Clostridium difficile in haematological malignancy.
Twenty patients with haematological malignancies who developed Clostridium difficile bowel infection or colonisation are described. All isolates of C difficile were toxigenic in vitro and faecal cytotoxin (toxin B) was detected in 20/26 episodes. Ten of 20 episodes with detectable faecal cytotoxin were associated with typical antibiotic associated diarrhoea. In the other 10 episodes (nine patients), there was a severe unusual illness which was associated with detection of C difficile. The unusual features of the illness were pronounced jaundice (total bilirubin greater than or equal to 44 mumol/l), abdominal pain and distension, and initial constipation followed either by diarrhoea or by large bowel stasis. Four of these patients died within seven days. Bacteraemia was often a presenting feature in neutropenic patients subsequently shown to have C difficile. This was not the case in non-neutropenic patients. Bacteraemia was commonly polymicrobial and in two cases C difficile was isolated from blood culture. The clinical implications of recognition of this atypical C difficile associated syndrome are discussed.
D000293:Adolescent; D000328:Adult; D000368:Aged; D003013:Clostridium / Q000302:isolation & purification; D003015:Clostridium Infections / Q000150:complications*; D003603:Cytotoxins / Q000032:analysis; D003967:Diarrhea / Q000150:complications; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications*; D007945:Leukemia, Lymphoid / Q000150:complications / Q000382:microbiology; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D018805:Sepsis / Q000150:complications
D003603:Cytotoxins