Positive role of Clostridium difficile infection in diarrhea in infants and children
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J D Gryboski1, R Pellerano, N Young
1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Insights
Children with recurrent Clostridium difficile infection often have low immunoglobulin levels, particularly transient hypogammaglobulinemia of infancy. Testing immunoglobulin levels can identify underlying immune disorders in children with persistent C. difficile diarrhea.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Immunology
Background:
- Clostridium difficile infection (CDI) is a significant cause of infectious diarrhea in children.
- Recurrent CDI can be associated with underlying immune deficiencies.
- Transient hypogammaglobulinemia of infancy (THI) is a common cause of low immunoglobulin levels in infants.
Purpose of the Study:
- To investigate the association between immunoglobulin levels and CDI in children.
- To identify potential immune dysregulation in children with recurrent or persistent CDI.
- To evaluate the role of THI in pediatric CDI.
Main Methods:
- Retrospective review of 43 pediatric patients with CDI and diarrhea.
- Analysis of immunoglobulin levels (including IgG, IgA, IgM) in CDI patients and controls.
- Comparison of patient demographics, clinical presentation, and recurrence rates based on immunoglobulin status.
Main Results:
- Fifteen percent of children with CDI had immunoglobulin levels below normal, consistent with THI.
- Children with THI were significantly younger and had a higher rate of recurrent CDI (46%) compared to those with normal immunoglobulin levels (18%).
- Children with C. difficile toxin but no diarrhea had normal immunoglobulin levels; IgA deficiency was noted in 7% of diarrheal patients with milk protein allergy.
Conclusions:
- Low immunoglobulin levels, particularly THI, are associated with recurrent CDI in children.
- Measuring immunoglobulin levels in children with problematic CDI may help identify underlying immune synthesis disorders.
- Identifying immune deficiencies can guide management and potentially reduce antibiotic use for associated recurrent infections.
Abstract:
A retrospective review of children with Clostridium difficile infection and diarrhea identified 43 patients. Fifteen (35%) had immunoglobulins below the normal range for age, and typified those with transient hypogammaglobulinemia of infancy, because all increased their levels over the following 12 months. The age of those with hypogammaglobulinemia was significantly younger (p less than 0.01), averaging 18.8 months, than those with normal immunoglobulins who had a mean age of 4.6 yr. The number with recurrent C. difficile infection was significantly greater (p less than 0.001) in the hypogammaglobulinemic group than in those with normal immunoglobulins (46% vs 18%). Eleven children were identified who had C. difficile toxin in the stool after antibiotic therapy, but who had no diarrhea at the time of study. All had normal immunoglobulins. Control patients (20 without and 40 with diarrhea) had no evidence of C. difficile infection, and all but three had normal immunoglobulins. Three (7%) of those with diarrhea had IgA deficiency, and all had a diagnosis of milk protein allergy. These data suggest that immunoglobulin values be obtained in infants and children who have problematic C. difficile diarrhea in order to identify disorders of immunoglobulin synthesis which may be the underlying cause of repeated upper respiratory disease requiring antibiotic usage.