Successful treatment of life-threatening, treatment resistant Clostridium difficile infection associated pseudomembranous colitis with faecal transplantation

2012 ◽  
Vol 153 (52) ◽  
pp. 2077-2083 ◽  
Author(s):  
Gergely György Nagy ◽  
Csaba Várvölgyi ◽  
György Paragh
Keyword(s):  
Clostridium Difficile ◽  
Antibiotic Treatment ◽  
Pseudomembranous Colitis ◽  
Supportive Therapy ◽  
Cost Effective ◽  
Epidemiological Data ◽  
Recurrence Rates ◽  
Antibiotic Resistant ◽  
Life Saving ◽  
Life Threatening

Due to world-wide spread of hypervirulent and antibiotic resistant Clostridium difficile strains, the incidence of these infections are dramatically increasing in Hungary with appalling mortality and recurrence rates. Authors present a case of a 59-year-old patient who developed a severe, relapsing pseudomembranous colitis after antibiotic treatment. Life-threatening symptoms of fulminant colitis were successfully treated with prolonged administration of metronidazole and vancomycin, careful supportive therapy and weeks of intensive care. However, a well-documented, severe relapse developed within a week and this time faecal bacteriotherapy was performed. This treatment resulted in a complete cure without any further antibiotic treatment. In relation to this life-saving faecal transplantation, methodology and indications are briefly discussed. In addition, microbiological issues, epidemiological data and threats associated with antibiotic treatment of Clostridium difficile infections are also covered. Finally, relevant professional societies are urged to prepare a national protocol for faecal transplantation, which could allow introduction of this valuable, cost-effective procedure into the routine clinical practice. Orv. Hetil., 2012, 153, 2077–2083.

scholarly journals Proteomic Signatures of Clostridium difficile Stressed with Metronidazole, Vancomycin, or Fidaxomicin

Cells ◽  
2018 ◽  
Vol 7 (11) ◽  
pp. 213 ◽  
Author(s):  
Sandra Maaß ◽  
Andreas Otto ◽  
Dirk Albrecht ◽  
Katharina Riedel ◽  
Anke Trautwein-Schult ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Antibiotic Treatment ◽  
Antimicrobial Agents ◽  
Cell Envelope ◽  
Protein Biosynthesis ◽  
Cellular Functions ◽  
Antibiotic Resistant ◽  
Incidence And Mortality ◽  
A Cell ◽  
Proteomic Response

The anaerobic pathogen Clostridium difficile is of growing significance for the health care system due to its increasing incidence and mortality. As C. difficile infection is both supported and treated by antibiotics, a deeper knowledge on how antimicrobial agents affect the physiology of this important pathogen may help to understand and prevent the development and spreading of antibiotic resistant strains. As the proteomic response of a cell to stress aims at counteracting the harmful effects of this stress, it can be expected that the pattern of a pathogen’s responses to antibiotic treatment will be dependent on the antibiotic mechanism of action. Hence, every antibiotic treatment is expected to result in a specific proteomic signature characterizing its mode of action. In the study presented here, the proteomic response of C. difficile 630∆erm to vancomycin, metronidazole, and fidaxomicin stress was investigated on the level of protein abundance and protein synthesis based on 2D PAGE. The quantification of 425 proteins of C. difficile allowed the deduction of proteomic signatures specific for each drug treatment. Indeed, these proteomic signatures indicate very specific cellular responses to each antibiotic with only little overlap of the responses. Whereas signature proteins for vancomycin stress fulfil various cellular functions, the proteomic signature of metronidazole stress is characterized by alterations of proteins involved in protein biosynthesis and protein degradation as well as in DNA replication, recombination, and repair. In contrast, proteins differentially expressed after fidaxomicin treatment can be assigned to amino acid biosynthesis, transcription, cell motility, and the cell envelope functions. Notably, the data provided by this study hint also at so far unknown antibiotic detoxification mechanisms.

scholarly journals Extended anticoagulation after venous thromboembolism: should it be done?

2019 ◽  
Vol 13 ◽  
pp. 175346661987855 ◽  
Author(s):  
Caio J. Fernandes ◽  
Daniela Calderaro ◽  
Bruna Piloto ◽  
Susana Hoette ◽  
Carlos Vianna Poyares Jardim ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Epidemiological Data ◽  
Recurrence Risk ◽  
Secondary Prophylaxis ◽  
Limited Disease ◽  
Recurrence Rates ◽  
Material Section ◽  
Life Threatening ◽  
Supplementary Material

Most physicians understand venous thromboembolism (VTE) to be an acute and time-limited disease. However, pathophysiological and epidemiological data suggest that in most patients VTE recurrence risk is not resolved after the first 6 months of anticoagulation. Recurrence rates are high and potentially life-threatening. In these cases, it would make sense to prolong anticoagulation for an undetermined length of time. However, what about the bleeding rates, induced by prolonged anticoagulation? Would they not outweigh the benefit of reducing the VTE recurrent risk? How long should anticoagulation be continued, and should all patients suffering from VTE be provided with extended anticoagulation? This review will address the most recent data concerning extended anticoagulation in VTE secondary prophylaxis. The reviews of this paper are available via the supplementary material section.

scholarly journals A Tetraspecific VHH-Based Neutralizing Antibody Modifies Disease Outcome in Three Animal Models of Clostridium difficile Infection

2016 ◽  
Vol 23 (9) ◽  
pp. 774-784 ◽  
Author(s):  
Diane J. Schmidt ◽  
Gillian Beamer ◽  
Jacqueline M. Tremblay ◽  
Jennifer A. Steele ◽  
Hyeun Bum Kim ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Neutralizing Antibody ◽  
Antibiotic Resistant ◽  
Content Type ◽  
New Therapeutic Approaches ◽  
Cell Assays ◽  
Life Threatening ◽  
Hospital Stays ◽  
Serious Disease ◽  
Gnotobiotic Piglets

ABSTRACTClostridium difficileinfection (CDI), a leading cause of nosocomial infection, is a serious disease in North America, Europe, and Asia. CDI varies greatly from asymptomatic carriage to life-threatening diarrhea, toxic megacolon, and toxemia. The incidence of community-acquired infection has increased due to the emergence of hypervirulent antibiotic-resistant strains. These new strains contribute to the frequent occurrence of disease relapse, complicating treatment, increasing hospital stays, and increasing morbidity and mortality among patients. Therefore, it is critical to develop new therapeutic approaches that bypass the development of antimicrobial resistance and avoid disruption of gut microflora. Here, we describe the construction of a single heteromultimeric VHH-based neutralizing agent (VNA) that targets the two primary virulence factors ofClostridium difficile, toxins A (TcdA) and B (TcdB). Designated VNA2-Tcd, this agent has subnanomolar toxin neutralization potencies for bothC. difficiletoxins in cell assays. When given systemically by parenteral administration, VNA2-Tcd protected against CDI in gnotobiotic piglets and mice and to a lesser extent in hamsters. Protection from CDI was also observed in gnotobiotic piglets treated by gene therapy with an adenovirus that promoted the expression of VNA2-Tcd.

scholarly journals Assessing the role of p-cresol tolerance in Clostridium difficile

2008 ◽  
Vol 57 (6) ◽  
pp. 745-749 ◽  
Author(s):  
Lisa F. Dawson ◽  
Richard A. Stabler ◽  
Brendan W. Wren
Keyword(s):  
Clostridium Difficile ◽  
Phenolic Compound ◽  
Pseudomembranous Colitis ◽  
Antibiotic Exposure ◽  
High Tolerance ◽  
Nosocomial Pathogen ◽  
Normal Bowel ◽  
Life Threatening ◽  
Clostridial Species

Clostridium difficile is an important nosocomial pathogen, resulting in antibiotic-associated disease ranging from mild diarrhoea to the life-threatening pseudomembranous colitis. Upon antibiotic exposure, it is believed that the normal bowel microflora of patients is disrupted, allowing C. difficile to proliferate. Significantly, C. difficile is among only a few bacteria able to ferment tyrosine to p-cresol, a phenolic compound that is toxic to other microbes via its ability to interfere with metabolism. Therefore, the ability of different C. difficile strains to produce and tolerate p-cresol may play an important role in the development and severity of C. difficile-associated disease. In this study, it was demonstrated that two C. difficile hypervirulent 027 strains (Stoke Mandeville and BI-16) are more tolerant to p-cresol than other C. difficile strains including 630, CF4 and CD196. Surprising, it was shown that Clostridium sordellii also has a high tolerance to p-cresol, suggesting an overlap in the tolerance pathways in these clostridial species.

scholarly journals A rare association of puerperal ovarian venous thrombosis with pseudomembranous colitis

2020 ◽  
Vol 9 (10) ◽  
pp. 4307
Author(s):  
Devika J. Kamat ◽  
Namrata P. Kavlekar
Keyword(s):  
Clostridium Difficile ◽  
Venous Thrombosis ◽  
Pseudomembranous Colitis ◽  
Puerperal Fever ◽  
Stool Culture ◽  
Vein Thrombosis ◽  
Persistent Symptoms ◽  
Puerperal Infection ◽  
Life Threatening ◽  
Enhanced Computed Tomography

Ovarian venous thrombosis is a rare but serious complication associated with early puerperium. The risk of this complication increases with associated puerperal infection or inflammatory condition. The present case report is of a 36-year-old lady who presented after emergency caesarean with puerperal fever and abdominal pain along with diarrhoea post antibiotic cover. Patient presented with moderate ascites and uterine subinvolution on examination. Contrast enhanced computed tomography (CECT) showed evidence of bowel wall edema due of colitis along with ovarian vein thrombosis. Patients had persistent symptoms despite receiving an empirical course of injectable cephalosporins. Stool culture confirmed growth of Clostridium difficile. Patient developed a rare infection after a course of antibiotic i.e. pseudomembranous colitis caused by Clostridium difficile. Patient then received a course of injectable vancomycin after which colitis subsided. This case increases our vigilance on management of puerperal fever which could get complicated with life-threatening events like deep vein thrombosis.

scholarly journals Snake bite management in a toddler: a case report in Sumbawa Besar

2021 ◽  
Vol 61 (4) ◽  
pp. 171-4
Author(s):  
Ferry Liwang ◽  
Fitria Nuraeni ◽  
Mulya R. Karyanti
Keyword(s):  
Rural Areas ◽  
Epidemiological Data ◽  
Snake Bite ◽  
Lower Limbs ◽  
Intervention Measures ◽  
Life Saving ◽  
Snake Bites ◽  
The Face ◽  
Life Threatening ◽  
Low Coverage

Snake bite is an often-neglected,1 life-threatening emergency prevalent in rural areas of tropical countries such as Indonesia.2 The WHO reported a worldwide incidence of 5 million snake bites per year, with 100,000–200,000 deaths.3 The incidence rate and likelihood of subsequent complications are higher in children than adults.4 According to the WHO, 35% of child deaths related to poisonous animal bites are attributable to snake bites and occur more frequently in boys than girls.5 In Indonesia, no national epidemiological data on snake bites in children is available, but the WHO estimated that 5–8 snake bite cases occur weekly in Lombok, West Nusa Tenggara.6 Lower limbs are the most common site for bites (72%), while facial bites are quite rare (10%).7 Bites involving children and/or the face are considered as severe envenomation and usually require antivenom at an appropriate dose and timing to be effective.8 Therefore, it is important that hospitals are equipped with life-saving intervention measures to optimize care and improve the chances of survival.9 Nevertheless, in developing countries, the use of antivenom is limited by the absence of standardized guidelines, scarcity/unavailability, and high cost.9 In Indonesia, the only antivenom, serum antibisa ular (SABU), is costly and difficult to obtain due to limited quantities, especially in rural areas. Furthermore, SABU is a polyvalent antivenom with low coverage, as it is only indicated for Naja sputatrix, Bungarus fasciatus, and Agkistrodon rhodostoma, despite the numerous other snake species endemic to Indonesia.2

Multi-Epitope Vaccines (MEVs), as a Novel Strategy Against Infectious Diseases

2020 ◽  
Vol 17 (5) ◽  
pp. 354-364
Author(s):  
Mohammad Mahmoudi Goumari ◽  
Ibrahim Farhani ◽  
Navid Nezafat ◽  
Shirin Mahmoodi
Keyword(s):  
Infectious Diseases ◽  
Epitope Prediction ◽  
Cost Effective ◽  
Antimicrobial Drugs ◽  
Antibiotic Resistant ◽  
Time Consumption ◽  
Preclinical Evaluation ◽  
Structural Evaluation ◽  
Novel Strategy ◽  
Epitope Vaccines

Infectious diseases have caused historical pandemics in the world. Three strategies, including sanitation programs, antimicrobial drugs, and vaccines are considered for the prevention and treatment of infectious diseases. Today, some infectious diseases cause millions of mortalities universally. Due to the emergence of antibiotic-resistant pathogens, as well as some limitations of traditional vaccines, focusing on novel strategies is essential. Multi-Epitope Vaccines (MEVs), as a novel strategy, have been designed based on immunoinformatics methods; epitope prediction by authentic servers, attachment of epitopes using proper linkers, physicochemical, immunological and structural evaluation by bioinformatics tools that are basic stages in MEVs designing. Advantages such as cost-effective, high safety, less time consumption in designing, the application of natural adjuvants, and satisfactory preclinical evaluation outstand MEVs than other types of vaccines. Therefore, MEVs are promising vaccines against resistant diseases such as lower respiratory infection and diarrhea.

scholarly journals Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 707
Author(s):  
Afifah Machlaurin ◽  
Franklin Christiaan Karel Dolk ◽  
Didik Setiawan ◽  
Tjipke Sytse van der Werf ◽  
Maarten J. Postma
Keyword(s):  
Cost Effectiveness ◽  
Univariate Analysis ◽  
Cost Effective ◽  
Epidemiological Data ◽  
Control Programme ◽  
Detection Rates ◽  
Middle Income ◽  
Bcg Vaccination ◽  
Life Years ◽  
The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

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