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The first case of antibiotic-associated colitis by Clostridium difficile PCR ribotype 027 in Korea.

Tae CH, Jung SA, Song HJ, Kim SE, Choi HJ, Lee M, Hwang Y, Kim H, Lee K - J. Korean Med. Sci. (2009)

Bottom Line: Recently, a highly virulent strain of C. difficile polymerase chain reaction ribotype 027 was found in North America, Europe, and Japan.After discharge, she was maintained on probiotics and rifaximin for 3 weeks.She had no relapse for 6 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
Clostridium difficile (C. difficile) is a common causative agent of pseudomembranous colitis (PMC). C. difficile-associated diarrhea (CDAD) ranges from mild diarrhea to life threatening PMC. Recently, a highly virulent strain of C. difficile polymerase chain reaction ribotype 027 was found in North America, Europe, and Japan. A 52-yr-old woman with anti-tuberculosis medication and neurogenic bladder due to traffic accident experienced five episodes of C. difficile PMC after taking antibiotics for pneumonia along with septic shock and acute renal failure. She was readmitted to the intensive care unit and treated with oral vancomycin with refractory of oral metronidazole, inotropics and probiotics for over 60 days. C. difficile isolated both at the first and the last admission was identified as C. difficile ribotype 027 by ribotyping, toxinotyping, and tcdC gene sequencing, which turned out the same pathogen as the epidemic hypervirulent B1/NAP1 strain. This is the first case of C. difficile PCR ribotype 027 in Korea. After discharge, she was maintained on probiotics and rifaximin for 3 weeks. She had no relapse for 6 months.

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Related in: MedlinePlus

Clinical course of the patient. Changes in serum CRP (gray line), diarrhea number (black bars), and medication per day are shown. HERZ, isoniazid 300 mg, ethambutol 800 mg, rifampin 600 mg, pyrazinamide 1,500 mg; Levo/Pip+TZ/AMK, levofloxacin, piperacillin, tazobatam, amikacin; IVIG, intravenous immunoglobulin; MDZ, metronidazole; Vanco, vancomycin; Adm, admission.
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Figure 1: Clinical course of the patient. Changes in serum CRP (gray line), diarrhea number (black bars), and medication per day are shown. HERZ, isoniazid 300 mg, ethambutol 800 mg, rifampin 600 mg, pyrazinamide 1,500 mg; Levo/Pip+TZ/AMK, levofloxacin, piperacillin, tazobatam, amikacin; IVIG, intravenous immunoglobulin; MDZ, metronidazole; Vanco, vancomycin; Adm, admission.

Mentions: She has had a traumatic paraplegia and neurogenic bladder for several years. At first admission, she had been treated for active pulmonary tuberculosis combined with pneumonia; rifampin (600 mg/day), isoniazid (300 mg/day), ethambutol (800 mg/day), pyrazinamide (1,500 mg/day), levofloxacin (750 mg/day), amikacin (750 mg/day) and azithromycin (500 mg/day) since December 5, 2007. Until pneumonic consolidation had improved; levofloxacin, amikacin, and azithromycin were used during 8, 5, and 3 days, respectively. She developed C. difficile PMC with septic shock on day 13 of anti-tuberculosis therapy, and then she had four documented episodes of C. difficile PMC (Fig. 1). C. difficile toxin A/B assay of the stool culture taken on admission day 3 gave positive result on C. difficile. On admission day 15, the sigmoidoscopic examination revealed scattered whitish to yellowish pseudomembranes with edematous hyperemic mucosa from the rectum to the descending colon (Fig. 2). Biopsy from the sigmoid colon revealed acute and chronic inflammation (Fig. 3). With a refractory of oral metronidazole for 8 days, she was treated with oral vancomycin and became well after 4 weeks. In spite of the oral vancomycin maintenance therapy, she was repeatedly readmitted with C. difficile PMC and required a stay in ICU due to the septic shock.


The first case of antibiotic-associated colitis by Clostridium difficile PCR ribotype 027 in Korea.

Tae CH, Jung SA, Song HJ, Kim SE, Choi HJ, Lee M, Hwang Y, Kim H, Lee K - J. Korean Med. Sci. (2009)

Clinical course of the patient. Changes in serum CRP (gray line), diarrhea number (black bars), and medication per day are shown. HERZ, isoniazid 300 mg, ethambutol 800 mg, rifampin 600 mg, pyrazinamide 1,500 mg; Levo/Pip+TZ/AMK, levofloxacin, piperacillin, tazobatam, amikacin; IVIG, intravenous immunoglobulin; MDZ, metronidazole; Vanco, vancomycin; Adm, admission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698204&req=5

Figure 1: Clinical course of the patient. Changes in serum CRP (gray line), diarrhea number (black bars), and medication per day are shown. HERZ, isoniazid 300 mg, ethambutol 800 mg, rifampin 600 mg, pyrazinamide 1,500 mg; Levo/Pip+TZ/AMK, levofloxacin, piperacillin, tazobatam, amikacin; IVIG, intravenous immunoglobulin; MDZ, metronidazole; Vanco, vancomycin; Adm, admission.
Mentions: She has had a traumatic paraplegia and neurogenic bladder for several years. At first admission, she had been treated for active pulmonary tuberculosis combined with pneumonia; rifampin (600 mg/day), isoniazid (300 mg/day), ethambutol (800 mg/day), pyrazinamide (1,500 mg/day), levofloxacin (750 mg/day), amikacin (750 mg/day) and azithromycin (500 mg/day) since December 5, 2007. Until pneumonic consolidation had improved; levofloxacin, amikacin, and azithromycin were used during 8, 5, and 3 days, respectively. She developed C. difficile PMC with septic shock on day 13 of anti-tuberculosis therapy, and then she had four documented episodes of C. difficile PMC (Fig. 1). C. difficile toxin A/B assay of the stool culture taken on admission day 3 gave positive result on C. difficile. On admission day 15, the sigmoidoscopic examination revealed scattered whitish to yellowish pseudomembranes with edematous hyperemic mucosa from the rectum to the descending colon (Fig. 2). Biopsy from the sigmoid colon revealed acute and chronic inflammation (Fig. 3). With a refractory of oral metronidazole for 8 days, she was treated with oral vancomycin and became well after 4 weeks. In spite of the oral vancomycin maintenance therapy, she was repeatedly readmitted with C. difficile PMC and required a stay in ICU due to the septic shock.

Bottom Line: Recently, a highly virulent strain of C. difficile polymerase chain reaction ribotype 027 was found in North America, Europe, and Japan.After discharge, she was maintained on probiotics and rifaximin for 3 weeks.She had no relapse for 6 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
Clostridium difficile (C. difficile) is a common causative agent of pseudomembranous colitis (PMC). C. difficile-associated diarrhea (CDAD) ranges from mild diarrhea to life threatening PMC. Recently, a highly virulent strain of C. difficile polymerase chain reaction ribotype 027 was found in North America, Europe, and Japan. A 52-yr-old woman with anti-tuberculosis medication and neurogenic bladder due to traffic accident experienced five episodes of C. difficile PMC after taking antibiotics for pneumonia along with septic shock and acute renal failure. She was readmitted to the intensive care unit and treated with oral vancomycin with refractory of oral metronidazole, inotropics and probiotics for over 60 days. C. difficile isolated both at the first and the last admission was identified as C. difficile ribotype 027 by ribotyping, toxinotyping, and tcdC gene sequencing, which turned out the same pathogen as the epidemic hypervirulent B1/NAP1 strain. This is the first case of C. difficile PCR ribotype 027 in Korea. After discharge, she was maintained on probiotics and rifaximin for 3 weeks. She had no relapse for 6 months.

Show MeSH
Related in: MedlinePlus