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Infectious diarrhea in children undergoing bone-marrow transplantation
J L Blakey1, G L Barnes, R F Bishop
1Department of Gastroenterology, Royal Children's Hospital, Vic, Australia.
Insights
Diarrhea is common in children after bone-marrow transplantation, often caused by infections. Identifying and preventing these enteric infections could improve outcomes for these vulnerable patients.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Gastroenterology
Background:
- Bone-marrow transplantation (BMT) is a critical treatment for various pediatric conditions.
- Diarrhea is a frequent and serious complication in pediatric BMT recipients.
- The etiology of diarrhea in this immunocompromised population requires thorough investigation.
Purpose of the Study:
- To prospectively monitor fecal flora in children undergoing BMT.
- To identify the causative agents of diarrhea in these patients.
- To assess the role of enteric infections in BMT-associated diarrhea.
Main Methods:
- Comprehensive microbiological analysis of fecal samples from 12 pediatric BMT patients.
- Prospective monitoring of fecal flora throughout the transplantation process.
- Identification of viral, parasitic, and bacterial pathogens in diarrheal episodes.
Main Results:
- Diarrhea occurred in 83% of the 12 children, with 24 episodes recorded.
- Recognized gut pathogens were isolated in 52% of diarrheal episodes.
- Viral pathogens (19%), parasites (19%), and Clostridioides difficile (14%) were identified; clostridial species were prevalent when no specific pathogen was found (90% of episodes).
Conclusions:
- Infections are frequently responsible for diarrhea in pediatric BMT patients.
- Targeted prophylaxis against enteric infections may decrease morbidity and mortality.
- Further research into pathogen-specific interventions is warranted.
Abstract:
Fecal flora of 12 children undergoing bone-marrow transplantation was monitored prospectively using comprehensive microbiological techniques. Diarrhea developed at least once in ten of the 12 children (83%), and a total of 24 episodes were recorded. Recognised gut pathogens were isolated from 11/21 (52%) diarrheal episodes where fecal specimens were obtained. Enteric pathogens identified included viral pathogens in 19% (rotaviruses, 'enteric' adenoviruses), parasites in 19% (cryptosporidium, Giardia lamblia) and cytotoxic C. difficile (14%). Excretion of clostridial species (including cytotoxin negative C. difficile, C. innocuum) occurred in 90% of diarrheal episodes when no enteric pathogen was identified. These results suggest that infection is often responsible for diarrhea associated with bone-marrow transplantation. Prophylaxis against enteric infection might reduce the morbidity and mortality associated with severe diarrhea in bone-marrow transplanted children.