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Absence of pseudomembranes in Clostridium difficile-associated diarrhea in patients using immunosuppression agents

Kenichi Nomura1, Yoshiko Fujimoto, Mihoko Yamashita

  • 1Department of Molecular Hematology and Oncology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan. nomuken@koto.kpu-m.ac.jp

Scandinavian Journal of Gastroenterology
|September 11, 2008
PubMed
Abstract

Insights

Pseudomembranes, key indicators of Clostridium difficile-associated diarrhea (CDAD), are absent in immunosuppressed patients. Further bacterial testing is crucial for diagnosing CDAD in these individuals, especially those with ulcerative colitis or post-transplant.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Immunology

Background:

  • Clostridium difficile-associated diarrhea (CDAD) is a common hospital-acquired infection.
  • Pseudomembranes are typical endoscopic findings for CDAD diagnosis.
  • Some CDAD cases, particularly in immunosuppressed patients, may lack pseudomembranes.

Purpose of the Study:

  • To investigate the absence of pseudomembranes in immunosuppressed patients with CDAD.
  • To test the hypothesis that immunosuppression prevents pseudomembrane formation due to reduced immunoreactions.

Main Methods:

  • Endoscopic findings were reviewed in patients with ulcerative colitis (UC) or post-hematopoietic stem cell transplantation (HSCT).
  • Patients presented with C. difficile toxin A and underwent colonoscopy between April 2002 and July 2007.
  • Eight patients were included: 4 with UC and C. difficile infection, and 4 with CDAD post-HSCT.

Main Results:

  • None of the 8 patients exhibited pseudomembranes during colonoscopy.
  • Patients with UC showed shallow ulcers.
  • CDAD patients post-HSCT had non-specific endoscopic findings.

Conclusions:

  • Pseudomembranes were not observed in immunosuppressed patients with CDAD.
  • Immunosuppressive agents may inhibit pseudomembrane formation.
  • Bacterial examination is essential for diagnosing exacerbated UC or diarrhea post-HSCT, even without pseudomembranes.

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