Recurrent Clostridium difficile colitis in cystic fibrosis: An emerging problem

Egressy, Katarine; Jansen, Michaelene; Meyer, Keith C.

doi:10.1016/j.jcf.2012.05.007

Cited by 21 publications

(20 citation statements)

References 12 publications

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“…CDI is increasingly seen in patient groups which prior to 2000 were considered to be at low-risk, i.e those with no recent exposure to antibiotics and in young adults [6]. A higher prevalence of CDI in patients with Inflammatory Bowel Disease (IBD) [7] and Cystic Fibrosis [8] has also been noted.…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile Modulates Host Innate Immunity via Toxin-Independent and Dependent Mechanism(s)

et al. 2013

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Clostridium difficile infection (CDI) is the leading cause of hospital and community-acquired antibiotic-associated diarrhoea and currently represents a significant health burden. Although the role and contribution of C. difficile toxins to disease pathogenesis is being increasingly understood, at present other facets of C. difficile-host interactions, in particular, bacterial-driven effects on host immunity remain less studied. Using an ex-vivo model of infection, we report that the human gastrointestinal mucosa elicits a rapid and significant cytokine response to C. difficile. Marked increase in IFN-γ with modest increase in IL-22 and IL-17A was noted. Significant increase in IL-8 suggested potential for neutrophil influx while presence of IL-12, IL-23, IL-1β and IL-6 was indicative of a cytokine milieu that may modulate subsequent T cell immunity. Majority of C. difficile-driven effects on murine bone-marrow-derived dendritic cell (BMDC) activation were toxin-independent; the toxins were however responsible for BMDC inflammasome activation. In contrast, human monocyte-derived DCs (mDCs) released IL-1β even in the absence of toxins suggesting host-specific mediation. Infected DC-T cell crosstalk revealed the ability of R20291 and 630 WT strains to elicit a differential DC IL-12 family cytokine milieu which culminated in significantly greater Th1 immunity in response to R20291. Interestingly, both strains induced a similar Th17 response. Elicitation of mucosal IFN-γ/IL-17A and Th1/Th17 immunity to C. difficile indicates a central role for this dual cytokine axis in establishing antimicrobial immunity to CDI.

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Section: Introductionmentioning

confidence: 99%

Clostridium difficile Modulates Host Innate Immunity via Toxin-Independent and Dependent Mechanism(s)

et al. 2013

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“…At 12 months follow-up, none of these patients experienced recurrent CDI despite having been exposed to further courses of antipseudomonal antibiotics. Official Case Reports Journal of the Asian Pacific Society of Respirology with CF including those who had received lung transplant [1,2]. Many patients with CF, including the three patients highlighted in this case report, did not have diarrhoea at their initial presentation with severe CDI.…”

Section: Case Reportmentioning

confidence: 86%

“…A literature search on Medline, EMBASE, and PubMed databases identified several reports of severe CDI in adults with CF including those who had received lung transplant . Many patients with CF, including the three patients highlighted in this case report, did not have diarrhoea at their initial presentation with severe CDI.…”

Section: Discussionmentioning

confidence: 99%

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Clostridium difficile infection in cystic fibrosis: an uncommon but life‐threatening complication

Piccolo

Tai

et al. 2016

Respirology Case Reports

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Adults with cystic fibrosis (CF) have significant rates of asymptomatic Clostridium difficile carriage and are frequently exposed to risk factors for C. difficile infection (CDI). Despite this, the rate of reported CDI in CF is low. We describe three cases of near fatal CDI in adults with CF and review the literature regarding presentation, management, and recurrence prevention. Early recognition is important as the clinical presentation may be atypical and the illness can be severe and even life‐threatening. Management can be complicated by respiratory and nutritional failure. CF‐related gastrointestinal dysfunction may alter the typical host–pathogen interaction between patient and C. difficile, potentially explaining the low rates of CDI and atypical presentation.

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“…In this setting, BAL, pepsin or bile salts may be a useful biomarker especially in patients in whom there is a high pre-test probability of severe GORD, such as CF patients or any LTR with vagal nerve injury-associated decreased gastric emptying. CF patients are also at risk from distal intestinal tract obstruction, older LTR are at risk from colonic complications such as diverticulitis, and in both groups, prolonged antibiotic use is associated with C. difficile colitis which can be very severe and even life threatening [324][325][326].…”

Section: Update On Lung Transplantationmentioning

confidence: 99%