The fulminant form of pseudomembranous colitis in a child with cystic fibrosis

Abstract

Аnnotation. A long-term persistent infection of the lower respiratory tract with cystic fibrosis and, as a consequence, the need for regular use of antibacterial drugs inevitably leads to changes in the composition of the intestinal microflora. At the same time, the most dangerous are toxigenic strains of Clostridium difficile. In turn, excessive growth of C. Difficile leads to increased sensitivity of enterocytes to its toxins. The leading pathogenicity factors of C. Difficile are exotoxins A (TcdA), B (TcdB) and binary toxin. TcdA and TcdB are enterotoxins acting on intestinal enterocytes, which leads to inflammation and necrosis of the mucous membrane. The binary toxin forms a complex on the enterocyte membrane that penetrates the cytoplasm, disrupts the functioning of the cell, leads to its death, and also enhances the adhesion and colonization of C. Difficile. One of the most accessible methods for determining the presence of toxin-producing C. Difficile in feces is immunochromatographic examination. The frequency of such a complication in patients with MV is unknown, the literature presents isolated cases of such a complication in Russia. There is one known case of fulminant pseudomembranous colitis (lethal). A clinical case of fulminant pseudomembranous colitis with recovery is presented. Conclusion. Patients with cystic fibrosis are at risk for the development of this complication, especially patients with a history of intestinal resection against the background of meconium ileus. In about 5% of cases, there is a fulminant course of pseudomembarnous colitis. In this form, the duration of the disease can be several hours. Lethality in the lightning-fast course reaches 58-70%. This option presents the greatest difficulty in terms of diagnosis due to atypical clinical symptoms. In particular, the diarrheal syndrome may not be pronounced or absent at all. Such patients often show symptoms of an acute abdomen, which makes differential diagnosis difficult. This is confirmed in our clinical case. It is necessary to increase awareness and alertness of doctors regarding the risk of developing this formidable complication in patients with Сystic fibrosis