Clinical and Pathological Features of Ulcerative Colitis in Patients with and without Clostridium Difficile Infection; An Observational Study

Abstract

BACKGROUND A dramatic rise in the rate of clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has been reported in recent years. METHODS In this observational case control study, 65 patients were included and were divided into two groups of IBD + CDI as case group and IBD without CDI as control group. RESULTS 35 patients who had positive test for clostridium difficile were assigned to the case group. The control group consisted of 30 patients with negative test for clostridium difficile. Pancolitis was seen in the cases more statistically significant than the controls and proctitis was seen more among the controls than the cases (p = 0.001). The cases were on immunosuppressive (p = 0.001) and antibiotic (p = 0.02) therapy more than the controls. Colonoscopic findings revealed more severe and extensive inflammation among the cases versus milder inflammation among the controls, but these differences were not statistically significant (p = 0.2). Colectomy was seen in 10% of controls and none of the cases and this difference was statistically significant (p value = 0.05). More fecal calprotectin were seen among the cases than the controls and this difference was statistically significant (p < 0.05) CONCLUSION This study showed more clostridium difficile infection among the patients on antibiotic or immunosuppressive therapy. Pathological investigation revealed more severe and extensive inflammation among the cases than the controls. Cases had clinically more severe signs and symptoms with higher mayo scores than the controls. ESR (Erythrocyte sedimentation rate) and fecal calprotectin were higher in patients with positive clostridium difficile infection and serum albumin was lower in such patients.

Gut Microbiota and Metabolite Changes in Patients With Ulcerative Colitis and Clostridioides difficile Infection

“…Clostridium XI (C. difficile belongs to this genus) is a well-known proinflammatory and colitis-inducing bacterium (Perez-Cobas et al, 2014;Aletaha et al, 2019). The cladogram shows that Clostridium XI belonged to the family Peptostreptococcaceae.…”

“…Clostridioides difficile (C. difficile) is a Gram-positive, obligate anaerobic bacillus, which can colonize the large intestine. The most common manifestation of C. difficile infection (CDI) is diarrhea (Aletaha et al, 2019). Compared to non-CDI patients, patients with CDI showed lower diversity and richness of gut microbiota and an overrepresentation of the members of Bacteroidaceae, Enterococcaceae, Lactobacillaceae, and Clostridium XI and XIVa (Perez-Cobas et al, 2014).…”

Fecal Calprotectin, CRP and Leucocytes in IBD Patients: Comparison of Biomarkers With Biopsy Results

“…FC is highly resistant to pancreatic and intestinal enzyme degradation, and thus, FC protein properties are ideally suited for home collections in stool samples, exhibiting impressive stability performance in most assays (approximately 7 days at room temperature), offering ample time for patients to transport specimens to the clinical laboratory for analysis. Many studies are currently evaluating the utility of FC for both identification of IBD as well as its quantitative relationship with severity of IBD ( 16–18 ). However, relatively little information is available characterizing the relationship between each parameter (i.e., CRP, leucocytes, FC and active inflammation) in patients being monitored.…”

Eosinophilic Colitis and Clostridioides difficile Sepsis With Rapid Remission After Antimicrobial Treatment; A Rare Coincidence and Its Pathogenic Implications

“…Nosocomial C. difficile strains exhibit high cytotoxicity and higher rates of recurrence and bloodstream infections ( 81 ). The occurrence of C. difficile infection in cases of inflammatory bowel disease leads to the activation of pro-inflammatory cytokines, including the IL-1β/Th17 axis ( 78 ) which aggravates the course of diseases ( 82 – 85 ), increases the risk of C. difficile recurrences ( 84 ) and raises the mortality by four times ( 86 ). Similarly the risk of sepsis in C. difficile infection is a severe event due to the altered intestinal barrier and the subsequent bacterial translocation ( 87 , 88 ).…”