Clostridium difficile-associated disease in children with solid tumors

Castagnola, Elio; Battaglia, Teresa; Bandettini, Roberto; Caviglia, Ilaria; Baldelli, Ivana; Nantron, Marilina; Moroni, C.; Garaventa, Alberto

doi:10.1007/s00520-008-0507-0

Cited by 40 publications

(28 citation statements)

References 17 publications

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“…Most reported cases have been associated with haematological malignancies, but a recent Italian study demonstrated that 6 % of children with solid tumours had C. difficile toxin A in their stools and gastrointestinal symptoms, with three out of nine of these being under 1 year old [93]. An earlier prospective study of oncology patients demonstrated higher rates of toxin detection in asymptomatic (19 %) than in symptomatic (8.7 %) children, questioning the significance of C. difficile as a pathogen in this patient group [74].…”

Section: Children With Co-morbiditiesmentioning

confidence: 96%

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Morris

Tebruegge

Pallett

et al. 2012

Advances in Experimental Medicine and Biology

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The clinical significance of the presence of Clostridium difficile in children's faeces remains uncertain using current diagnostic procedures. Clostridium difficile is a relatively common finding in infants with no symptoms of gastrointestinal disease, suggesting it may be an incidental finding and form part of the normal gut micro-flora in this age group. On the other hand, particularly in older children or those with significant co-morbidity, there are examples where C. difficile causes disease and exerts considerable morbidity and even mortality (C. difficile infection, CDI). Between these extremes lie a substantial group of children who have both diarrhoea and C. difficile in their stools but where the nature of the association is not clear: Clostridium difficile associated disease (CDAD). We review the significance of C. difficile in children presenting recently uncovered paediatric data from a large UK epidemiological study that informs some key unanswered questions.

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Section: Children With Co-morbiditiesmentioning

confidence: 96%

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Morris

Tebruegge

Pallett

et al. 2012

Advances in Experimental Medicine and Biology

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“…Similarly, metronidazole was the treatment of choice in an Italian prospective study of CDI in children with solid tumours and lymphomas. 7 None progressed to pseudomembranous colitis or died. C. difficile was the only pathogen found in two cases of severe enterocolitis reported from one centre.…”

Section: Treatment and Outcomementioning

confidence: 99%

“…7 The age range was 11 monthse17 years (median 5.5 years). All had abdominal pain and 8 had diarrhoea, though none progressed to pseudomembranous colitis and none died.…”

Section: Incidence and Epidemiologymentioning

confidence: 99%

Clostridium difficile in children: Colonisation and disease

Enoch

Butler

Pai

et al. 2011

Journal of Infection

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“…The risk factors associated with C. difficile infection include recent antibiotic therapy, prolonged hospitalization, advanced age, and immunosuppression [3]. Children with solid tumors, children who underwent organ transplantation, and children with inflammatory bowel disease (IBD) are also at increased risk [4,5,6]. IBD patients are particularly challenging as their active disease is often indistinguishable from the clinical presentation of infection with C. difficile [7].…”

Section: Introductionmentioning

confidence: 99%

Incidence of Clostridium difficile Infection in Children with Inflammatory Bowel Disease Compared to Oncology and Immunocompetent Patients

Hojsak

Ferenc²,

Bojanić³

et al. 2012

Digestion

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Aims: The aim of this study was to determine the incidence of Clostridium difficile infection in hospitalized children with inflammatory bowel disease (IBD) and to compare it to other immunosuppressed patients at risk (oncology patients) as well as to immunocompetent patients. Methods: We analyzed data from all hospitalized children who underwent stool detection of C. difficile toxins A and B (n = 757) in a 5.5-year study period. Results: The number of positive tests was significantly increased in the oncology group compared to the IBD group (12.45 vs. 6.02%, p = 0.03) and immunocompetent group (12.45 vs. 5.7%, p = 0.01). Patients who had C. difficile infection used antibiotics prior to the test more often than patients who did not (12.69 vs. 1.73%, p = 0.03). Pearson’s correlation was positive for C. difficile infection and both antibiotics and immunosuppressants, while no correlation was found regarding age and gender. There were no significant differences regarding either IBD diagnosis (Crohn’s disease vs. ulcerative colitis, p = 0.71) or treatment used for IBD (p = 0.53) and C. difficile infection. Conclusion: In our setting, the incidence of C. difficile infection among hospitalized children with active IBD was found to be low. Children at increased risk for C. difficile infection were oncology patients receiving immunosuppressants and antibiotics.

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Clostridium difficile-associated disease in children with solid tumors

Abstract: CDAD may be a complication of children with solid tumours. Since this disease may be life threatening and cause epidemic clusters, this possibility must be kept in mind for the differential diagnosis of abdominal diseases in children with cancer, especially in absence of neutropenia.

Cited by 40 publications

References 17 publications

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Clostridium difficile in children: Colonisation and disease

Incidence of Clostridium difficile Infection in Children with Inflammatory Bowel Disease Compared to Oncology and Immunocompetent Patients

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