Absence of pseudomembranes in Clostridium difficile-associated diarrhea in patients using immunosuppression agents.

Abstract:

OBJECTIVE:Clostridium difficile is a major cause of diarrhea in hospitalized patients. Although pseudomembranes are crucial evidence for diagnosis of C. difficile-associated diarrhea (CDAD), some cases do not show any pseudomembranes. The aim of this study was to verify the hypothesis that pseudomembranes are not generated in immunosuppressed patients because of the absence of immunoreactions. MATERIAL AND METHODS:We investigated the endoscopic findings of patients with ulcerative colitis (UC) or who had received hematopoietic stem cell transplantation, and who presented with C. difficile toxin A and had undergone colonoscopy between April 2002 and July 2007 at our institutes. Results. In 4 patients the diagnosis was UC and C. difficile infection, and in another 4 patients the diagnosis was CDAD after hematopoietic stem cell transplantation. None of these cases showed pseudomembranes. Shallow ulcers were found in all four cases with UC. Only non-specific findings were obtained for the CDAD patients after hematopoietic stem cell transplantation. CONCLUSIONS:Pseudomembranes, the typical evidence for CDAD, were not detected in any patients using immunosuppressive agents. Additional bacterial examination is therefore essential when UC becomes exacerbated and when patients present with diarrhea after hematopoietic stem cell transplantation, even in the absence of pseudomembranes.

journal_name

Scand J Gastroenterol

authors

Nomura K,Fujimoto Y,Yamashita M,Morimoto Y,Ohshiro M,Sato K,Oyake T,Kowata S,Konishi H,Yoshikawa T,Ishida Y,Taniwaki M,Japan Hematology\/Oncology Study (J-HOST) Group Kyoto.

doi

10.1080/00365520802321238

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

74-8

issue

1

eissn

0036-5521

issn

1502-7708

pii

902364997

journal_volume

44

pub_type

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