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Colonization with Clostridium difficile in Children with Cancer
Shahnaz Armin1, Shahin Shamsian2, Hojatollah Drakhshanfar2
1Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Iranian Journal of Pediatrics
|January 16, 2014
Summary
Clostridium difficile colonization is high in pediatric cancer patients, with cotrimoxazole use linked to toxic effects. Diagnostic methods like ELISA may not fully capture toxin presence in this vulnerable group.
Area of Science:
- Microbiology
- Pediatric Oncology
- Infectious Diseases
Background:
- Clostridium difficile (C. difficile) is an anaerobic, spore-forming bacterium.
- Antibiotic use, especially broad-spectrum agents, disrupts gut flora and increases C. difficile infection risk.
- Children with malignancy undergoing treatment are particularly susceptible to C. difficile colonization and infection.
Purpose of the Study:
- To investigate the prevalence of C. difficile intestinal colonization and toxin production in pediatric cancer patients.
- To evaluate the correlation between antibiotic/cytotoxic drug use and C. difficile colonization/toxigenicity.
- To assess the diagnostic accuracy of different methods for detecting C. difficile toxins in this population.
Main Methods:
- Prospective study of 152 pediatric patients with malignancy.
- Stool sample analysis included C. difficile culture, HELA cell cytopathic effect assay, and ELISA for toxins A and B.
- Data collected on patient demographics, antibiotic history, and cytotoxic drug use.
Main Results:
- 25.6% of patients were colonized with C. difficile, and 23.7% harbored toxigenic strains.
- 92% of positive cultures showed cytopathic effect on HELA cells.
- Cotrimoxazole use was significantly associated with positive cytopathic effect (P=0.03).
- ELISA results for toxins A and B did not consistently correlate with culture and cytopathic effect findings.
Conclusions:
- High rates of C. difficile colonization and toxigenic strains exist in pediatric hematology patients.
- ELISA may underestimate toxin presence, suggesting potential for other toxins (e.g., Toxin C) contributing to cytopathic effects.
- Further investigation into diagnostic methods and C. difficile epidemiology in immunocompromised children is warranted.
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