Clostridium difficile Infection and Inflammatory Bowel Disease: A Review

Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, 676 N St Clair Street, Suite 1400, Chicago, IL 60611, USA.
Gastroenterology Research and Practice (Impact Factor: 1.75). 09/2011; 2011(3):136064. DOI: 10.1155/2011/136064
Source: PubMed


The incidence of Clostridium difficile infection (CDI) has significantly increased in the last decade in the United States adding to the health care burden of the country. Patients with inflammatory bowel disease (IBD) have a higher prevalence of CDI and worse outcomes. In the past, the traditional risk factors for CDI were exposure to antibiotics and hospitalizations in elderly people. Today, it is not uncommon to diagnose CDI in a pregnant women or young adult who has no risk factors. C. difficile can be detected at the initial presentation of IBD, during a relapse or in asymptomatic carriers. It is important to keep a high index of suspicion for CDI in IBD patients and initiate prompt treatment to minimize complications. We summarize here the changing epidemiology, pathogenesis, risk factors, clinical features, and treatment of CDI in IBD.


Available from: Preetika Sinh, Oct 27, 2014
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    • "These patients undergo more frequent endoscopy and surgical procedures, and are hospitalised more frequently with longer hospital stays, both of which are risk factors for CDI. The CDAD in patients with IBD is characterised by more severe disease course and higher mortality compared with the general population [12]. The inflammatory process usually involves the colon, but may include the small intestine, particularly in patients post colectomy, as well as those who have inflammation of the reservoir (pouchitis) [3, 4]. "
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    ABSTRACT: Clostridium difficile is a bacterium widely distributed in the human environment. In the last decade the incidence and severity of Clostridium difficile infection has grown, particularly in Europe and North America, making it one of the more common nosocomial infections. A group particularly susceptible to Clostridium difficile infection are patients with inflammatory bowel disease, especially those with involvement of the colon. This paper presents relevant data on Clostridium difficile infections in inflammatory bowel disease patients, including epidemiology, pathogenesis, diagnosis and treatment.
    Przegląd Gastroenterologiczny 06/2014; 9(3):125-9. DOI:10.5114/pg.2014.43572 · 0.38 Impact Factor
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    • "CDI is increasingly seen in patient groups which prior to 2000 were considered to be at low-risk, i.e those with no recent exposure to antibiotics and in young adults [6]. A higher prevalence of CDI in patients with Inflammatory Bowel Disease (IBD) [7] and Cystic Fibrosis [8] has also been noted. "
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    ABSTRACT: Clostridium difficile infection (CDI) is the leading cause of hospital and community-acquired antibiotic-associated diarrhoea and currently represents a significant health burden. Although the role and contribution of C. difficile toxins to disease pathogenesis is being increasingly understood, at present other facets of C. difficile-host interactions, in particular, bacterial-driven effects on host immunity remain less studied. Using an ex-vivo model of infection, we report that the human gastrointestinal mucosa elicits a rapid and significant cytokine response to C. difficile. Marked increase in IFN-γ with modest increase in IL-22 and IL-17A was noted. Significant increase in IL-8 suggested potential for neutrophil influx while presence of IL-12, IL-23, IL-1β and IL-6 was indicative of a cytokine milieu that may modulate subsequent T cell immunity. Majority of C. difficile-driven effects on murine bone-marrow-derived dendritic cell (BMDC) activation were toxin-independent; the toxins were however responsible for BMDC inflammasome activation. In contrast, human monocyte-derived DCs (mDCs) released IL-1β even in the absence of toxins suggesting host-specific mediation. Infected DC-T cell crosstalk revealed the ability of R20291 and 630 WT strains to elicit a differential DC IL-12 family cytokine milieu which culminated in significantly greater Th1 immunity in response to R20291. Interestingly, both strains induced a similar Th17 response. Elicitation of mucosal IFN-γ/IL-17A and Th1/Th17 immunity to C. difficile indicates a central role for this dual cytokine axis in establishing antimicrobial immunity to CDI.
    PLoS ONE 07/2013; 8(7):e69846. DOI:10.1371/journal.pone.0069846 · 3.23 Impact Factor
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    • "Hospitalized patients with unexplained leukocytosis, even in the absence of diarrhea, should be tested for C. difficile.28 Hypervirulent strain NAP1/B1/027 of C. difficile is associated with severe disease and resistance to conventional medical therapy.27 "
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    ABSTRACT: Biologics such as antitumor necrosis factor (anti-TNF) drugs have emerged as important agents in the treatment of many chronic inflammatory diseases, especially in cases refractory to conventional treatment modalities. However, opportunistic infections have become a major safety concern in patients on anti-TNF therapy, and physicians who utilize these agents must understand the increased risks of infection. A literature review of the published data on the risk of bacterial, viral, fungal, and parasitic infections associated with anti-TNF therapy was performed and the clinical presentation, diagnostic tests, management, and prevention of opportunistic infections in patients receiving anti-TNF therapy were reviewed. Awareness of the therapeutic potential and associated adverse events is necessary for maximizing therapeutic benefits while minimizing adverse effects from anti-TNF treatments. Patients should be adequately vaccinated when possible and closely monitored for early signs of infection. When serious infections occur, withdrawal of anti-TNF therapy may be necessary until the infection has been identified and properly treated.
    Drug, Healthcare and Patient Safety 03/2013; 5:79-99. DOI:10.2147/DHPS.S28801
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