Posts filed under ‘Infecciones intraabdominales’

Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis.

J Microbiol Immunol Infect. 2016 Jan 12.

Chan KS1, Lee WY2, Yu WL3.

Author information

1Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan.

2Department of Pathology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Pathology, Taipei Medical University, Taipei City, Taiwan.

3Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Medicine, Taipei Medical University, Taipei City, Taiwan. Electronic address: yuleon_md@yahoo.com.tw

Abstract

Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents.

However, CMV colitis is increasingly recognized in immunocompetent hosts.

Notably, CMV colitis coexisting with Clostridium difficile infection (CDI) in apparently healthy individuals has been published in recent years, which could result in high morbidity and mortality.

CMV colitis is a rare but possible differential diagnosis in immunocompetent patients with abdominal pain, watery, or especially bloody diarrhea, which could be refractory to standard treatment for CDI. As a characteristic of CDI, however, pseudomembranous colitis may be only caused by CMV infection.

Real-time CMV-polymerase chain reaction (PCR) for blood and stool samples may be a useful and noninvasive diagnostic strategy to identify CMV infection when treatment of CDI eventually fails to show significant benefits. Quantitative CMV-PCR in mucosal biopsies may increase the diagnostic yield of traditional histopathology.

CMV colitis is potentially life-threatening if severe complications occur, such as sepsis secondary to colitis, massive colorectal bleeding, toxic megacolon, and colonic perforation, so that may necessitate pre-emptive antiviral treatment for those who are positive for CMV-PCR in blood and/or stool samples while pending histological diagnosis

PDF

http://www.e-jmii.com/article/S1684-1182(16)00008-6/pdf

November 29, 2016 at 7:54 am

Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review.

World J Gastroenterol. 2016 Aug 21;22(31):7166-74.

Makker J1, Bajantri B1, Sakam S1, Chilimuri S1.

Author information

1Jasbir Makker, Sridhar Chilimuri, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457, United States.

Abstract

Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts.

In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids.

The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response.

Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV.

As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality.

Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988300/pdf/WJG-22-7166.pdf

November 29, 2016 at 7:51 am

Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients.

Clin Infect Dis. 2015 Mar 15;60(6):e20-6.

Ko JH1, Peck KR1, Lee WJ1, Lee JY1, Cho SY1, Ha YE1, Kang CI1, Chung DR1, Kim YH2, Lee NY3, Kim KM4, Song JH1.

Author information

1Division of Infectious Diseases.

2Division of Gastroenterology.

3Department of Laboratory Medicine.

4Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Abstract

BACKGROUND:

Cytomegalovirus (CMV) colitis is a common manifestation of CMV end-organ disease, which has typically been described in immunocompromised hosts. Recently, it has been noted that this also occurs in immunocompetent patients. To gather relevant data about clinical presentation, prognosis, and risk factors for development of CMV colitis in immunocompetent hosts, we analyzed all cases that occurred during a 19-year period at our institution.

METHODS:

A case-control study was performed to identify risk factors for CMV colitis in immunocompetent hosts. Electronic medical records of individuals who were admitted and diagnosed with CMV colitis between January 1995 and February 2014 at a tertiary care university hospital were reviewed. Two non-CMV colitis patients who were age- and sex-matched were selected as controls for each case.

RESULTS:

A total of 51 patients with CMV colitis were included in this study along with 102 control patients. Certain conditions including renal disease on hemodialysis, neurologic disease, rheumatologic disease, intensive care unit admission, and exposure to antibiotics, antacids, steroids, or red blood cell (RBC) transfusions within 1 month of diagnosis of colitis were associated with CMV colitis on univariate analysis. Among these, steroid use and RBC transfusion within 1 month were identified as independent risk factors for developing CMV colitis on multivariate analysis. The 30-day mortality rate was 7.8% without any attributable mortality.

CONCLUSIONS:

Steroid use and RBC transfusion within 1 month of the diagnosis of colitis were independent risk factors for development of CMV colitis in immunocompetent hosts

PDF

http://cid.oxfordjournals.org/content/60/6/e20.full.pdf+html

November 27, 2016 at 7:46 pm

European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection.

Clin Microbiol Infect. August 2016 V.22 Suppl 4 S63-81.

Crobach MJ1, Planche T2, Eckert C3, Barbut F3, Terveer EM1, Dekkers OM4, Wilcox MH5, Kuijper EJ6.

Author information

1Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.

2Department of Medical Microbiology, St. George’s Hospital, London, UK.

3National Reference Laboratory for Clostridium difficile, Paris, France.

4Departments of Clinical Epidemiology and Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.

5Department of Microbiology, Leeds Teaching Hospitals & University of Leeds, Leeds, UK.

6Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: E.J.Kuijper@lumc.nl

Abstract

In 2009 the first European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline for diagnosing Clostridium difficile infection (CDI) was launched.

Since then newer tests for diagnosing CDI have become available, especially nucleic acid amplification tests.

The main objectives of this update of the guidance document are to summarize the currently available evidence concerning laboratory diagnosis of CDI and to formulate and revise recommendations to optimize CDI testing.

This update is essential to improve the diagnosis of CDI and to improve uniformity in CDI diagnosis for surveillance purposes among Europe. An electronic search for literature concerning the laboratory diagnosis of CDI was performed.

Studies evaluating a commercial laboratory test compared to a reference test were also included in a meta-analysis. The commercial tests that were evaluated included enzyme immunoassays (EIAs) detecting glutamate dehydrogenase, EIAs detecting toxins A and B and nucleic acid amplification tests.

Recommendations were formulated by an executive committee, and the strength of recommendations and quality of evidence were graded using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. No single commercial test can be used as a stand-alone test for diagnosing CDI as a result of inadequate positive predictive values at low CDI prevalence.

Therefore, the use of a two-step algorithm is recommended. Samples without free toxin detected by toxins A and B EIA but with positive glutamate dehydrogenase EIA, nucleic acid amplification test or toxigenic culture results need clinical evaluation to discern CDI from asymptomatic carriage.

FULL TEXT (CLIC en PDF)

http://www.sciencedirect.com/science/article/pii/S1198743X16300258

November 21, 2016 at 7:51 am

REVIEW – Clostridium difficile Infection in Special High-Risk Populations.

Infect Dis Ther. September 2016 V.5 N.3 P.253-69.

Cózar-Llistó A1, Ramos-Martinez A1, Cobo J2.

Author information

1Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.

2Infectious Diseases Service, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo Km 9.1, 28034, Madrid, Spain. javier.cobo@salud.madrid.org

Abstract

Antibiotic use continues to be the most important risk factor for the development of Clostridium difficile infection (CDI) through disruption of the indigenous microbiota of the colon.

This factor, together with environmental contamination, makes hospital and other healthcare facilities the perfect breeding ground for the infection.

Several groups of patients are exposed to the hospital environment and, at the same time, affected by conditions that can make CDI more prevalent, more severe or make it present a different clinical picture. The list of such conditions appears too extensive to be reviewed in a single article.

Nevertheless, several groups, including the critically ill, oncological patients, solid organ and hematopoietic transplant recipients, patients with inflammatory bowel disease, patients with kidney disease and pregnant women, have generated more attention and have been studied in more detail.

On the other hand, pediatric patients constitute a controversial group because the large number of asymptomatic carriers makes interpretation of clinical findings and diagnostic tests difficult, as is the development of an appropriate approach to treatment.

We present an in-depth discussion of CDI in these high-risk populations and we also review the issue of CDI in pediatric patients.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019980/pdf/40121_2016_Article_124.pdf

November 21, 2016 at 7:48 am

Fecal Microbiota Therapy for Clostridium difficile Infection: A Health Technology Assessment.

Ontario Health Technology Assessment Series July 2016 V.16 N.17 P.1–69

Health Quality Ontario.

Abstract

BACKGROUND:

Fecal microbiota therapy is increasingly being used to treat patients with Clostridium difficile infection. This health technology assessment primarily evaluated the effectiveness and cost-effectiveness of fecal microbiota therapy compared with the usual treatment (antibiotic therapy).

METHODS:

We performed a literature search using Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CRD Health Technology Assessment Database, Cochrane Central Register of Controlled Trials, and NHS Economic Evaluation Database. For the economic review, we applied economic filters to these search results. We also searched the websites of agencies for other health technology assessments. We conducted a meta-analysis to analyze effectiveness. The quality of the body of evidence for each outcome was examined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Using a step-wise, structural methodology, we determined the overall quality to be high, moderate, low, or very low. We used a survey to examine physicians’ perception of patients’ lived experience, and a modified grounded theory method to analyze information from the survey.

RESULTS:

For the review of clinical effectiveness, 16 of 1,173 citations met the inclusion criteria. A meta-analysis of two randomized controlled trials found that fecal microbiota therapy significantly improved diarrhea associated with recurrent C. difficile infection versus treatment with vancomycin (relative risk 3.24, 95% confidence interval [CI] 1.85-5.68) (GRADE: moderate). While fecal microbiota therapy is not associated with a significant decrease in mortality compared with antibiotic therapy (relative risk 0.69, 95% CI 0.14-3.39) (GRADE: low), it is associated with a significant increase in adverse events (e.g., short-term diarrhea, relative risk 30.76, 95% CI 4.46-212.44; abdominal cramping, relative risk 14.81, 95% CI 2.07-105.97) (GRADE: low). For the value-for-money component, two of 151 economic evaluations met the inclusion criteria. One reported that fecal microbiota therapy was dominant (more effective and less expensive) compared with vancomycin; the other reported an incremental cost-effectiveness ratio of $17,016 USD per quality-adjusted life-year for fecal microbiota therapy compared with vancomycin. This ratio for the second study indicated that there would be additional cost associated with each recurrent C. difficile infection resolved. In Ontario, if fecal microbiota therapy were adopted to treat recurrent C. difficile infection, considering it from the perspective of the Ministry of Health and Long-Term Care as the payer, an estimated $1.5 million would be saved after the first year of adoption and $2.9 million after 3 years. The contradiction between the second economic evaluation and the savings we estimated may be a result of the lower cost of fecal microbiota therapy and hospitalization in Ontario compared with the cost of therapy used in the US model. Physicians reported that C. difficile infection significantly reduced patients’ quality of life. Physicians saw fecal microbiota therapy as improving patients’ quality of life because patients could resume daily activities. Physicians reported that their patients were happy with the procedures required to receive fecal microbiota therapy.

CONCLUSIONS:

In patients with recurrent C. difficile infection, fecal microbiota therapy improves outcomes that are important to patients and provides good value for money.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973962/pdf/ohtas-16-1.pdf

November 21, 2016 at 7:46 am

A prospective view of animal and human Fasciolosis.

Parasite Immunol. 2016 Sep;38(9):558-68.

Cwiklinski K1, O’Neill SM2, Donnelly S3, Dalton JP4.

Author information

1School of Biological Sciences, Queen’s University Belfast, Belfast, UK. k.cwiklinski@qub.ac.uk.

2School of Biotechnology, Dublin City University, Dublin, Republic of Ireland.

3The i3 Institute & School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, NSW, Australia.

4School of Biological Sciences, Queen’s University Belfast, Belfast, UK.

Abstract

Fasciolosis, a food-borne trematodiasis, results following infection with the parasites, Fasciola hepatica and Fasciola gigantica. These trematodes greatly affect the global agricultural community, infecting millions of ruminants worldwide and causing annual economic losses in excess of US $3 billion. Fasciolosis, an important zoonosis, is classified by WHO as a neglected tropical disease with an estimated 17 million people infected and a further 180 million people at risk of infection. The significant impact on agriculture and human health together with the increasing demand for animal-derived food products to support global population growth demonstrate that fasciolosis is a major One Health problem. This review details the problematic issues surrounding fasciolosis control, including drug resistance, lack of diagnosis and the threat that hybridization of the Fasciola species poses to future animal and human health. We discuss how these parasites may mediate their long-term survival through regulation and modulation of the host immune system, by altering the host immune homeostasis and/or by influencing the intestinal microbiome particularly in respect to concurrent infections with other pathogens. Large genome, transcriptome and proteomic data sets are now available to support an integrated One Health approach to develop novel diagnostic and control strategies for both animal and human disease.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053257/pdf/PIM-38-558.pdf

October 27, 2016 at 4:06 pm

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