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Clostridium difficile and its cytotoxin in infants admitted to hospital with infectious gastroenteritis
Insights
Clostridium difficile (C. diff) cytotoxin was found in nearly 5% of young children with infectious gastroenteritis. This bacterium can cause severe illness, even without prior antibiotic use, and should be considered in pediatric diarrhea cases.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Gastroenterology
Background:
- Infectious gastroenteritis is common in children under 2 years.
- Clostridium difficile is a known cause of antibiotic-associated diarrhea.
- The role of C. difficile in non-antibiotic-associated pediatric gastroenteritis is less understood.
Purpose of the Study:
- To investigate the prevalence of Clostridium difficile cytotoxin in young children with infectious gastroenteritis.
- To explore the association between antibiotic use and C. difficile infection in this age group.
Main Methods:
- Prospective study of 390 children under 2 years with infectious gastroenteritis.
- Detection of Clostridium difficile cytotoxin in fecal samples.
- Bacterial culture for Clostridium difficile from stool samples.
- Comparison with antibiotic use history in control patients.
Main Results:
- Clostridium difficile cytotoxin detected in 4.9% of patients.
- C. difficile cultured from 49% of children's stools.
- Severe outcomes observed in some cases, including toxic megacolon and need for vancomycin.
- No significant association found between past antibiotic use and C. difficile isolation or cytotoxin presence in controls.
Conclusions:
- Clostridium difficile should be considered a potential cause of acute diarrhea and vomiting in children under 2 years, irrespective of antibiotic history.
- The pathogen can lead to severe gastrointestinal illness in infants.
- Further investigation into non-antibiotic-associated C. difficile infections in pediatrics is warranted.
Abstract:
During a prospective study of infectious gastroenteritis in children under 2 years, 19 out of 390 patients (4.9%) were found to have Clostridium difficile cytotoxin in the faeces. In several there was no history of use of antibiotics. The symptoms of many infants with toxin settled spontaneously, but one child became acutely and severely ill and developed a toxic megacolon and five others required, and responded to, vancomycin. Cl difficile was cultured from the stools in 191 (49%) of the children. The highly significant increased prevalence of past use of antibiotics in 118 control patients was not associated with an increased incidence of either isolation of Cl difficile or presence of faecal cytotoxin. Cl difficile should not be overlooked as a cause of acute diarrhoea and vomiting in children under 2 years.