Pseudomembranous Enterocolitis in Childhood

Buts, Jean-Paul; Weber, Andrée; Roy, Claude; Morin, Claude

doi:10.1016/s0016-5085(19)31791-3

Cited by 31 publications

(3 citation statements)

References 27 publications

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“…In children, AAC appears to be a rare condition (4, 5,6). Whereas C. difjficile occurs in a high proportion (60%) of infants 1-8 months old, it is comparatively uncommon (less than 5%) in infants below and above that age (7).…”

mentioning

confidence: 99%

CLOSTRIDIUM DIFFICILE TOXIN IN FAECAL SPECIMENS OF HEALTHY CHILDREN AND CHILDREN WITH DIARRHOEA

et al. 1982

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Presence of cytopathogenic effect (CPE) that could be inhibited by an antitoxin to Clostridium sordelli, known to cross-react with Clostridium difficile toxin, was sought in faecal specimens from 101 infants. Of the children, 45 were healthy, while 56 had been hospitalized because of diarrhoea. CPE was found in 12 of the healthy infants and in 5 of those hospitalized. Faecal specimens of these 5 gave a CPE at titres of 10(3-4), whereas in the 12 healthy infants the titres were 10(1-2). Studies on consecutive samples showed that the CPE could persist for between 7-11 weeks up to 9 months and more. Of the 45 healthy infants, 11 harboured C. difficile compared with 6 of the 56 with diarrhoea. In both groups, 3 CPE-positive infants were culture-negative for C. difficile. Four of those hospitalized had recently been given antibiotics; all were negative in both culture and CPE tests. The present study demonstrates that care should be exercised when interpreting the results of cultures for C. difficile and tests for CPE made on faecal specimens in order to establish a diagnosis of antibiotic-associated enterocolitis in infants and children.

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confidence: 99%

CLOSTRIDIUM DIFFICILE TOXIN IN FAECAL SPECIMENS OF HEALTHY CHILDREN AND CHILDREN WITH DIARRHOEA

et al. 1982

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“…In neonates and infants, however, its role in intestinal diseases has been questioned (2,3). Asymptomatic carriage of nontoxinogenic as well as toxinogenic isolates is frequent until the age of 2 years (4), and only a few cases of pseudomembra- nous colitis related to C. difficile have been reported in infants (5,6). Although the association of toxinogenic strains of C. difficile with chronic diarrhea, Hirschsprung's disease, necrotizing enterocolitis, and relapses of inflammatory bowel disease has been described in children (7)(8)(9), systematic antibiotic therapy for children with diarrhea and fecal C. difficiLe toxin remains controversial because of the absence of objective criteria of pathogenicity.…”

Section: Saccharomyces Boulardii For Clostridium Difficile-associated...mentioning

confidence: 99%

Saccharomyces boulardii for Clostridium difficile‐Associated Enteropathies in Infants

Buts,

Corthier,

Delmee

1993

J. pediatr. gastroenterol. nutr.

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SummaryBased on experimental evidence in animals showing that the oral administration of Saccharomyces boulardii is effective in reducing morbidity and mortality due to Clostridium difficile‐induced pseudomembranous colitis, we conducted an open trial to examine the effects of the living yeast, given as primary therapy, in a selected group of infants and children with persistent intestinal symptoms related to toxinogenic C. difficile overgrowth. Over a period of 10 consecutive months, we studied 19 eligible patients (median age 8 months) who presented with enteral symptoms lasting for > 15 days and who had solely C. difficile in stools with positive cytotoxin B assay. Serotyping of the strains and determination in vitro of production of toxins A and B were performed subsequently. The patients presented with persistent or protracted diarrhea, malabsorption, and failure to grow (n = 8), or with repeated attacks of colics, emesis, and hypermeteorism without diarrhea (n = 4), or with both entities (n = 7). Patients with chronic protracted diarrhea (n = 3) had‐depressed jejunal disaecharidase activities and ultrastructural changes of enterocytes, including sparce and shortened microvilli. None had evidence of colitis. All the strains of C. difficile tested (n = 17) belonged to pathogenic serotypes (A1, A8, C, F, G, H, and K) and produced in vitro high levels of toxins A (n = 16) and B (n = 17). S. boulardii was given orally in a lyophilized form over 15 days (250 mg two to four times per day according to age). Within 1 week of treatment, enteral symptoms and physical findings resolved in 18 patients (95%) with marked decreases (p < 0.001) in the number of stools, frequency of colic episodes, and total duration of colics per day. Clearing of toxin B was observed within 15 days of therapy in 16 cases (85%), whereas eradication of C. difficile from stools was complete after 1 month in 14 (73%). Also, the ultrastructural changes observed in patients with chronic protracted diarrhea (n = 3) had disappeared after 1 month. A clinical and bacteriological relapse occurred in two patients (11%), which resolved rapidly with a second 15‐day course of S. boulardii. These findings suggest that some toxinogenic strains of C. difficile may cause chronic enteropathies without colitis that may be improved by oral administration of S. boulardii.

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“…10,11,15,20,30,35,80,84,86]. Beschrieben ist diese Komplikation namentlich ffir Lincomycin, dessen besser resorbierbares 7-chloro-Derivat Clindamycin und ffir Ampicillin, aber auch ffir Penicillin, Amoxicillin, Cloxacillin, Erythromycin, Cephalosporine, Aminoglycoside, Tetracycline, Chloramphenicol und Sulfonamide [u.a.…”

Section: Antibiotikaunclassified

Antibiotika-assoziierte Diarrhoe und Enterocolitis

Loeschke

1980

Klin Wochenschr

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Many antibiotics, particularly the lincomycins, may cause diarrhoea with or without enterocolitis. The pathogenesis of antibiotic-associated diarrhoea without colitis is uncertain; colloidosmotic water binding in the colon by endogenous glycoproteins undegraded by colonic bacteria is considered. Antibiotic-associated enterocolitis is now known to be due to toxin-producing clostridia, proven for Cl. difficile. Improved methods for the detection of toxin and clostridia are presently being studied. Endoscopically, pseudomembranes are characteristic but not antibiotic-specific, they may be absent or missed diagnostically. A possible role of asymptomatic clostridia-carriers in enterocolitis clustering remains to be determined. The potentially lethal course of the disease requires rapid diagnosis and therapy, with discontinuation of the antibiotic, intensive supportive measures and, at least in severe disease, oral vancomycin.

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Pseudomembranous Enterocolitis in Childhood

Cited by 31 publications

References 27 publications

CLOSTRIDIUM DIFFICILE TOXIN IN FAECAL SPECIMENS OF HEALTHY CHILDREN AND CHILDREN WITH DIARRHOEA

CLOSTRIDIUM DIFFICILE TOXIN IN FAECAL SPECIMENS OF HEALTHY CHILDREN AND CHILDREN WITH DIARRHOEA

Saccharomyces boulardii for Clostridium difficile‐Associated Enteropathies in Infants

Antibiotika-assoziierte Diarrhoe und Enterocolitis

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