Non-clostridium difficile induced pseudomembranous colitis

Pseudomembranous colitis is severe inflammation of the inner lining of the colon due to anoxia,ischemia,endothelial damage,and toxin production.The majority of cases of pseudomembranous colitis are due to Clostridium difficile.However,other causative pathogens and agents have been responsible for causing a similar pattern of injury to the bowel with the endoscopic appearance of yellow-white plaques and membranes on the mucosal surface of the colon.Common presenting symptoms and signs include crampy abdominal pain,nausea,watery diarrhea that can progress to bloody diarrhea,fever,leukocytosis,and dehydration.Negative testing for Clostridium difficile or failure to improve on treatment should prompt evaluation for other causes of pseudomembranous colitis.Bacterial infections other than Clostridium difficile,Viruses such as cytomegalovirus,parasitic infections,medications,drugs,chemicals,inflammatory diseases,and ischemia are other differential diagnoses to look out for in pseudomembranous colitis.Complications of pseudomembranous colitis include toxic megacolon,hypotension,colonic perforation with peritonitis,and septic shock with organ failure.Early diagnosis and treatment to prevent progression are important.The central perspective of this paper is to provide a concise review of the various etiologies for pseudomembranous colitis and management per prior literature.

Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication

Helicobacter pylori(H.pylori)is one of the most common chronic bacterial infections in humans,affecting half of world’s population.Therapy for H.pylori infection has proven to be both effective and safe.The oneweek triple therapy including proton pump inhibitor,clarithromycin,and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate H.pylori infection in countries with low clarithromycin resistance.Generally,this therapy is well-tolerated,with only a few and usually minor side effects.However,rare but severe adverse effects such as pseudomembranous colitis have been reported,Clostridium difficile(C.difficile)infection being the main causative factor in all cases.We report the cases of two women who developed pseudomembranous colitis after a 1-wk triple therapy consisting of pantoprazole 20 mg bid,clarithromycin 500 mg bid,and amoxicillin 1 g bid to eradicate H.pylori infection.A limited colonoscopy showed typical appearance of pseudomembranous colitis,and the stool test for C.difficile toxins was positive.Rapid resolution of symptoms and negative C.difficile toxins were obtained in both patients with oral vancomycin.No relapse occurred during a four and eleven-month,respectively,follow up.These cases suggest that physicians should have a high index of suspicion for pseudomembranous colitis when evaluate patients with diarrhea following H.pylori eradication therapy.

Atypical presentation of pseudomembranous colitis localized in adenomatous polyps

The most frequent cause of pseudomembranous colitis is Clostridium difficile(C.difficile) infection.This type of colitis is characterized by an endoscopic pattern of numerous small,yellowish or whitish plaques diffusely distributed,which typically compromises the rectum extending to proximal colon.Occasionally,the pseudomembranes compromise only the transverse or right colon,but their exclusive localization over polyps has not been reported.In this case report we have described a patient with symptoms compatible with C.difficile infection and positive for C.difficile toxigenic culture.Colonoscopy examination showed two small polyps with a whitish surface,and histopathological analysis confirmed them to be pseudomembranes over tubular adenomas.The rest of the colonic mucosa was normal and no other cause was demonstrated.We suggest that this particular distribution might be due to a higher affinity for dysplastic cells such as adenomatous polyps of colon by C.difficile and/or its toxins.

Localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis

A 61-year-old male was admitted to our hospital due to right lower abdominal pain and watery diarrhea for 3 d.Beginning 3 wk before he arrived in our hospital,he took 3 rd-generation cephalosporin(cefixime) for 2 wk due to chronic left ear otitis media.Colonoscopic examination revealed yellowish patches of ulcerations and swelling covered with thick serosanguineous exudate in the cecum and ascending colon.After 7 d of oral metronidazole treatment,his symptoms completely disappeared.We report a case of localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis associated with cefixime.

Protein-losing pseudomembranous colitis with cap polyposis-like features

Protein-losing enteropathy(PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Here we present an unusual case of severe PLE in a 55-year old female with a one-year history of recurrent diarrhea, crampy abdominal pain, and peripheral edema. Endoscopy and MRI showed a diffuse inflammatory thickening of the sigmoid colon and the rectum. Surgical resection of the involved colon was performed and the symptoms were significantly resolved. The final histologic evaluation confirmed a diagnosis of a pseudomembranous colitis with cap polyposis-like features. Such a cause of PLE has never been described before.

Pseudomembranous necrotizing tracheobronchial aspergillosis： an analysis of 16 cases

Background In our clinical practice we have been attracted by a group of patients with airway aspergillosis who have airway obstruction; we termed the condition as pseudomembranous necrotizing tracheobronchial aspergillosis （PNTA）. In this study we analyzed the clinical data from patients with PNTA, so as to guide the diagnosis and treatment of the disease. Methods A total of 16 PNTA patients were treated in Changhai Hospital from January 2000 clinical data, including the demographic information, clinical symptoms, imaging findings treatment strategies and efficacy, and prognosis, were retrospectively analyzed. to January 2009. Their bronchoscopy findings, Results All 16 patients were found to have primary systemic immunodeficiency diseases and/or damage of the focal airways. Nine patients （9/16, 56.3%） had pulmonary and tracheobronchial tumors, 5/16 （31.3%） had tracheobronchial involvement secondary to non-pulmonary tumors, and 2/16 （12.5%） had lung transplantation. The most common causes of PNTA included local radiotherapy （10/16, 62.5%）, repeated chemotherapy （7/16, 43.8%） and recurrent intervention therapy by bronchoscope （4/16, 25.0%）. Aspergillus fumigatus was the most frequent pathogen （62.5%, 10/16）. The main clinical manifestations included progressive dyspnea （14/16, 87.5%） and irritable cough （12/16, 75.0%）. The trachea was involved in 9/16 patients （56.3%）, right main bronchus in 10/16 （62.5%）. All 16 patients were treated with systemic anti-aspergillosis agents, local anti-aspergillosis agents with amphotericin B inhalation and direct perfusion of amphotericin B by bronchoscope, and interventional treatment by bronchoscope to ensure an unobstructed airway. The total efficiency was 31.3%. Conclusions PNTA is an infectious disease caused by aspergillus and it mainly involves the trachea, primary bronchus and segmental bronchus. A. fumigatus is the most common pathogen. PNTA can pose a severe clinical threat and often occurs after systemic immunodeficiency and/or local airway damage, with the main symptoms including dyspnea and irritable cough. Bronchoscopic findings supply the main evidence for diagnosis of PNTA. Treatment of PNTA is difficult and requires a long course. Systemic and local anti-aspergillosis agents plus bronchoscopy debridement can improve the prognosis of the disease.

A case of pseudomembranous colitis associated with rifampicin

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Stool therapy may become a preferred treatment of recurrent Clostridium difficile?

Fecal enemas were first reported to successfully treat life threatening enterocolitis in 1958, but fecal therapy to treat Clostridium difficile (C. difficile ) infection has remained esoteric and not well investigated until recently. In the past few years, systematic reviews of case series and case reports of fecal microbiota transplant for recurrent C. difficile infection have become available and validate use of fecal transplant for C. difficile enterocolitis. Methods of fecal transplant reported in the literature include: nasogastric tube, gastroscope, duodenal tube, colonoscopy, rectal tube, and fecal enemas administered at home; no method has been shown to be superior. A recent randomized study published in New England Journal of Medicine found fecal transplant to be superior to oral vancomycin alone in treatment of recurrent C. difficile enterocolitis. The significance of this trial cannot be underestimated as it lends credibility to the idea of intentionally using microbes to combat disease, providing an alternative to the older paradigm of disease eradication through use of antimicrobials.

Clostridium difficile infection in the community:Are proton pump inhibitors to blame?

Once a nosocomial disease,Clostridium difficile infection(CDI)now appears frequently in the community in the absence of exposure to antibiotics.Prior studies have shown that patients with community-acquired CDI are younger,more likely to be female,and have fewer comorbidities compared to patients with hospital-associated CDI.Because most studies of CDI are hospitalbased,comparatively little is known about communityacquired CDI.The recent study by Chitnis has received widespread attention because it used active surveillance to capture all cases of community-acquired CDI within a large population and assessed key risk factors.The authors found that low-level healthcare exposure and proton pump inhibitor use were common among those with non-antibiotics associated,community-acquired CDI.In this commentary,we discuss the changing epidemiology of community-acquired CDI and the evidence basis for the controversial association between proton pump inhibitors and community-acquired CDI.

Severe colitis associated with docetaxel use:A report of four cases

Diarrhea is a common side effect of chemotherapy.Pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed,albeit rarely,with certain chemotherapeutic agents.We present four cases of severe colitis in patients undergoing treatment with taxane-based chemotherapy for pancreatic,lung and breast cancer.None of them had recently received antibiotics.One patient presented with a bowel perforation and three had endoscopic findings of pseudomembranous colitis.Two of these three patients had negative stool toxin assays for Clostridium difficile.In the patient presenting with perforation,an emergency left hemicolectomy was performed and the pathological findings in the colon were acute inflammation and ischemic necrosis;the other three patients were treated with oral vancomycin and/or oral or intravenous metronidazole leading to complete resolution of the symptoms.Apart from pseudomembranous colitis,we describe patients presenting with neutropenic enterocolitis as well as ischemic colitis after docetaxel use.These cases provide some insight into the spectrum and varied clinical presentations of severe colitis associated with taxane-based chemotherapy.

Immunological mechanisms of fecal microbiota transplantation in recurrent Clostridioides difficile infection

Fecal microbiota transplantation(FMT)is a successful method for treating recurrent Clostridioides difficile(C.difficile)infection(rCDI)with around 90%efficacy.Due to the relative simplicity of this approach,it is being widely used and currently,thousands of patients have been treated with FMT worldwide.Nonetheless,the mechanisms underlying its effects are just beginning to be understood.Data indicate that FMT effectiveness is due to a combination of microbiological direct mechanisms against C.difficile,but also through indirect mechanisms including the production of microbiota-derived metabolites as secondary bile acids and short chain fatty acids.Moreover,the modulation of the strong inflammatory response triggered by C.difficile after FMT seems to rely on a pivotal role of regulatory T cells,which would be responsible for the reduction of several cells and soluble inflammatory mediators,ensuing normalization of the intestinal mucosal immune system.In this minireview,we analyze recent advances in these immunological aspects associated with the efficacy of FMT.

钬激光切除会厌囊肿术后假膜生成及脱落情况临床观察

会厌黏膜上的黏液腺腺管阻塞导致黏液潴留被认为是会厌囊肿的病因[1],手术切除是公认有效方法。因会厌黏膜血供丰富,既能迅速止血又能切割,并对周围热损伤小的手术方法一直是耳鼻咽喉科医师的追求,钬激光切除手术恰满足以上要求。我科自2012年就应用钬激光治疗会厌囊肿等疾患,取得满意的疗效,并对会厌囊肿术后假膜生成及脱落情况与电刀切除组进行了对比,现报道如下。1一般资料1.1病例资料。