Ewha Med J.  2011 Sep;34(2):3-12. 10.12771/emj.2011.34.2.3.

Clostridium difficile Infections in Children

• Gil JH
• Seo JW

• KMID: 2283963
• DOI: http://doi.org/10.12771/emj.2011.34.2.3

Abstract

During the past decade, rates of Clostridium difficile infection (CDI) increased worldwide. Hypervirulent strains of C. difficile such as NAP1/BI/027 and PCR ribotype 078 have emerged that have changed the epidemiology of CDI. Especially, CDI rates also have increased in the community, in children previously thought to be at low risk. Recently, the use of gastric acid suppressant that facilitates intestinal transit of the bacteria and presence of inflammatory bowel disease has been reported as risk factors. Treatment for CDI usually relies on metronidazole or vancomycin, but recurrence rates remains high. New treatment options for multiple recurrence are challenging. In this article, we reviewed recent epidemiological changes, current knowledge of virulence factors, reasonable approach to the diagnosis, and optimal treatment of CDI. But, clinical guidelines for pediatric C. difficile disease have not been defined. It seems that the consensus and recommendations for managing pediatric CDI are urgently needed.

Keyword

Clostridium difficile; Child; Risk factors; Diagnosis; Therapeutics

MeSH Terms

Bacteria
Child
Clostridium
Clostridium difficile
Consensus
Gastric Acid
Humans
Inflammatory Bowel Diseases
Metronidazole
Polymerase Chain Reaction
Recurrence
Ribotyping
Risk Factors
Vancomycin
Virulence Factors
Metronidazole
Vancomycin
Virulence Factors

Figure

• 

  Fig. 1 A case of psedomembranous colitis in a 23-month-old girl presented with watery diarrhea and fever who had received broad spectrum antibiotics and steroid for the treatment of asthma. (A) Colonoscopic findings shows characteristic inflammatory membranous (pseudomembranous) nodules surrounded by hyperemia, edema and superficial erosion. (B) CT findings demonstrates wall thickening of nearly entire colon, associated with omental inflammatory infiltration and ascites. (C) Histopathologic findings shows inflammatory exudate erupts from the superficial degenerating crypts (mushroom-like configuration) and nonspecific infiltration of inflammatory cells on the mucosal layer.

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