Infectious Gastroenteritis in Bone-Marrow-Transplant Recipients

Yolken, Robert H.; Bishop, Catherine A.; Townsend, Timothy R.; Bolyard, Elizabeth; Bartlett, John G.; Santos, George W.; Saral, Rein

doi:10.1056/nejm198204293061701

Cited by 301 publications

(159 citation statements)

References 17 publications

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“…Rotavirus has been reported to be an important cause of ND, ranging from 5 to 78 % (Lam et al, 1989), and was attributed to 8 % of the cases of ND in the present study. In the current study, in the 22 cases where no infectious organism could be isolated, the diarrhoea was presumably non-infectious in origin or the result of infection by, for example, adenovirus or Norwalk virus, which have also been reported by the CDC (Yolken et al, 1982), varying from 8 to 29 % of cases. These viruses were not looked for in our study.…”

Section: Discussionsupporting

confidence: 53%

Diarrhoeagenic Escherichia coli as a predominant cause of paediatric nosocomial diarrhoea in India

Chandra

Singh

Taneja

et al. 2012

Journal of Medical Microbiology

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Intestinal nosocomial infections remain a major concern in paediatric wards leading to increased morbidity and mortality. This study determined the aetiological and epidemiological profile of nosocomial diarrhoea (ND) among children admitted to a hospital in India. During the period of January 2008 to June 2009, we consecutively enrolled 100 children between the age of 2 months and 14 years who developed ND as defined by the Centers for Disease Control and Prevention. A control group of patients matched for age and severity score but with no diarrhoea at admission or during their hospital stay (n550) were also enrolled. Stool samples were cultured for various pathogens using standard protocols. Clostridium difficile toxins and rotavirus antigen were detected using commercial ELISAs. Detection of diarrhoeagenic Escherichia coli was carried out by multiplex PCR assay. All patient details were noted. In this study, males predominated (77 %), and 56 % children were ,1 year of age and 96 % were ,5 years. The mean duration of diarrhoea and hospitalization in the case group was 3.2 days and 27.5 days, respectively. Malignancy and nasogastric tube usage were significant underlying factors for the development of ND. Diarrhoeagenic E. coli was the commonest agent (47 %: enterotoxigenic E. coli, enteroaggregative E. coli and enteropathogenic E. coli were isolated in 22, 18 and 7 % of patients, respectively). C. difficile toxin was seen in 9 % of cases, whilst rotavirus was found in 8 % of cases. Although rotavirus and C. difficile are major causative agents of hospital-acquired diarrhoea in the developed world, in this setting diarrhoeagenic E. coli was responsible for the majority of cases of hospital-acquired diarrhoea. ND was most common in children aged ,5 years.

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Section: Discussionsupporting

confidence: 53%

Diarrhoeagenic Escherichia coli as a predominant cause of paediatric nosocomial diarrhoea in India

Chandra

Singh

Taneja

et al. 2012

Journal of Medical Microbiology

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“…3 This report identified an increased mortality in patients with C. difficile and enteric viral infections and also a trend towards increased GVHD which was not statistically significant. Although recent studies have examined this issue in autologous transplants 6,7 without identifying any definite risk factor, the literature on C. difficile in allogeneic HSCT recipients remains scanty.…”

mentioning

confidence: 68%

Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality

Chakrabarti

Lees

et al. 2000

Bone Marrow Transplant

120

118

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Summary:We retrospectively evaluated 75 allogeneic stem cell transplant recipients to ascertain the incidence, risk factors and outcome of infection with Clostridium difficile. Ten patients (13%) had Clostridium difficile infection at a median of 38 days (range day −6 to day +72) following the transplant. There was no difference in the duration or severity of diarrhoea in patients with Clostridium difficile infection compared to the uninfected patients and no relationship to the prior antibiotic or chemotherapy usage, age, gender, underlying disease, donor type, CMV serostatus, total body irradiation or time to engraftment. The incidence of viral infections was increased in patients infected with Clostridium difficile (7/10 vs 15/65, P = 0.005, odds ratio 7.7), but the strongest association was with GVHD Ͼgrade 2 (5/10 vs 6/65 uninfected patients, P = 0.004, odds ratio 9.8). Patients infected with Clostridium difficile also suffered a higher non-relapse mortality with 7/10 patients succumbing to either GVHD or infections, compared to 19/65 patients in the uninfected group (P = 0.02, odds ratio 5.6). Thus Clostridium difficile infections in our study had a strong association with GVHD and increased non-relapse mortality. It is possible that Clostridium difficile toxin might predispose to increased severity of GVHD leading to an adverse outcome. Bone Marrow Transplantation (2000) 26, 871-876.

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“…[7][8][9] Yolken et al 7 found the presence of CDT+ stool in nine of 78 patients (11.5%). However, they examined stool samples twice weekly regardless of symptoms, and of the nine patients found to be CDT+, only five had diarrhea.…”

Section: Discussionmentioning

confidence: 97%

Rarity of toxigenic Clostridium difficile infections after hematopoietic stem cell transplantation: implications for symptomatic management of diarrhea

Tomblyn

Singhal

et al. 2002

Bone Marrow Transplant

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Summary:Diarrhea is a common complication of high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT). The frequent and prolonged use of multiple antibiotics in this setting can predispose to infection with toxigenic Clostridium difficile and the development of pseudomembranous colitis. Anti-motility agents are usually not administered in this setting until C. difficile infection has been excluded. The objective of this study was to determine the incidence of C. difficile toxin (CDT) positivity at the time of initial diarrhea in HSCT recipients, and to see if the practice of ensuring negative CDT assays prior to initiating symptomatic management of diarrhea needs modification. One hundred and nineteen patients with malignant diseases undergoing autologous or allogeneic HSCT were studied to determine the incidence of diarrhea and CDT positivity with initial diarrhea. One hundred and nine (91%) had diarrhea. Of these, only seven (6%) were CDT+ at the time of initial diarrhea. The median interval between onset of diarrhea and starting symptomatic antidiarrheal therapy was 1 day. There were no significant differences between the patients with CDT+ diarrhea and the others in terms of timing or severity of diarrhea, number or duration of antibiotic usage, or leukocyte count. The infection resolved in all patients with metronidazole therapy. Our data suggest that the incidence of CDT+ diarrhea is low in HSCT recipients. Concern about C. difficile infection should not delay symptomatic therapy of initial diarrhea in HSCT recipients.

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Infectious Gastroenteritis in Bone-Marrow-Transplant Recipients

Cited by 301 publications

References 17 publications

Diarrhoeagenic Escherichia coli as a predominant cause of paediatric nosocomial diarrhoea in India

Diarrhoeagenic Escherichia coli as a predominant cause of paediatric nosocomial diarrhoea in India

Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality

Rarity of toxigenic Clostridium difficile infections after hematopoietic stem cell transplantation: implications for symptomatic management of diarrhea

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