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    Journal Reading: Clostridium Difficile Causing

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    Feggy Melati
    This document reports a case study of a 42-year-old man who presented with worsening shortness of breath and was found to have an empyema caused by Clostridium difficile. C. difficile typically causes antibiotic-associated diarrhea but can rarely lead to extraintestinal infections like empyema. The patient had risk factors like prolonged hospitalization and prior antibiotic use. Testing of his pleural fluid grew C. difficile even though his stool samples were negative. Extraintestinal C. difficile infections are uncommon but this case highlights empyema as a potential extraintestinal manifestation.

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    Journal Reading: Clostridium Difficile Causing

    Uploaded by

    Feggy Melati
    41 views11 pages
    This document reports a case study of a 42-year-old man who presented with worsening shortness of breath and was found to have an empyema caused by Clostridium difficile. C. difficile typically causes antibiotic-associated diarrhea but can rarely lead to extraintestinal infections like empyema. The patient had risk factors like prolonged hospitalization and prior antibiotic use. Testing of his pleural fluid grew C. difficile even though his stool samples were negative. Extraintestinal C. difficile infections are uncommon but this case highlights empyema as a potential extraintestinal manifestation.

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    Clostridium difficile Causing Empyema

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    Journal Reading

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    This document reports a case study of a 42-year-old man who presented with worsening shortness of breath and was found to have an empyema caused by Clostridium difficile. C. difficile typically causes antibiotic-associated diarrhea but can rarely lead to extraintestinal infections like empyema. The patient had risk factors like prolonged hospitalization and prior antibiotic use. Testing of his pleural fluid grew C. difficile even though his stool samples were negative. Extraintestinal C. difficile infections are uncommon but this case highlights empyema as a potential extraintestinal manifestation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    41 views11 pages

    Journal Reading: Clostridium Difficile Causing

    Uploaded by

    Feggy Melati
    This document reports a case study of a 42-year-old man who presented with worsening shortness of breath and was found to have an empyema caused by Clostridium difficile. C. difficile typically causes antibiotic-associated diarrhea but can rarely lead to extraintestinal infections like empyema. The patient had risk factors like prolonged hospitalization and prior antibiotic use. Testing of his pleural fluid grew C. difficile even though his stool samples were negative. Extraintestinal C. difficile infections are uncommon but this case highlights empyema as a potential extraintestinal manifestation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 11

    JOURNAL

    READING
    Clostridium difficile Causing
    Empyema
    INTRODUCTION
     Clostridium difficile was discovered in the stool in 1935 by Hall and
    O’Toole , but it was not until approximately 43 years later when in
    1978 George et al. discovered that C. difficile was the organism
    responsible for most of the cases of antibiotic- associated
    diarrhea.
     C. difficile is a spore-forming, Gram-positive anaerobic bacillus
    that produces two exotoxins: toxin A and toxin B. It is a common
    cause of antibiotic-associated diarrhea. It accounts for 15–25% of
    all episodes of antibiotic-associated diarrhea.
     Extraintestinal manifestations of CDI especially empyema are
    rare. Smith and King were one of the first to describe extracolonic
    CDI. They reported on 2 cases of empyema caused by CDI.
    CASE REPORT
    A 42-year-old Hispanic male presented to our hospital with
    worsening shortness of breath of 3 weeks’ duration, cough
    with green color sputum, subjective fevers, decreased PO
    intake, and as per the patient a 40-pound weight loss.
     Four months prior to this presentation, the patient was
    admitted to our hospital with similar complaints and he was
    diagnosed with Klebsiella pneumoniae with parapneumonic
    effusion. The patient was given antibiotics and thoracentesis
    was done. Pleural fluid analysis is shown in Table 1.
     Hispast medical history including liver cirrhosis,
    hypothyroidism, and morbid obesity
     Physical exam was normal except for diminished lung
    sounds in the right lower and right middle lobes
     The patient was admitted to the general medical floors and
    started on meropenem and linezolid.
     A 14-Fr pigtail catheter was inserted in pleural cavity with
    removal of approximately 200 cm3 of thick purulent pleural fluid.
    The fluid was sent for evaluation including cytology which was
    suggestive of empyema.
     The pleural fluid was sent for analysis including anaerobic and
    aerobic Gram culture and stain which was positive for C. difficile.
     The patient had no history of CDI, and blood cultures were
    negative for C. difficile but were positive for K. pneumoniae.
     A stool C. difficile toxin assay was sent which returned negative
    for toxin, antigen, and PCR testing.
    Discussion
     Extra-intestinalmanifestations of CDI are rare. Smith and
    King were among the first to describe extracolonic CDI .
    They described 2 cases of empyema caused by CDI
     The first case was a 65-year-old man who had suffered from
    chronic pleuritis where CDI was isolated on two separate
    occasions.
     The second case was a 58-year-old male with a
    pneumothorax and subsequent pleural effusion. In both
    cases, the infections were likely secondary to aspiration.
     Simpson et al. also reported one case of CDI in empyema. In
    that case, the proposed method of infection was a chest
    tube into a pre-existing empyema. The only other mechanism
    through which the pleural fluid could be contaminated is
    hematogenous spread.
     The precise mechanism of C. difficile empyema in our
    patient is unclear. Possible risk factors were prolonged
    hospital stay and broad-spectrum antibiotics. In addition, he
    had undergone a prior thoracentesis which could have
    caused contamination of pleural space.
     Interestingly, he had never been infected with C. difficile on
    the current or prior admission.
     His stool toxin assay was negative and blood cultures sent on
    two separate occasions remained negative.
    Conclusion
     ExtraintestinalClostridium difficile infection (CDI) is extremely
    uncommon. Empyema is one of the extraintestinal
    manifestations of CDI. Possible mechanisms to develop this
    parapneumonic effusion are aspiration and contamination
    of the chest tube.

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