicrobials may cause this problem. Symptoms vary from watery to bloody diarrhea; the extent and severity of the diarrhea, fever, and abdominal cramps and the incidence of complications (such as toxic megacolon and perforation of the bowel) and of fatality are variable. Normal carriage of C. difficile in infants and asymptomatic carriage in adults who have received antimicrobial therapy make it impossible to rely on culture for diagnosis. The presence of cytotoxin or enterotoxin produced by C. difficile is much more reliable diagnostically, but there may be false-positives with this as well, particularly in infants. However, the combination of the appropriate clinical picture and background and presence of toxin usually permit accurate diagnosis. The definitive method of diagnosis, often not feasible to employ, is demonstration by colonoscopy or sigmoidoscopy of the pathognomonic yellow, elevated plaques on the colonic mucosa. Colonoscopy is preferred since the plaques may be restricted to the right colon, particularly in early cases. From the practical standpoint, the best diagnostic test is demonstration of C. difficile toxin.
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PMID:Clinical considerations in the diagnosis of antimicrobial agent-associated gastroenteritis. 369 42

A 61-year-old woman presented with an acute condition involving confusion, abdominal cramps and bloody diarrhea six hours after accidental ingestion of colocynth mistaken for zucchini. Colonoscopic examination revealed pseudomembranous colitis though the patient had no condition known to be associated with pseudomembranous colitis. Within ten days the mental state returned to normal and the colitis resolved completely. It is suggested that the colitis was caused by the ingestion of colocynth.
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PMID:[Pseudomembranous colitis caused by the ingestion of colocynth]. 382 25

Abdominal cramping and diarrhea developed in a 24-year-old woman with facial acne vulgaris five days after she started topical therapy with 1% clindamycin hydrochloride. A stool specimen contained a significant titer of a toxin produced by Clostridium difficile. Findings from sigmoidoscopy and a colonic biopsy specimen were consistent with pseudomembranous colitis. The patient became asymptomatic after ten days of supportive care and oral vancomycin hydrochloride therapy. This case is presented as an example of pseudomembranous colitis associated with topical application of clindamycin.
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PMID:Pseudomembranous colitis after topical application of clindamycin. 645 96

Campylobacter fetus subspecies jejuni was isolated fom the feces of 63 (3.2%) of the 1,953 patients who had stools cultured at the Mayo Clinic in 1979. In contrast, Salmonella and Shigella combined were isolated from 31 (1.6%) patients. Two patients had double infections with Salmonella species and C. fetus subsp jejuni. Three patients had no diarrhea at the time of stool culture. One patient, who had chronic lymphocytic leukemia, had both blood and stool cultures positive for C. fetus subsp jejuni. There was a seasonal incidence that peaked in July when 7.8% of all patients who had stools cultured had C. fetus subsp jejuni isolated. Thirteen cases occurred in children 5 years of age and younger and 29 cases occurred between the ages of 15 and 30 years. Clinical features often included a prodrome of malaise, which preceded the onset of abdominal cramps, diarrhea, anorexia, fever, nausea, and vomiting. Grossly bloody diarrhea occurred in 33 patients, and massive intestinal bleeding occurred in 1 patient as a late complication after diarrhea had resolved. Transient splenomegaly was attributed to C. fetus subsp jejuni on one occasion. Proctoscopic findings may be similar to those seen in inflammatory bowel disease or pseudomembranous colitis. Three patients were referred to this institution with newly diagnosed chronic ulcerative colitis, and one patient was referred with newly diagnosed Crohn's disease. C. fetus subsp jejuni was isolated from their stools, and the diagnosis of inflammatory bowel disease was subsequently dropped. A selected review of cases illustrates the variety of gastrointestinal manifestations seen with this organism.
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PMID:Diarrhea due to Campylobacter fetus subspecies jejuni. A clinical review of 63 cases. 725 3

Clostridium difficile is the leading cause of nosocomially acquired intestinal infection in the United States, affecting virtually all cases of pseudomembranous colitis and up to 20% of cases of antibiotic-associated diarrhea. Even after receiving antibiotic treatment with either metronidazole or vancomycin, 20% of patients will have recurrent Clostridium difficile diarrhea. An innovative approach to the problem involves the introduction of competing, nonpathogenic (probiotic) organisms into the intestinal tract to restore microbial balance. The theoretical premise behind this approach is that the protective intestinal microflora is damaged by antibiotic treatment; the initial antibiotic exposure thus leaves the host susceptible to colonization and subsequent infection by Clostridium difficile. A so-called "second-hit" to the intestinal microflora occurs when the infected host is treated with flagyl or vancomycin, further destroying susceptible bacterial flora. Probiotic agents, such as Lactobacillus GG and Saccharomyces boulardii, have been studied for the treatment of Clostridium difficile. We are currently running a prospective, randomized, placebo-controlled trial of Lactobacillus GG in combination with standard antibiotics for the treatment of Clostridium difficile infection. Although it is too early to draw statistically significant conclusions, two patterns seem to be emerging: Lactobacillus GG is effective in reducing the 3-wk recurrence rate of Clostridium difficile, and patients feel better when taking Lactobacillus GG, as compared with the placebo, with early disappearance of abdominal cramps and diarrhea. In conclusion, the use of probiotics for the treatment of primary and recurrent Clostridium difficile diarrhea looks promising. Patients seem to have less recurrent Clostridium difficile diarrhea and early symptomatic improvement when using the probiotic Lactobacillus GG.
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PMID:The effect of probiotics on Clostridium difficile diarrhea. 1095 76