Lymphopenia as a novel marker of Clostridium difficile infection recurrence

Lavergne, Valéry; Beauséjour, Yannick; Pichette, Gilbert; Ghannoum, Marc; Su, S.

doi:10.1016/j.jinf.2012.11.001

Cited by 15 publications

(8 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Frequent risk factors for recurrence are shown in Figure 2: age (9 studies) (Figure 2A), antibiotics during or after CDI diagnosis (7 studies) (Figure 2B), and use of PPIs (3 studies) (Figure 2C). The relative risk for recurrence ranged between 1.01 and 1.04 for each additional year of age [26]–[29],_ENREF_27 between 1.3 and 10.4 with age >65 years [26], [30]–[32], between 1.6 and 5.0 with use of antibiotics after CDI [20], [32]–[34], and between 1.4 and 18.2 with use of PPIs [20], [30], [35]. In four studies with different typing methods [33], [36]–[38], the hypervirulent strain (NAP1/BI/027) was associated with recurrence (Table 1), but this association was not significant in a study using genome sequencing [25].…”

Section: Resultsmentioning

confidence: 99%

“…Many other risk factors were examined, and among them three were considered as related to recurrent CDI, but each in only one or two studies (Figure 3). The role of the immune response was addressed in only three studies (Figure 3) [29], [32], [40], but all showed that recurrence was associated with low antibody titres (IgM and IgG anti-toxin A, and IL-8) [32], [40], and a positive C. difficile antitoxin serology (HR = 0.17; 95% CI = 0.05–0.59) [29].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Recurrence, Complications and Mortality in Clostridium difficile Infection: A Systematic Review

et al. 2014

View full text Add to dashboard Cite

Background Clostridium difficile infection (CDI) can lead to complications, recurrence, and death. Numerous studies have assessed risk factors for these unfavourable outcomes, but systematic reviews or meta-analyses published so far were limited in scope or in quality.MethodsA systematic review was completed according to PRISMA guidelines. An electronic search in five databases was performed. Studies published until October 2013 were included if risk factors for at least one CDI outcome were assessed with multivariate analyses.Results68 studies were included: 24 assessed risk factors for recurrence, 18 for complicated CDI, 8 for treatment failure, and 30 for mortality. Most studies accounted for mortality in the definition of complicated CDI. Important variables were inconsistently reported, such as previous episodes and use of antibiotics. Substantial heterogeneity and methodological limitations were noted, mainly in the sample size, the definition of the outcomes and periods of follow-up, precluding a meta-analysis. Older age, use of antibiotics after diagnosis, use of proton pump inhibitors, and strain type were the most frequent risk factors for recurrence. Older age, leucocytosis, renal failure and co-morbidities were frequent risk factors for complicated CDI. When considered alone, mortality was associated with age, co-morbidities, hypo-albuminemia, leucocytosis, acute renal failure, and infection with ribotype 027.ConclusionLaboratory parameters currently used in European and American guidelines to define patients at risk of a complicated CDI are adequate. Strategies for the management of CDI should be tailored according to the age of the patient, biological markers of severity, and underlying co-morbidities.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk Factors for Recurrence, Complications and Mortality in Clostridium difficile Infection: A Systematic Review

et al. 2014

View full text Add to dashboard Cite

show abstract

“…His cohort was male dominated, over 60 years of age, and many had cancer (Bulusu et al , 2000). Lavergne et al (2013) reported the presence of lymphopenia at the end of SOC treatment for CDI. These authors suggested that the initial T-cell response was not robust and the lymphopenia could be used as a transient biomarker for recurrence (Lavergne et al , 2013).…”

Section: Discussionmentioning

confidence: 99%

“…Lavergne et al (2013) reported the presence of lymphopenia at the end of SOC treatment for CDI. These authors suggested that the initial T-cell response was not robust and the lymphopenia could be used as a transient biomarker for recurrence (Lavergne et al , 2013). Forty-two per cent of this population was female and the mean age was 77, suggesting that age and immune senescence could also be involved.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile recurrence is characterized by pro-inflammatory peripheral blood mononuclear cell (PBMC) phenotype

Yacyshyn

Reddy

Plageman

et al. 2014

Journal of Medical Microbiology

View full text Add to dashboard Cite

Clostridium difficile infection (CDI) is a prevalent nosocomial and increasingly communityacquired problem. Little is known about the productive cellular response in patients. We used flow cytometry to define inflammatory (Th1 and Th17) and regulatory [Foxp3 + T-regulatory (Treg)] cells present in circulating peripheral blood mononuclear cells (PBMC) from CDI patients. We consented 67 inpatients that tested either positive or negative for CDI and 16 healthy controls and compared their PBMC phenotypes. PBMC were collected, isolated, and stained for CD3, CD8 and either IL17 (Th17), IFN-c (Th1) or Foxp3 (Treg) and analysed using flow cytometry. Twenty thousand events were collected in the lymphocyte gate (gate 1) and T-cell phenotypes were defined. CDI patients who clear the primary initial infection have greater numbers of non-CD3 PBMC. CDI patients who develop recurrence of CDI have a greater percentage of CD3 + CD8 + , CD3 + CD4 + Foxp3 and fewer low granular CD3 " Foxp3 + PBMC. These patients have greater numbers of IFN-c-producing lymphocytes, as well as PBMC phenotypes represented by increased IFN-c-and IL17-co-expressing CD4 + CD3 + . This initial proinflammatory phenotype decreases with repeated recurrence, demonstrating importance of timing of sample collection and history of symptoms. Patients with a history of recurrence had increased Foxp3 + CD3 + CD4 + and IL17 + CD3 + CD4 + populations. Hence, CDI recurrence is hallmarked by greater numbers of circulating CD3 + lymphocytes skewed towards a Th1/Th17 inflammatory population as well as possible immune plasticity (Th17/Treg).

show abstract

“…• Interferon gamma-secreting T follicular cells (110) • Protective Th17-mediated primary and recall response (150) • Poor initial T-cell and Tfh response in patients and infected mice (183,193) Antibodies (Abs) and Plasma cells (PC)…”

Section: Clostridioides Difficilementioning

confidence: 99%

Bacteria That Cause Enteric Diseases Stimulate Distinct Humoral Immune Responses

Amani

Lang

2020

Front. Immunol.

View full text Add to dashboard Cite

Bacterial enteric pathogens individually and collectively represent a serious global health burden. Humoral immune responses following natural or experimentally-induced infections are broadly appreciated to contribute to pathogen clearance and prevention of disease recurrence. Herein, we have compared observations on humoral immune mechanisms following infection with Citrobacter rodentium, the model for enteropathogenic Escherichia coli, Vibrio cholerae, Shigella species, Salmonella enterica species, and Clostridioides difficile. A comparison of what is known about the humoral immune responses to these pathogens reveals considerable variance in specific features of humoral immunity including establishment of high affinity, IgG class-switched memory B cell and long-lived plasma cell compartments. This article suggests that such variance could be contributory to persistent and recurrent disease.

show abstract

Lymphopenia as a novel marker of Clostridium difficile infection recurrence

Cited by 15 publications

References 43 publications

Risk Factors for Recurrence, Complications and Mortality in Clostridium difficile Infection: A Systematic Review

Risk Factors for Recurrence, Complications and Mortality in Clostridium difficile Infection: A Systematic Review

Clostridium difficile recurrence is characterized by pro-inflammatory peripheral blood mononuclear cell (PBMC) phenotype

Bacteria That Cause Enteric Diseases Stimulate Distinct Humoral Immune Responses

Contact Info

Product

Resources

About