Saccharomyces boulardii for Clostridium difficile-associated enteropathies in infants.
Based on experimental evidence in animals showing that the oral administration of Saccharomyces boulardii is effective in reducing morbidity and mortality due to Clostridium difficile-induced pseudomembranous colitis, we conducted an open trial to examine the effects of the living yeast, given as primary therapy, in a selected group of infants and children with persistent intestinal symptoms related to toxinogenic C. difficile overgrowth. Over a period of 10 consecutive months, we studied 19 eligible patients (median age 8 months) who presented with enteral symptoms lasting for > 15 days and who had solely C. difficile in stools with positive cytotoxin B assay. Serotyping of the strains and determination in vitro of production of toxins A and B were performed subsequently. The patients presented with persistent or protracted diarrhea, malabsorption, and failure to grow (n = 8), or with repeated attacks of colics, emesis, and hypermeteorism without diarrhea (n = 4), or with both entities (n = 7). Patients with chronic protracted diarrhea (n = 3) had depressed jejunal disaccharidase activities and ultrastructural changes of enterocytes, including sparce and shortened microvilli. None had evidence of colitis. All the strains of C. difficile tested (n = 17) belonged to pathogenic serotypes (A1, A8, C, F, G, H, and K) and produced in vitro high levels of toxins A (n = 16) and B (n = 17). S. boulardii was given orally in a lyophilized form over 15 days (250 mg two to four times per day according to age).(ABSTRACT TRUNCATED AT 250 WORDS)
Buts
J P
JP
Laboratory of Paediatric Gastroenterology and Nutrition, Catholic University of Louvain, Brussels, Belgium.
Corthier
G
G
Delmee
M
M
D000284:Administration, Oral; D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D016360:Clostridioides difficile / Q000145:classification; D003967:Diarrhea / Q000209:etiology; D003968:Diarrhea, Infantile / Q000209:etiology; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000628:therapy*; D004768:Enterotoxins / Q000032:analysis; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000648:ultrastructure; D008297:Male; D012440:Saccharomyces; D012703:Serotyping; D016896:Treatment Outcome
D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile