Ultrasound diagnosis of Clostridium difficile-associated diarrhea

Abstract

Clostridium difficile colitis is diagnosed using an immunoassay or polymerase chain reaction (PCR) assay for toxins A/B. Since ultrasound is frequently used as a screening test for hospitalized patients suffering from different abdominal morbidities, we searched for sonographic indicators of C. difficile infection (CDI). In a prospective and blinded case-control study, abdominal ultrasound was performed on hospitalized patients for whom stool samples were sent for C. difficile toxin immunoassay. All patients with positive toxin were included as the case group and patients with negative toxin comprised the control group. Sonographic parameters of both groups were compared. Demographic variables of the 67 patients in the toxin-positive group were similar to those of the 71 patients in the toxin-negative group. The sonographic parameters which were found to be associated with CDI included colonic wall thickening, appearing in 61 (91%) patients of the toxin-positive group versus 15 (21%) patients of the toxin-negative group (p < 0.001), and also internal ring (24 versus 0%, p < 0.001), external ring (15 versus 0%, p < 0.001), ascites (24 versus 10%, p < 0.001), and diminution of large bowel content (16 versus 1%, p < 0.001). Bowel wall thickening had high positive and negative predictive values (0.80 and 0.90, respectively), while the other features had only high positive predictive values (0.7-1.0). Abdominal ultrasound may contribute to the diagnosis of C. difficile colitis in patients developing hospital-acquired diarrhea.

Exploring the Diagnostic Spectrum of Children with Raised Faecal Calprotectin Levels

“…Sub-group analysis within the 500+ group µg/g showed that for children where the index FC was related to a new diagnosis of IBD, they were more likely to have abnormal abdominal USSs than if they had an infectious GI condition or subsequent IBD. While abnormalities may be seen in USSs in children with infectious diarrhoea [26][27][28], abdominal USSs carried out on children presenting with diarrhoea, bleeding diarrhoea, or weight loss have positive findings in approximately 20% of cases [29]. In one further study, abnormal USS findings did not distinguish between functional and organic conditions [16].…”

Imaging Inflammation and Infection in the Gastrointestinal Tract

“…As with most diseases of the GI tract, infection by nontyphoid Salmonella enterica (NTS), referred to as salmonellosis, presents with enterocolitis and symptoms such as abdominal pain, diarrhea, and fever [62][63][64]. Most often, this bacterial infection is acquired through consuming infected foods, primarily consisting of meats, eggs, and dairy products.…”

“…Approximately 20% of IBD patients are diagnosed during their childhood [99,104]. The effects of IBD have long-term impacts on children, namely growth failure or delays in puberty onset [63,100]. In 10-15% of IBD cases, CD and UC cannot be distinguished based on how they present in the patient, who is given an "IBD-unclassified" diagnosis.…”