Toxic megacolon complicating a Clostridium difficile infection in a pregnant woman

Candiotto, Alberto; Pascoli, Irene; Gritti, Alessandra; Busato, Enrico; Pozzo, G

doi:10.1099/jmm.0.012526-0

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…As far as we could ascertain, apart from 1 case report of toxic megacolon in a pregnant woman with no apparent risk factors for CDI, there have been no reports from the United Kingdom or Europe. 19 All our patients had antibiotics prescribed at a mean time of 14.5 days after delivery. Also, in our cohort of cases, the mean duration from the time of last antibiotic exposure to the development of CDI was 14 days.…”

Section: Discussionmentioning

confidence: 99%

“…A search of literature from all languages on Medline PubMed, EMBASE, and CINAHL from 1946 to January 2018 was performed. We identified 11 retrospective studies 3-5,7-12 and 8 case reports 8,[17][18][19][20][21][22][23] on CDI in peripartum/pregnant/postpartum women ( Table 3). All studies were from the United States, with the exception of our current study and 3 case reports.…”

Section: Review Of Literature On Pregnancy and Peripartum C Difficilmentioning

confidence: 99%

See 1 more Smart Citation

Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature

Meda

Virgincar

Gentry

et al. 2019

American Journal of Infection Control

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Section: Discussionmentioning

confidence: 99%

Section: Review Of Literature On Pregnancy and Peripartum C Difficilmentioning

confidence: 99%

Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature

Meda

Virgincar

Gentry

et al. 2019

American Journal of Infection Control

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“…No traditional risk factors of CDI were documented in that case. 23 Toxic megacolon complicating PMC is associated with a mortality rate of 38%-80%. 6,24 There is a striking lack of current reliable data on the epidemiology of toxic megacolon.…”

Section: Epidemiologymentioning

confidence: 99%

“…These findings may represent distinguishing pathomorphological features of colonic dilatation due to colitic conditions as opposed to congenital megacolon in Hirschsprung's disease in which aganglionosis is the defining histological finding. 23 …”

Section: Pathogenesismentioning

confidence: 99%

Toxic megacolon

and

Baumgart

2012

Inflammatory Bowel Diseases

122

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Toxic megacolon represents a dreaded complication of mainly inflammatory or infectious conditions of the colon. It is most commonly associated with inflammatory bowel disease (IBD), i.e., ulcerative colitis or ileocolonic Crohn's disease. Lately, the epidemiology has shifted toward infectious causes, specifically due to an increase of Clostridium difficile-associated colitis possibly due to the extensive (ab)use of broad-spectrum antibiotics. Other important infectious etiologies include Salmonella, Shigella, Campylobacter, Cytomegalovirus (CMV), rotavirus, Aspergillus, and Entameba. Less frequently, toxic megacolon has been attributed to ischemic colitis, collagenous colitis, or obstructive colorectal cancer. Toxic colonic dilatation may also occur in hemolytic-uremic syndrome (HUS) caused by enterohemorrhagic or enteroaggregative Escherichia coli O157 (EHEC, EAEC, or EAHEC). The pathophysiological mechanisms leading to toxic colonic dilatation are incompletely understood. The main characteristics of toxic megacolon are signs of systemic toxicity and severe colonic distension. Diagnosis is made by clinical evaluation for systemic toxicity and imaging studies depicting colonic dilatation. Plain abdominal imaging is still the most established radiological instrument. However, computed tomography scanning and transabdominal intestinal ultrasound are promising alternatives that add additional information. Management of toxic megacolon is an interdisciplinary task that requires close interaction of gastroenterologists and surgeons from the very beginning. The optimal timing of surgery for toxic megacolon can be challenging. Here we review the latest data on the pathogenesis, clinical presentation, laboratory, and imaging modalities and provide algorithms for an evidence-based diagnostic and therapeutic approach.

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“…Those with serious CD infection often have a high degree of comorbidity and long exposure to antibiotics [10]. Only a few case reports indicate that grave CD 027 infections can also occur in patients without significant comorbidity [11,12]. To emphasize the risk of fulminant pseudomembranous colitis (PMC) associated with CD 027, we report a case in a patient with modest comorbidity given short-term cephalosporin treatment.…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile 027-associated pseudomembranous colitis after short-term treatment with cefuroxime and cephalexin in an elderly orthopedic patient: a case report

2012

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BackgroundClostridium difficile ribotype 027 has become increasingly prevalent in European countries. The clinical picture varies from self-limiting diarrhea to pseudomembranous colitis with toxic megacolon and ultimately death. Use of antibiotics is the principal risk factor; others include comorbidity, advanced age and hospitalization. However even with extensive knowledge of risk factors, it remains difficult to define “minimum risk,” as illustrated by the following case.Case presentationAn 80-year-old Danish man in good health was hospitalized for a penetrating knee injury. He received 5 days of intravenous cefuroxime after surgical revision and was discharged with oral cephalexin. Post-discharge he suffered from abdominal discomfort and was readmitted with ileus 4 days after discharge, i.e. 10 days after initiation of antibiotic treatment. His condition deteriorated, and pseudomembranous colitis was diagnosed. Due to lack of response to vancomycin and metronidazole, a total colectomy was performed. Stool cultures were positive for CD 027.ConclusionShort-term use of cephalosporins may have induced CD 027 infection, and the patient’s age was the only identifiable risk factor for the fulminant course. Thus, even short-term prophylactic treatment with cephalosporins cannot be considered entirely safe.

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Toxic megacolon complicating a Clostridium difficile infection in a pregnant woman

Cited by 9 publications

References 10 publications

Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature

Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature

Toxic megacolon

Clostridium difficile 027-associated pseudomembranous colitis after short-term treatment with cefuroxime and cephalexin in an elderly orthopedic patient: a case report

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