NAL CENTER FOR CASE STUDY TACHING IN SN Part Il-Relapse When Danielle mentioned

Question

NAL CENTER FOR CASE STUDY TACHING IN SN Part Il-Relapse When Danielle mentioned her stomachache to her father, he immediarely sook her to the emergency room. There they confirmed Danielle had C: diff. Danielle was given a three-week course of metronidaxole, by the end of which she was feeling benter. Once she went off the drugs, however, her abdominal pain returned Questions 1. Does the reappearance of Daniclle's symptoms suggest another bout of C difficile disease? 2. What factors could cause a redapse in C dafficile diease 3. If Danielle's symptoms are due to a relapse of C difficile, what aleermative treatments might you suggest for her

Explanation / Answer

1. Recurrent CDI occurs in 20 to 30% of the patients, with increase rates of recurrences with each subsequent episodes In clinical settings, it not possible to distinguish recurrences that develop as a relapse of CDI with the same strain of C. difficileversus a reinfection that is the result of a new strain. Surprisingly, recurrent CDI does not seem to be the result of resistance. Therefore, when it does recurs, it can be treated in the way.

2. Primary risk factor for the developing CDI includes advanced age (greater than 65 years), antibiotic usage, severe illness, and hospitalization.

Secondary factors that can cause development of CDI includes gastric acid suppression (with proton pump inhibitors or histamine-2 receptor antagonists), gastrointestinal procedures, chemotherapy, residence at a long-term care facility, inflammatory bowel disease, and immunosuppression.Further, in those infected with C. difficile, low levels of vitamin D have been shown to be an independent predictor of poor outcome and are associated with higher recurrence

3. Metronidazole is not given because treatments beyond a first recurrence of mild disease as prolonged use may cause to neurotoxicity.

For second recurrences, tapered plans with pulsed doses of vancomycin over 6 weeks have been suggested

Also recently, therapy with fidaxomicin has been offered as an adjunct, particularly in patients on a concomitant antibiotic for systemic infection but the current high cost of fidaxomici inhibits wider use.

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