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Chronic diarrhea associated with Clostridium difficile in children
Insights
Clostridium difficile infection can cause chronic diarrhea in children, even without colitis symptoms. Antibiotic use and family contact spread are key factors, with vancomycin showing initial effectiveness but relapses occurring.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Antibiotic-associated diarrhea is a significant concern in pediatrics.
- Clostridium difficile infection (CDI) is increasingly recognized in children.
- Classic CDI symptoms like colitis may be absent in pediatric cases.
Purpose of the Study:
- To investigate the association between Clostridium difficile toxin and chronic diarrhea in children.
- To evaluate the efficacy of vancomycin hydrochloride in treating pediatric CDI.
- To assess the infectious potential of CDI within family units.
Main Methods:
- Case series of seven children (7 weeks to 7 years) with chronic diarrhea.
- Stool toxin assays performed during symptomatic and asymptomatic periods.
- Treatment with vancomycin hydrochloride for six patients.
- Family contact screening for C. difficile.
Main Results:
- Clostridium difficile toxin detected in children with chronic diarrhea, often without colitis.
- Vancomycin treatment led to initial improvement in six of seven patients.
- Relapses occurred in four patients, with toxin reappearance during relapse.
- Fifty-six percent of family contacts tested positive for C. difficile.
Conclusions:
- Clostridium difficile is a probable cause of chronic diarrhea in childhood.
- CDI has significant infectious potential within households.
- Recurrence of CDI is common, necessitating further therapeutic considerations.
Abstract:
Clostridium difficile toxin was associated with chronic diarrhea without classic symptoms of colitis in seven children (age range, 7 weeks to 7 years). All patients had received antibiotics. Six of the seven were treated with vancomycin hydrochloride and demonstrated improvement. After treatment, four patients suffered relapses, and three required further therapy. One patient had four relapses. During all clinical relapses, toxin reappeared in the stool; recovery was always associated with its disappearance. Fifty-six percent of family contacts examined had positive cultures. These findings document C difficile as a probable cause of chronic diarrhea in childhood and emphasize its infectious potential.