Invading beyond bounds: extraintestinal<i>Clostridium difficile</i>infection leading to pancreatic and liver abscesses

Roy, Moni; Dahal, Kumud; Roy, Arindam

doi:10.1136/bcr-2017-220240

Cited by 5 publications

(7 citation statements)

References 37 publications

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“…Extraluminal C. difficile infection is not common, reflecting 0.1% of total C. difficile infections 1,2 . Extraintestinal manifestations include peritoneal infections, osteomyelitis, wound infection, perianal abscess, bacteremia, urinary tract infections, lung infections, and reactive arthritis 1,3–9 . Several cases of secondary bacterial peritonitis due to C. difficile have been previously described in the literature, but only 11 cases of SBP have been reported 1,3,4,10 …”

Section: Discussionmentioning

confidence: 99%

“…1,2 Extraintestinal manifestations include peritoneal infections, osteomyelitis, wound infection, perianal abscess, bacteremia, urinary tract infections, lung infections, and reactive arthritis. 1,[3][4][5][6][7][8][9] Several cases of secondary bacterial peritonitis due to C. difficile have been previously described in the literature, but only 11 cases of SBP have been reported. 1,3,4,10 Most reported infections of extracolonic C. difficile have been polymicrobial.…”

Section: Discussionmentioning

confidence: 99%

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A Difficult Microbiologic Diagnosis of Spontaneous Peritonitis

Palacios

Grant

2022

Infect Dis Clin Pract

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The patient is a 72-year-old man with a medical history of cirrhosis secondary to alcohol use who was admitted because of decompensated cirrhosis and ascites.Five months before his current admission, the patient was hospitalized for decompensated cirrhosis and found to have spontaneous bacterial peritonitis (SBP) with peritoneal cultures growing Bacteroides fragilis. He was treated with metronidazole for a 7-day course.On presentation, he reported 7 days of gradually worsening abdominal pain and distension and lower extremity edema, without diarrhea. On admission, temperature was 96.2°F, heart rate 72 beats per minute, respiratory rate 18 breaths per minute, and blood pressure 107/67 mm Hg. Physical examination was notable for mild respiratory distress, scleral icterus, and bibasilar crackles. Abdomen was soft, distended with a palpable fluid wave, and had mild tenderness to palpation over his epigastric area. The lower extremities were edematous, and on skin examination, there were diffuse spider angiomata and telangiectasias.Laboratory evaluation demonstrated a white blood cell count of 7.0 K/μL, hemoglobin 9.2 g/dL, and platelets 40 K/μL (baseline, 130 K/μL). His liver function tests were only remarkable for a total From the

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Difficult Microbiologic Diagnosis of Spontaneous Peritonitis

Palacios

Grant

2022

Infect Dis Clin Pract

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“…The most common form of symptomatic CDI is enterocolitis followed by pseudomembranous colitis, and less commonly, toxic megacolon [3] . Colitis is the most common manifestation of CDI but there are occasional reported cases of extraintestinal infections (EI) including bacteraemia, pyogenic liver abscess, intraabdominal abscess, and brain abscess [4][5][6] . Overall, the reported frequency of EI CDI is between 0.17% and 0.6% [6] .…”

Section: Discussionmentioning

confidence: 99%

Treatment of Extra-Intestinal Clostridioides difficile Abscess following Acute Appendicitis

Chatterjee

Roy

Ahmad

2022

European Journal of Case Reports in Internal Medicine

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Clostridioides difficile infection (CDI) commonly presents with diarrhoea, colitis, and in more severe cases, toxic megacolon. Extraintestinal Clostridioides difficile infection (EI CDI) is rarely reported. Intraabdominal abscesses are the most commonly reported EI CDI presentation. EI CDI-associated bacteraemia, as well as bone, lung, and even intracranial infections have been reported in the literature. EI CDI is usually seen in patients with multiple comorbidities. Due to the rarity of cases, no clear treatment guidelines exist, but metronidazole and vancomycin have been primarily used to treat EI CDI and additional antibiotics have been used for treatment when the isolates are polymicrobial. We report a case of a patient with significant comorbidities who developed EI CDI following acute ruptured appendicitis. She was successfully treated with drainage of abscess and intravenous metronidazole followed by oral metronidazole.

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“…It is important to report that most cases of extraintestinal CDI were polymicrobial in nature, Marina et al [26] reported on anaerobic pleuropulmonary infections and found that of 116 organisms isolated, only two were Cd and only one of these was isolated in a pure culture. Roy et al [27] described a patient presented with hepatic and pancreatic abscess with a polymicrobial infection. With the findings of sigmoid perforation, they considered the route of infection being translocation of bacteria across the gastrointestinal lumen due to colonic inflammation with direct seeding to the site.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Extraintestinal Clostridioides difficile Infections: Epidemiology in a University Hospital in Hungary and Review of the Literature

2020

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Extraintestinal manifestations of Clostridioides difficile infections (CDIs) are very uncommon, and according to the literature, poor outcomes and a high mortality have been observed among affected individuals. The objective of this study was to investigate the incidence rate of extraintestinal infections caused by C. difficile (ECD) in a tertiary-care university hospital in Hungary. During a 10-year study period, the microbiology laboratory isolated 4129 individual strains of C. difficile; among these, the majority were either from diarrheal fecal samples or from colonic material and only n = 24 (0.58%) were from extraintestinal sources. The 24 extraintestinal C. difficile isolates were recovered from 22 patients (female-to-male ratio: 1, average age: 55.4 years). The isolates in n = 8 patients were obtained from abdominal infections, e.g., appendicitis, rectal abscess or Crohn’s disease. These extraintestinal cases occurred without concomitant diarrhea. In all, but two cases C. difficile was obtained as a part of a polymicrobial flora. Our isolates were frequently toxigenic and mostly belonged to PCR ribotype 027. Resistance to metronidazole, vancomycin, clindamycin and rifampin were 0%, 0%, 20.5% and 9.7%, respectively. The increasing amount of reports of C. difficile extraintestinal infections should be noted, as these infections are characterized by a poor outcome and high mortality rate.

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Invading beyond bounds: extraintestinalClostridium difficileinfection leading to pancreatic and liver abscesses

Cited by 5 publications

References 37 publications

A Difficult Microbiologic Diagnosis of Spontaneous Peritonitis

A Difficult Microbiologic Diagnosis of Spontaneous Peritonitis

Treatment of Extra-Intestinal Clostridioides difficile Abscess following Acute Appendicitis

Extraintestinal Clostridioides difficile Infections: Epidemiology in a University Hospital in Hungary and Review of the Literature

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