Pseudomembraneous clostridium after autologous bone marrow transplantation

Abstract

Summary:Clostridium difficile (C. difficile) pseudomembraneous colitis was diagnosed in a 13-year-old boy with Hodgkin's disease 3 months after autologous bone marrow transplantation. Hematopoiesis was fully reconstituted at the time. C. difficile infection occurred after gall bladder empyema had been treated conservatively with i.v. antibiotics and prophylactic 4-week administration of oral amoxicillin. C. difficile colitis was diagnosed early and intensive supportive therapy combined with administration of i.v. and subsequently oral vancomycin therapy failed. It is a phenomenon rarely seen and successful eradication of the clostridium infection was only achieved by a combination of higher dose vancomycin with metronidazole. During the post-colitis recovery the patient experienced a relapse of Hodgkin's disease and died following further surgical intervention 137 days post-transplantation.

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

“…[2][3][4][5] These studies evaluated diarrhea occurring any time after HSCT up to 100 days after the transplant. The incidence of CDT+ diarrhea in these series ranged from 4% to 13%.…”

“…[2][3][4][5] However, none has focused specifically on C. difficile infections in the early post-transplant period, or symptomatic management. We sought to determine the incidence of CDT positivity at the time of initial diarrhea in autologous and allogeneic HSCT recipients.…”

Severity of Clostridium difficile–Associated Disease (CDAD) in Allogeneic Stem Cell Transplant Recipients: Evaluation of a CDAD Severity Grading System

“…However, studies of CDAD in hematopoietic cell transplantation patients disagree about the incidence of, severity of, and risk factors for CDAD. [2][3][4][5][6][7][8][9][10] A lack of differentiation between mild cases and severe cases of CDAD may explain some of these discrepancies. To address this deficiency and to further study CDAD outcomes among allogeneic stem cell transplant recipients, we developed and validated a grading system for CDAD severity using a modified version of the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE) and based on the presenting clinical CDAD symptoms.…”

High prevalence of diarrhea but infrequency of documented Clostridium difficile in autologous peripheral blood progenitor cell transplant recipients

“…Relatively few studies have addressed the issue of the frequency of diarrhea and C. difficile colitis in PBPC recipients, 11,12 although several studies have been performed in allogeneic bone marrow recipients. [13][14][15][16] The objectives of the current study were to compare the frequency of diarrhea with the frequency of a positive C. difficile toxin assay, in a representative group of patients undergoing PBPC transplant.…”