Atypical presentation of Clostridium difficile colitis in patients with cystic fibrosis.

Binkovitz, Larry A.; Allen, Edward D.; Bloom, David A.; Long, Florence C.; Hammond, Sue; Buonomo, Carlo; Donnelly, Lauren

doi:10.2214/ajr.172.2.9930816

Cited by 39 publications

(28 citation statements)

References 4 publications

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“…Nevertheless, severe cases of CDI do occur in children with cystic fibrosis, emphasizing the importance of considering the diagnosis [88]. Patients may present atypically, without watery diarrhoea but rather abdominal distension and reduced bowel motions, risking confusion with faecal impaction or meconium ileus equivalent [89,90]. There also appears to be a greater risk of CDI following lung transplantation for cystic fibrosis, with patients experiencing a fulminant course resulting in high mortality [91,92].…”

Section: Children With Co-morbiditiesmentioning

confidence: 99%

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Morris

Tebruegge

Pallett

et al. 2012

Advances in Experimental Medicine and Biology

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The clinical significance of the presence of Clostridium difficile in children's faeces remains uncertain using current diagnostic procedures. Clostridium difficile is a relatively common finding in infants with no symptoms of gastrointestinal disease, suggesting it may be an incidental finding and form part of the normal gut micro-flora in this age group. On the other hand, particularly in older children or those with significant co-morbidity, there are examples where C. difficile causes disease and exerts considerable morbidity and even mortality (C. difficile infection, CDI). Between these extremes lie a substantial group of children who have both diarrhoea and C. difficile in their stools but where the nature of the association is not clear: Clostridium difficile associated disease (CDAD). We review the significance of C. difficile in children presenting recently uncovered paediatric data from a large UK epidemiological study that informs some key unanswered questions.

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Section: Children With Co-morbiditiesmentioning

confidence: 99%

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Morris

Tebruegge

Pallett

et al. 2012

Advances in Experimental Medicine and Biology

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“…One of the important clinical manifestations in CF patients is constipation and its complications. Although those complications are mainly associated with steatorrhea resulting from the deficiency of pancreatic enzyme secretion to digest fat (Rubinstein et al, 1986), the impaired fluid secretion caused by defects of Cl Ϫ transport in the intestinal epithelia also may play a pathophysiological role in gastrointestinal symptoms of CF patients (Gabriel et al, 1994;Binkovitz et al, 1999). On the other hand, capsaicin has been reported to cause diarrhea by increasing fluid secretion accompanied with stimulation of intestinal ion transport (Miller et al, 2000).…”

Section: Capsaicin On Cftr Chloride Channel 1421mentioning

confidence: 99%

Capsaicin Potentiates Wild-Type and Mutant Cystic Fibrosis Transmembrane Conductance Regulator Chloride-Channel Currents

Ai¹,

Bompadre²,

Wang³

et al. 2004

Mol Pharmacol

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To examine the effects of capsaicin on cystic fibrosis transmembrane conductance regulator (CFTR), we recorded wildtype and mutant CFTR chloride-channel currents using patchclamp methods. The effects of capsaicin were compared with those of genistein, a well-characterized CFTR activator. In whole-cell experiments, capsaicin potentiates cAMP-stimulated wild-type CFTR currents expressed in NIH 3T3 cells or Chinese hamster ovary cells in a dose-dependent manner with a maximal response ϳ60% of that with genistein and an apparent K d of 48.4 Ϯ 6.8 M. In cell-attached recordings, capsaicin alone fails to activate CFTR in cells that show negligible basal CFTR activity, indicating that capsaicin does not stimulate the cAMP cascade. The magnitude of potentiation with capsaicin depends on the channel activity before drug application; the lower the prestimulated P o , the higher the potentiation. Single-channel kinetic analysis shows that capsaicin potentiates CFTR by increasing the opening rate and decreasing the closing rate of the channel.

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“…Positive stool cultures for C. difficile have been reported in up to 43% of individuals with CF but patients with toxin producing strains were asymptomatic [1] and overall the reported incidence of symptomatic C. difficile infection is low [2]. No individuals attending our CF centre had been diagnosed with C. difficile colitis until 2006 and the cause of this apparent cluster remains unclear.…”

Section: Discussionmentioning

confidence: 97%

Clostridium difficile pancolitis in adults with cystic fibrosis

Barker

Haworth

Williams

et al. 2008

Journal of Cystic Fibrosis

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We report three cases of Clostridium difficile pancolitis in adults with cystic fibrosis (CF) in whom the presenting symptoms were atypical. All three required treatment with systemic steroids, in addition to oral vancomycin and metronidazole to achieve resolution of the colitis. This experience suggests that C. difficile colitis should be considered in individuals with CF presenting with non-specific abdominal symptoms.

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Atypical presentation of Clostridium difficile colitis in patients with cystic fibrosis.

Cited by 39 publications

References 4 publications

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Capsaicin Potentiates Wild-Type and Mutant Cystic Fibrosis Transmembrane Conductance Regulator Chloride-Channel Currents

Clostridium difficile pancolitis in adults with cystic fibrosis

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