CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
CAP TODAY and the Association for Molecular Pathology have teamed up to bring molecular case reports to CAP TODAY readers. AMP members write the reports using clinical cases from their own practices that show molecular testing’s important role in diagnosis, prognosis, and treatment. Case report No. 10, which begins here, comes from Diatherix Laboratories. If you would like to submit a case report, please send email to the AMP at amp@amp.org. For more information about the AMP and all previously published case reports, visit www.amp.org.
Donald Lazas, MD
Leslie C. Ber, MD
Elena Grigorenko, PhD
Don Stalons, PhD, D(ABMM), MPH
December 2015—Clostridium difficile is an anaerobic spore-forming, Gram-positive bacteria transmitted by the fecal-oral route. The virulence of Clostridium difficile is primarily conferred from two toxins, A and B. Disruption of the normal gut flora, typically from intake of antimicrobials, allows Clostridium difficile to proliferate, causing a broad spectrum of clinical symptoms from asymptomatic colonization to colitis, a spectrum of diarrhea severity, and a protracted course of disease. The incidence of Clostridium difficile infection (CDI) among hospitalized children has increased dramatically in the past decade. Here, we report on a case of Clostridium difficile and Salmonella enterica co-infection in a seven-month-old patient with previous antibiotic treatment for sinusitis using Augmentin. The presence of Salmonella enterica detected in this patient may have acted synergistically or compounded the symptoms of the infection.
Introduction. Infectious diarrheal diseases are the second leading cause of mortality and morbidity, and age-specific rates are highest for children under age three. Although CDI predominantly affects adult and elderly populations,1 a recently published retrospective cohort study suggested that pediatric CDI is associated with increased mortality, longer hospitalization, and higher patient care costs.2 The pediatric population, previously considered at low risk for CDI, has had an increased incidence of CDI-associated hospital admissions. Although testing of infants is not recommended, recent data have shown that 26 percent of children hospitalized with CDI were infants younger than one year and five percent were neonates. Recognized risk factors for children with detected CDI include extensive antimicrobial therapy, gastrointestinal surgeries, frequent hospitalizations, and impaired immunity. Breastfed infants have a lower carriage rate of Clostridium difficile compared with formula-fed infants. This pediatric population group may be asymptomatic for Clostridium difficile infection in the face of a positive test when the colonic wall receptor site for toxin may be nonfunctional or immature.3