Abstract
Two case reports of children with muco-hemorrhagic diarrhea positive for Clostridium difficile introduce into the world of Clostridium difficile infection in the pediatric age. Epidemiological, clinical, and microbiological findings represent pieces of the puzzle of one of the most emerging infections at all the ages.
Highlights
Clostridium difficile infection (CDI): Clostridium Difficile Infection, HA-CDI: Hospital Acquired Clostridium Difficile Infection, CA-CDI: Community Acquired Clostridium Difficile Infection, FMT: Faecal Microbiota Transplantation, inflammatory bowel disease (IBD): Inflammatory Bowel Disease, PPI: Proton pump inhibitors
Two months later, when he was 1-year-old, he developed progressively irritability, feeding refusal, associated with failure to thrive; an urine analysis showed the presence of an infection by E.coli resistant to amoxicillin and iv cephalosporin therapy was administrated at home
Blood and faecal cultures were negative, but a search for toxigenic Clostridium difficile (CD) came back positive suggesting a presumptive diagnosis of Clostridium difficile infection (CDI)
Summary
Figure: Abdominal radiograph showing a marked dilation of all segments of the large bowel, with conservation of haustra. It is the case of concomitant colonic diseases, or previous digestive surgery, or excessive exposure to health-care admissions, or disequilibrium of intestinal microflora caused by repeated antibiotic courses or immunosuppressive drugs [3,4] In such conditions, rapid growth of Clostridium difficile may occur, and production of toxins A and/or B, as well as other less-known. Even if the burden of disease regards the adult age, a concomitant increase of number of hospitalizations, hospital length of stay, medical expenses, colectomy rate for CDI have been reported in children [8,9] In spite of this phenomenon, CDI infection is rarely severe at this age, and severity is strongly related to the presence of multiple antibiotic courses [4]. Table: Options of treatment for different forms of CDI, CDI: Clostridium difficile infection; FMT: Faecal microbiota transplantation
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