Pseudomembranous colitis (PMC) usually manifests asfever and diarrhea in hospitalized patients treated withsystemic antibiotics. We described a case of PMC withintestinal obstruction but without diarrhea. A 60-yearold...Pseudomembranous colitis (PMC) usually manifests asfever and diarrhea in hospitalized patients treated withsystemic antibiotics. We described a case of PMC withintestinal obstruction but without diarrhea. A 60-yearold man was hospitalized for chemotherapy for the treatment of Burkitt lymphoma of the stomach. The patient became febrile and complained of crampy abdominal pain during the post-chemotherapy nadir. Plain abdominal radiography showed some intestinal gas and niveau. Because stool cytotoxin assay for clostridium difficile was positive and colon fiberscopic examination showed a pseudomembrane at the left side of the colon,and a diagnosis of PMC was made. Treatment with intracolonic vancomycin administration by colonoscopy and nasoileus tube was successful. Physicians should take into account the possibility of bowel obstruction due to PMC occurring in patients undergoing chemotherapy and perform emergency colonoscopy examination of suspected cases.展开更多
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 ...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.展开更多
Probiotic agents are live microbes or components of microbes that have a positive effect on the host. They exert their action through interplay with the immune system of the host. Some of this effect is local and some...Probiotic agents are live microbes or components of microbes that have a positive effect on the host. They exert their action through interplay with the immune system of the host. Some of this effect is local and some is systemic. The full story is yet to be discovered. Probiotics have a definite positive effect on rotavirus diarrhea, post antibiotic diarrhea and pouchitis. Their exact role in inflammatory bowel disease, irritable bowel syndrome, other forms of infectious diarrhea, and prevention of cancer is yet to be determined. This review summarizes the data about probiotics in these conditions.展开更多
Clostridium difficile (CD), specifically its toxins, have been implicated as a risk factor for exacerbation of the inflammatory process in up to 5% of patients with ulcerative colitis or Crohn’s disease. Typical evid...Clostridium difficile (CD), specifically its toxins, have been implicated as a risk factor for exacerbation of the inflammatory process in up to 5% of patients with ulcerative colitis or Crohn’s disease. Typical evidence of colonic changes with CD infection, including pseudomembranous exudate, are often not present; however, a severe clinical course may result, including precipitation of toxic colitis and toxic megacolon. Recently, hypervirulent CD strains have been reported raising concern for a more severe disease process in patients with underlying inflammatory bowel disease.Moreover, small bowel involvement or CD enteritis has been increasingly described, usually in those with a history of a prior colectomy or total proctocolectomy for prior severe and extensive inflammatory bowel disease. Finally, refractory or treatment-resistant pouchitis may occur with CD infection.展开更多
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 bein...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.展开更多
文摘Pseudomembranous colitis (PMC) usually manifests asfever and diarrhea in hospitalized patients treated withsystemic antibiotics. We described a case of PMC withintestinal obstruction but without diarrhea. A 60-yearold man was hospitalized for chemotherapy for the treatment of Burkitt lymphoma of the stomach. The patient became febrile and complained of crampy abdominal pain during the post-chemotherapy nadir. Plain abdominal radiography showed some intestinal gas and niveau. Because stool cytotoxin assay for clostridium difficile was positive and colon fiberscopic examination showed a pseudomembrane at the left side of the colon,and a diagnosis of PMC was made. Treatment with intracolonic vancomycin administration by colonoscopy and nasoileus tube was successful. Physicians should take into account the possibility of bowel obstruction due to PMC occurring in patients undergoing chemotherapy and perform emergency colonoscopy examination of suspected cases.
文摘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.
文摘Probiotic agents are live microbes or components of microbes that have a positive effect on the host. They exert their action through interplay with the immune system of the host. Some of this effect is local and some is systemic. The full story is yet to be discovered. Probiotics have a definite positive effect on rotavirus diarrhea, post antibiotic diarrhea and pouchitis. Their exact role in inflammatory bowel disease, irritable bowel syndrome, other forms of infectious diarrhea, and prevention of cancer is yet to be determined. This review summarizes the data about probiotics in these conditions.
文摘Clostridium difficile (CD), specifically its toxins, have been implicated as a risk factor for exacerbation of the inflammatory process in up to 5% of patients with ulcerative colitis or Crohn’s disease. Typical evidence of colonic changes with CD infection, including pseudomembranous exudate, are often not present; however, a severe clinical course may result, including precipitation of toxic colitis and toxic megacolon. Recently, hypervirulent CD strains have been reported raising concern for a more severe disease process in patients with underlying inflammatory bowel disease.Moreover, small bowel involvement or CD enteritis has been increasingly described, usually in those with a history of a prior colectomy or total proctocolectomy for prior severe and extensive inflammatory bowel disease. Finally, refractory or treatment-resistant pouchitis may occur with CD infection.
基金the grant“Programa de ciencia tecnologia e inovacao aos grupos de pesquisa da Universidade Federal de Santa Catarina”,FAPESC(2021TR000301)Soveral LF is a graduate student fellow of Fundação de AmparoàPesquisa e Inovação do Estado de Santa Catarina,FAPESC(3003/2021)+1 种基金Schmidt PS is student fellow of Programa Institucional de Iniciacao Cientifica e Tecnologica,PIBIC of the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico,CNPq(2021/949248)Nunes IS is a graduate student fellow of Coordenacao de Aperfeiçoamento de Pessoal de Nivel Superior,CAPES(202003075).
文摘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.
