Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents

Stampfer, Laura; Deutschmann, Andrea; Dür, Elisabeth; Eitelberger, Franz; Fürpass, Theresia; Gorkiewicz, Gregor; Heinz‐Erian, Peter; Heller, Ingrid; Herzog, Kathrin; Hopfer, Barbara; Kerbl, Reinhold; Klug, E; Krause, Robert; Leitner, Eva; Mache, Christoph J.; Müller, Thomas; Pansy, Jasmin; Pocivalnik, Mirjam; Scheuba, Eva; Schneditz, Georg; Schweintzger, Gerolf; Sterniczky, Edith; Zechner, Ellen L.; Hauer, A.; Högenauer, Christoph; Hoffmann, K. Martin

doi:10.1097/md.0000000000007793

Cited by 14 publications

(14 citation statements)

References 32 publications

(63 reference statements)

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“…In a study of children aged 0–2 years that included 6,625 diarrheal stool specimens, adenovirus detection was similar in children with and without blood in their stools 37 . Although norovirus was detected in specimens from only 4.5% of children and adolescents with hematochezia in Austria, 2 a study of norovirus‐associated gastroenteritis in Brazil reported the presence of hematochezia in over 10% of children and adults 38 . These findings are in‐keeping with our detection of norovirus in 11.3% of children with hematochezia.…”

Section: Discussionmentioning

confidence: 98%

Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study

Böhrer¹,

Fitzpatrick

Hurley

et al. 2022

Academic Emergency Medicine

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Objectives: Although the passage of blood in stools in children represents a medical emergency, children seeking emergency department (ED) care remain poorly characterized. Our primary objective was to compare clinical characteristics and etiologic pathogens in children with acute diarrhea with and without caregiver-reported hematochezia. Secondary objectives were to characterize interventions and resource utilization. Methods:We conducted a secondary analysis of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) database. Children <18 years presenting to two pediatric EDs within a 24-hour period and <7 days of symptoms were consecutively recruited. Results: Of 1,061 participants, 115 (10.8%) reported hematochezia at the enrollment visit at which time those with hematochezia, compared to those without, had more HEMATOCHEZIA IN CHILDREN WITH ACUTE DIARRHEA SEEKING EMERGENCY DEPARTMENT CARE -A PROSPECTIVE COHORT STUDY INTRODUC TI ON Acute onset of blood in stools is a medical emergency 1 with etiologies varying with age. 2 Bacterial infections are a common consideration in children with hematochezia across all age groups 2 with Shigella spp., Campylobacter spp., Salmonella spp., Yersinia spp., Escherichia coli O157:H7, and other Shiga toxin-producing E. coli (STEC) being most often implicated. 1 However, viruses such as rotavirus, enteric adenovirus, and norovirus have also been detected in children in whom the diarrhea contains visible blood, but the pathogenesis remains unclear. 3,4 Furthermore, Clostridioides difficile infection must also be considered in the appropriate clinical scenario, with the most important risk factors being recent antibiotic use and hospitalization. 5,6 Pediatric bacterial enteric infections are associated with an acute onset of diarrhea, greater stool frequency in the 24 hours before emergency department (ED) presentation, abdominal tenderness, absence of vomiting, history of fever, 1,3,7-12 and spring/summer seasonality. 8,10,12-14 Although reports have described the etiologies of bloody stools associated with gastroenterology consultation and care, to the best of our knowledge, no publications have focused on the clinical features, infectious etiologies, and health care resource use of children with acute hematochezia seeking ED care. We sought to fill this knowledge gap by conducting a secondary analysis of the Alberta Provincial Pediatric EnTeric TEam (APPETITE) dataset. The latter was created through the conduct of a large, prospective cohort study of children with vomiting and diarrhea that conducted extensive stool testing using a broad, nucleic acid-based, enteropathogen detection strategy. 15-19 Our primary objective was to describe and compare the clinical characteristics and infectious etiologies of children with acute diarrhea and hematochezia presenting for ED care to those without hematochezia. Secondary objectives included a description and comparison of health care resource utilization by children with and without hematochezia. ME THODS Study design and p...

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Section: Discussionmentioning

confidence: 98%

Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study

Böhrer¹,

Fitzpatrick

Hurley

et al. 2022

Academic Emergency Medicine

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“…The principal virulence factors of Clostridium di cile (C.di cile), toxins A, B and ADP-ribosyltransferase (CDT) 37 , are the main causes of pseudomembranouscolitis 24 ,accounting for 15-25% of the antibioticassociated bloody diarrhea (AABD) inpatients 38 , especially in the aging population 22 . However, only 14% C.di cile infection presents bloody stools 39 . The morbidity rate of AAC increased because most patients developed secondary infection withC.di cile 3 .…”

Section: Treatment and Follow-up Resultsmentioning

confidence: 99%

“…AAC might be caused by other pathogens in addition to K.oxytocaor C.di cile 39 .StampfeLet al 39 reported AAC:antibiotic associated colitis; AAHC:antibiotic associated hemorrhagic colitis; CNKI:Chinese national knowledge infrastructure; WBC:white blood cell count; HGB:The laboratory tests for hemoglobin; RBC: red blood cell count; ESR:erythrocyte sedimentation rate; CRP:C-reactive protein; CT:computed tomography; K. oxytoca:Klebsiella oxytoca; OB:occult blood; CDT:ADP-ribosyltransferase; AABD:antibiotic-associated bloody diarrhea.…”

Section: Treatment and Follow-up Resultsmentioning

confidence: 99%

Clinical and Pathological Characteristics of Amoxicillin Associated Hemorrhagic Colitis

Liu

Gao

et al. 2021

Preprint

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Background and objective: Amoxicillin is an antibiotic with various benefits for patients. However, adverse reactionssometimes occur, and the clinical misdiagnosis rate is highbecause some clinicians have limited knowledge regarding this drug. Combined with literature review, this study explores the clinical pathological features of hemorrhagiccolitis caused by amoxicillin to improveits diagnosis and treatment. Methods: “Amoxicillin”, “hemorrhagiccolitis”, “antibioticassociated colitis (AAC) ”, “antibioticassociated hemorrhagic colitis (AAHC) ”were used as the index words to retrieve Pubmed, EMbase, Wanfang Database and Chinese national knowledge infrastructure (CNKI). Related articles were then selected and combined with thepatient information obtained from our department to complete the clinical pathological files.To summarize the clinicopathological data, diagnosis, treatmentof the disease.Results: A total of 19 articles were included in the study. Patients may have abdominal pain, bloody stools or blood in the stool, but generally no anemia.The laboratory tests for hemoglobin (HGB) and erythrocyte sedimentation rate (ESR) are normal, andC-reactive protein (CRP) is often elevated. Abdominal ultrasound and computed tomography (CT) findings revealed that the intestinal wall wasthickened and presented edema, and some partsexhibited peritoneal effusion.Upper gastrointestinal endoscopy usually has no bleeding changes. A colonoscope was used to reveal the mucosal erosion, mainly found on the right hemicolon and this finding was consistent with acute colitis. The pathology is consistent with acute hemorrhagic colitis.The symptoms were relieved after drug withdrawal and principally with supportive treatment. The patient’s gastrointestinal symptoms usually did not recur.Conclusion: Patients with acute colitis caused by amoxicillingenerally experienced abdominal cramps and bloody stools, but treatment response was good, and follow-up monitoring revealed norecurrence. The history of antibiotic therpy and early total colonoscopy examination are important to establish the correct diagnosis. Klebsiella oxytoca (K. oxytoca) were cultured in fourteen cases, which is described as a causative organism for AAHC.

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“…Apart from autoimmunity, pathogens also exploit the role of indole metabolism in maintaining homeostasis in the host. The pathobiont Klebsiella oxytoca secretes the indole analog tilivalline to induce antibiotic-associated hemorrhagic colitis (Stampfer et al, 2017). Substantially simplified tilivalline mimics block the production of tilivalline (von Tesmar et al, 2018).…”

Section: Downloaded Frommentioning

confidence: 99%

Weak Microbial Metabolites: a Treasure Trove for Using Biomimicry to Discover and Optimize Drugs

et al. 2020

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Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 32 publications

Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study

Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study

Clinical and Pathological Characteristics of Amoxicillin Associated Hemorrhagic Colitis

Weak Microbial Metabolites: a Treasure Trove for Using Biomimicry to Discover and Optimize Drugs

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