Clostridium difficile in haematological malignancy

J Clin Pathol. 1985 Apr;38(4):445-51. doi: 10.1136/jcp.38.4.445.

Abstract

Twenty patients with haematological malignancies who developed Clostridium difficile bowel infection or colonisation are described. All isolates of C difficile were toxigenic in vitro and faecal cytotoxin (toxin B) was detected in 20/26 episodes. Ten of 20 episodes with detectable faecal cytotoxin were associated with typical antibiotic associated diarrhoea. In the other 10 episodes (nine patients), there was a severe unusual illness which was associated with detection of C difficile. The unusual features of the illness were pronounced jaundice (total bilirubin greater than or equal to 44 mumol/l), abdominal pain and distension, and initial constipation followed either by diarrhoea or by large bowel stasis. Four of these patients died within seven days. Bacteraemia was often a presenting feature in neutropenic patients subsequently shown to have C difficile. This was not the case in non-neutropenic patients. Bacteraemia was commonly polymicrobial and in two cases C difficile was isolated from blood culture. The clinical implications of recognition of this atypical C difficile associated syndrome are discussed.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Clostridium / isolation & purification
  • Clostridium Infections / complications*
  • Cytotoxins / analysis
  • Diarrhea / complications
  • Feces / microbiology
  • Female
  • Humans
  • Leukemia / complications*
  • Leukemia, Lymphoid / complications
  • Leukemia, Lymphoid / microbiology
  • Leukemia, Myeloid, Acute / complications
  • Leukemia, Myeloid, Acute / microbiology
  • Male
  • Middle Aged
  • Neutropenia / complications
  • Sepsis / complications

Substances

  • Cytotoxins