#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Pseudomembranous colitis


Authors: D. Bergmann 1;  J. Koten 1;  Z. Beneš 1;  P. Kohout 1;  A. Chlumská 2
Authors‘ workplace: II. interní klinika Fakultní Thomayerovy nemocnice s poliklinikou, Praha, přednosta MUDr. Zdeněk Beneš, CSc. 1;  Bioptická laboratoř s. r. o., Plzeň, vedoucí lékařka prof. MUDr. Alena Skálová, CSc. 2
Published in: Vnitř Lék 2007; 53(10): 1100-1107
Category: Reviews

Overview

For some thirty years it has been known that pathologic proliferation of toxigenic Clostridium difficile may lead to inflammation of colonic mucosa which, in its fully developed form, manifests as pseudomembranous colitis. CDAD (Clostridium difficile – Associated Disease or Diarrhoea) is the term which is generally and quite aptly used for the disease in literature on the subject. In most cases, the disease develops after the administration of broad-spectrum antibiotics, yet there are also other important pathogenetic factors involved which should not be ignored. The disease has grown in significance over recent years due to the occurrence of serious epidemics in a number of advanced countries provoked by a highly virulent strain characterised as ribotype 027, toxinotype III, pulsovar NAP1. CDAD is a potentially fatal disease, yet it can be effectively cured if diagnosed on time. Stool toxin testing plays a crucial role in the diagnostics of the disease, and the use of endoscopy has been on the rise. Administration of targeted antibiotics is of critical importance for successful therapy, metronidazol or orally administered vankomycine being considered the most reliable, and there are also other drugs with promising effects. However, the rate of recurrence of the disease is as high as 25 %. In view of the realistic threat of propagation of the highly virulent strain in the territory of the Czech Republic, preparations have started for the setting up of a national reference laboratory for Clostridium difficile typification.

Keywords:
pseudomembranous colitis – CDAD – Clostridium difficile


Sources

1. Thielman NM, Wilson KH. Antibiotic-Associated Colitis. In: Principles and Practice of Infectious Diseases. Elsevier 2005.

2. Rupnik M, Dupuy B, Fairweather NF et al. Revised nomenclature of Clostridium difficile toxins and associated genes. J Med Microbiol 2005; 54: 113-117.

3. Geric B, Carman RJ, Rupnik M et al. Binary Toxin-Producing, Large Clostridial Toxin-Negative Clostridium difficile Strains Are Enterotoxic but Do Not Cause Disease in Hamsters. The Journal of Infectious Diseases 2006; 193: 1143-1150.

4. Barbut F, Petit JC. Epidemiology of Clostridium difficile-associated infections. Clin Microbiol Infect 2001; 7: 405-410.

5. Phillips C. Serum antibody responses to Clostridium difficile toxin A: predictive and protective? Gut 2001; 49: 167-168.

6. Kyne L, Warny M, Qamar A et al. Asymptomatic Carriage of Clostridium difficile and Serum Levels of IgG Antibody against Toxin A. N Engl J Med 2000; 342: 390-397.

7. Johal SS, Hammond J, Solomon K at al. Clostridium difficile associated diarrhoea in hospitalised patients: onset in the community and hospital and role of flexible sigmoidoscopy. Gut 2004; 53: 673-677.

8. Gaynes RP, Rimland D, McDonald C. Community-Acquired Clostridium difficile-Associated Diarrhea (CDAD) among Outpatients in a VA Medical Center Atlanta. Abstract book, 46th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Francisco, September 27-30, 2006. Washington (USA): American Society for Microbiology 2006: L-1550.

9. Arroyo LG, Kruth SA, Willey BM et al. PCR ribotyping of Clostridium difficile isolates originating from human and animal sources. J Med Microbiol 2005; 54: 163-166.

10. Pépin J, Valiquette L, Alary ME et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. Can Med Assoc J 2004; 171: 466-472.

11. Pépin J, Valiquette L, Cossette B Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. Can Med Assoc J 2005; 173: 1037-1042.

12. McDonald LC, Killgore GE, Thompson A et al. An Epidemic, Toxin Gene-Variant Strain of Clostridium difficile. N Engl J Med 2005; 353: 2433-2441.

13. Coignard B, Barbut F, Blanckaert K et al. Emergence of Clostridium difficile toxinotype III, PCR-ribotype 027-associated disease, France, 2006. Eurosurveillance 2006; 11: 060914. (http://www.eurosurveillance.org).

14. Kuijper EJ, Van den Berg RJ, Debast S et al. Clostridium difficile Ribotype 027, Toxinotype III, the Netherlands. Emerg Inf Dis 2006; 12: 827-830.

15. Weil HP, Van den Berg RJ, Kuijper EJ et al. Emerging Outbreaks of Clostridium difficile Associated Diarrhea (CDAD) in Three Hospitals in Northwestern Germany. Abstract book, 46th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Francisco, September 27-30, 2006. Washington (USA): American Society for Microbiology 2006: K-1012.

16. Kuijper EJ, Delmée M, Barbut F. Rapidly Spreading of Clostridium difficile PCR Ribotype 027, Toxinotype III in Europe. Abstract book, 46th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Francisco, September 27-30, 2006. Washington (USA): American Society for Microbiology 2006: K-348.

17. Kuijper EJ, Coignard B, Tüll P et al. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microb Infect 2006; 12: 2-18.

18. Beneš J, Sýkorová B. Kolitida vyvolaná Clostridium difficile. Zpráva z kongresu ICAAC 2006. Klin Mikrobiol Inf Lék 2006; 12: 247-251.

19. Indra A, Huhulescu S, Hasenberger P et al. First isolation of Clostridium difficile PCR ribotype 027 in Austria. Eurosurveillance 2006; 11: 060914. (http://www.eurosurveillance.org).

20. Warny M, Pepin J, Fang A et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005; 366: 1079-1084.

21. Loo VG, Poirier L, Miller MA et al. A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile-Associated Diarrhea with High Morbidity and Mortality. N Engl J Med 2005; 353: 2442-2449.

22. Pépin J, Saheb N, Coulombe MA et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005; 41: 1254-1260.

23. Vaessen N, Debast S, Choudry A et al. Fluoroquinolone-Use is a Major Risk Factor for Clostridium difficile NAP1/027-Associated Disease (CDAD). Abstract book, 46th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Francisco, September 27-30, 2006. Washington (USA): American Society for Microbiology 2006: K-350.

24. Dial S, Delaney C, Schneider V et al. Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy. Can Med Assoc J 2006; 175: 745-748.

25. Lowe DO, Mamdani MM, Kopp A et al. Proton Pump Inhibitors and Hospitalization for Clostridium difficile-Associated Disease: A Population-Based Study. Clin Infect Dis 2006; 43: 1272-1276.

26. Husová L, Lata J, Husa P et al. Pseudomembranózní kolitida jako komplikace eradikační terapie infekce Helicobacterem pylori. Čes a Slov Gastroent 1999; 53: 90-93.

27. Rüssmann H, Panthel K, Bader RC et al. Evaluation of three rapid assays for detection of Clostridium difficile toxin A and toxin B in stool specimens. Eur J Clin Microbiol Infect Dis 2007; 26: 115-119.

28. Van den Berg RJ, Vaessen N, Endtz HP et al. Evaluation of real-time PCR and conventional diagnostic methods for the detection of Clostridium difficile-associated diarrhoea in a prospective multicentre study. J Med Microbiol 2007; 56: 36-42.

29. McFarland LV. Alternative treatments for Clostridium difficile disease: what really works? J Med Microbiol 2005; 54: 101-111.

30. Pépin J, Routhier S, Gagnon S et al. Management and Outcomes of a First Recurrence of Clostridium difficile-Associated Disease in Quebec, Canada. Clin Infect Dis 2006; 42: 758-764.

31. Musher DM, Aslam S, Logan N. Relatively Poor Outcome after Treatment of Clostridium difficile Colitis with Metronidazole. Clin Infect Dis 2005; 40: 1586-1590.

32. Beneš J, Vacek V. Postantibiotická pseudomembranozní kolitida: Mýty a skutečnost. Prakt Lék 1995; 75: 504-509.

33. Zemanová E, Urban O, Chalupa J et al. Asociace infekce Clostridium difficile a pseudomembranózní kolitidy v nemocnici okresního typu. Vnitř Lék 2003; 49: 645-649.

34. Louie TJ, Peppe J, Watt CK et al. Tolevamer, a Novel Nonantibiotic Polymer, Compared with Vancomycin in the Treatment of Mild to Moderately Severe Clostridium difficile-Associated Diarrhea. Clin Infect Dis 2006; 43: 411-420.

35. Musher DM, Logan N, Hamill RJ et al. Nitazoxanide for the Treatment of Clostridium difficile Colitis. Clin Infect Dis 2006; 43: 421-427.

36. De Lalla F, Nicolin R, Rinaldi E et al. Prospective study of oral teicoplanin versus oral vancomycin for therapy of pseudomembranous colitis and Clostridium difficile-associated diarrhea. Antimicrob Agents Chemother 1992; 36: 2192-2196.

37. Norén T, Wullt M, Åkerlund T et al. Frequent Emergence of Resistance in Clostridium difficile during Treatment of C. difficile-Associated Diarrhea with Fusidic Acid. Antimicrob Agents Chemother 2006; 50: 3028-3032.

38. Pantosti A, Luzzi I, Cardines R et al. Comparison of the in vitro activities of teicoplanin and vancomycin against Clostridium difficile and their interactions with cholestyramine. Antimicrob Agents Chemother 1985; 28: 847-848.

39. Dendukuri N, Costa V, McGregor M et al. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review. Can Med Assoc J 2005; 173: 167-170.

40. McFarland L Meta-Analysis of Probiotics for the Prevention of Antibiotic Associated Diarrhea and the Treatment of Clostridium difficile Disease. Am J Gastroenterol 2006; 101: 812-822.

41. Johnson S, Schriever C, Galang M et al. Interruption of Recurrent Clostridium difficile-Associated Diarrhea Episodes by Serial Therapy with Vancomycin and Rifaximin. Clin Infect Dis 2007; 44: 846-848.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 10

2007 Issue 10

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#