背景:艰难梭菌(C.difficile)是引起抗生素相关性腹泻的主要病原体。成人有多种与艰难梭菌感染(CDI)相关的症状,包括自限性腹泻,假膜性结肠炎,有毒的巨结肠,感染性休克,甚至因感染而死亡。然而,婴儿的肠道似乎完全抵抗艰难梭菌毒素A和B的影响,很少出现临床症状。
方法:在本研究中,我们报道了一名1个月大的CDI女孩,她出生时患有新生儿低血糖和坏死性小肠结肠炎.她的腹泻症状发生在住院期间广泛使用广谱抗生素后,并伴有白细胞升高,血小板,和C反应蛋白水平,重复的常规大便检查异常。她通过去甲万古霉素(万古霉素的类似物)和益生菌治疗恢复。16SrRNA基因测序的结果还证明了随着厚壁菌和乳酸菌的富集,肠道微生物群的恢复。
结论:根据文献综述和本病例报告,临床医生还应注意婴幼儿艰难梭菌引起的腹泻。需要更有力的证据来解释CDI在该人群中的真实患病率,并更好地了解婴儿中艰难梭菌相关性腹泻。
BACKGROUND: Clostridioides difficile (C. difficile) is the major pathogen causing antibiotic-associated diarrhea. There are a variety of symptoms associated with C. difficile infection (CDI) in adults, including self-limiting diarrhea, pseudomembranous colitis, toxic megacolon, septic shock, and even death from the infection. However, the infant\'s intestine appears to be completely resistant to the effects of C. difficile toxins A and B with rare development of clinical symptoms.
METHODS: In this study, we reported a 1-month-old girl with CDI who was born with neonatal hypoglycemia and necrotizing enterocolitis. Her symptom of diarrhea occurred after extensive use of broad-spectrum antibiotics during hospitalization and was accompanied by elevated white blood cell, platelet, and C-reactive protein levels, and repeated routine stool examinations were abnormal. She was recovered by norvancomycin (an analogue of vancomycin) and probiotic treatment. The results of 16 S rRNA gene sequencing also demonstrated the recovery of intestinal microbiota with the enrichment of Firmicutes and Lactobacillus.
CONCLUSIONS: Based on the literature review and this
case report, clinicians should also pay attention to diarrhea caused by C. difficile in infants and young children. More strong evidence is needed to explain the true prevalence of CDI in this population and to better understand the C. difficile-associated diarrhea in infants.