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1/481. Recognizing and managing clostridium difficile-associated diarrhea.

    clostridium difficile-associated diarrhea poses a significant physical risk and cost to the recovery of hospitalized older adults. C. difficile is responsible for 75% or more of the diarrhea-associated enteric infections acquired during a hospital stay (Gerding, Johnson, Peterson, Mulligan, & Silva, 1995). C. difficile is easily spread by direct or indirect contact, therefore placing other patients at great risk for contamination by this organism. nursing plays a significant role in early identification, management, and control of the spread of this potentially lethal infection. ( info)

2/481. clostridium difficile-associated disease. Implications for midwifery practice.

    clostridium difficile-associated disease (CDAD), a gastrointestinal infection with a wide range of manifestations whose primary symptom is diarrhea, occurs when antibiotic medications, or rarely other drugs or conditions, disrupt the normal colonic microflora, making it susceptible to the growth of toxigenic C difficile. It is a significant nosocomial infection and an increased incidence has been noted in recent years. Although infrequently seen in midwifery practices, it does occur and may increase with the growing usage of intrapartal antibiotics. Midwives may evaluate and treat a client with an initial episode of mild to moderate CDAD; they also may manage collaboratively or refer for medical management those clients with recurrent or severe disease. This article reviews the epidemiology, pathogenesis, clinical presentation, prevention, and midwifery management of initial and recurrent CDAD. The limitation in the use of oral vancomycin due to the emergence of vancomycin-resistant enterococcus, resulting in metronidazole becoming the primary agent for treatment of CDAD, and the implications of this in the treatment of CDAD during pregnancy and lactation are addressed. ( info)

3/481. clostridium difficile-associated diarrhea after short term vaginal administration of clindamycin.

    A 32-yr-old woman developed frequent watery diarrhea with occult blood after 3 days treatment with clindamycin vaginal cream. clostridium difficile toxin was demonstrated in stool samples and was considered the cause of an antibiotic-associated diarrhea. No other antibiotic was used at least 3 months before the start of diarrhea. To our knowledge, antibiotic-associated diarrhea after vaginal application has previously been reported only once. ( info)

4/481. Pseudomembranous colitis after itraconazole therapy.

    A 53-yr-old man was admitted with new onset of abdominal pain and nonbloody diarrhea 1 month after exposure to the antifungal agent itraconazole. Flexible sigmoidoscopy demonstrated the presence of pseudomembranes, and subsequent evaluation excluded other causes of diarrhea. Disruption of the resident fungal flora of the colon by itraconazole is proposed as the mechanism by which this patient developed pseudomembranous colitis. This association has not previously been reported. ( info)

5/481. Reactive arthritis induced by clostridium difficile enteritis as a complication of helicobacter pylori eradication.

    clostridium difficile has recently been established as a cause of reactive arthritis (ReA). We present a case of clostridium difficile-induced ReA as a complication of helicobacter pylori eradication, which, to the best of our knowledge, is the first such case reported. ( info)

6/481. clostridium difficile colitis associated with infant botulism: near-fatal case analogous to Hirschsprung's enterocolitis.

    We present the first five reported cases of clostridium difficile-associated diarrhea (CDAD) in children with infant botulism caused by clostridium botulinum. We compare two fulminant cases of colitis in children with colonic stasis, the first caused by infant botulism and the second caused by Hirschsprung's disease. In both children, colitis was accompanied by hypovolemia, hypotension, profuse ascites, pulmonary effusion, restrictive pulmonary disease, and femoral-caval thrombosis. Laboratory findings included pronounced leukocytosis, hypoalbuminemia, hyponatremia, coagulopathy, and, when examined in the child with infant botulism, detection of C. difficile toxin in ascites. CDAD recurred in both children, even though difficile cytotoxin was undetectable in stool after prolonged initial therapy. Four children who had both infant botulism and milder CDAD also are described. Colonic stasis, whether acquired, as in infant botulism, or congenital, as in Hirschsprung's disease, may contribute to the susceptibility to and the severity of CDAD. ( info)

7/481. Pneumatosis intestinalis complicating C. difficile pseudomembranous colitis.

    Pneumatosis intestinalis (PI) is characterized by multiple gas-filled cysts or linear gas within the bowel wall. PI may be idiopathic (15%) or secondary (85%) to a variety of disorders. We report here the first otherwise healthy adult with C. difficile infection complicated by PI and review the possible mechanisms of this previously unrecognized complication of pseudomembranous colitis. With treatment of the underlying infection, the PI resolved within 6 days of presentation. ( info)

8/481. clostridium difficile diarrhea and colitis: a clinical overview.

    infection with toxin-producing strains of clostridium difficile is common and potentially life-threatening. It occurs mostly in patients in the hospital or nursing home who are taking or have recently taken antibiotics. Two toxins, A and B, damage the colonic mucosa, resulting in symptoms ranging from mild diarrhea to bloody diarrhea with fever and abdominal pain, colitis, or even pseudomembranous colitis. Severe cases may involve dehydration, toxic megacolon, or colonic perforation. This article reviews the microbiology, epidemiology, clinical manifestations, diagnosis, treatment, and prevention of this disease. ( info)

9/481. association of IgA nephropathy with clostridium difficile colitis.

    immunoglobulin a (IgA) nephropathy, the most common cause of glomerulonephritis worldwide, is usually idiopathic in origin and renal limited. Secondary IgA nephropathy has been associated with systemic disease, including such gastrointestinal tract disturbances as celiac sprue and inflammatory bowel disease. We describe gross hematuria and reversible acute renal failure from IgA nephropathy in a patient with cephalosporin-induced clostridium difficile colitis. In addition to mesangial IgA and C3 deposition, renal histological examination showed glomerular bleeding, intratubular red blood cell casts, and acute tubular necrosis. To the best of our knowledge, this is the first report of an association between IgA nephropathy and C difficile colitis. ( info)

10/481. Diarrhoea and colitis associated with antibiotic treatment.

    Sixteen cases of colitis developing within twenty-one days of antibiotic therapy are reported. There was a wide range of disease severity. lincomycin and clindamycin were implicated in twelve. The colitis was of two pathological patterns pseudomembranous colitis and "non-specific" colitis. There is a relative sparing of the rectum in some cases making the diagnosis more difficult on sigmoidoscopy. ( info)
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