Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jul 31, 2019; 7(7): 350-357
Published online Jul 31, 2019. doi: 10.13105/wjma.v7.i7.350
Pediatric recurrent Clostridium difficile infections in immunocompetent children: Lessons learned from case reports of the first twelve consecutive patients
Angela Chu, Sonia Michail
Angela Chu, Sonia Michail, Department of Pediatrics, Miller Children’s and Women’s Hospital, Long Beach, CA 90826, United States
Angela Chu, Sonia Michail, Department of Pediatrics, UC Irvine School of Medicine, Irvine, CA 92612, United States
Sonia Michail, Pediatric Gastroenterology, Hepatology and Nutrition Center, Miller Children’s and Women’s Hospital, Long Beach, CA 90826, United States
Sonia Michail, University of Southern California, Los Angeles, CA 92708, United States
Author contributions: Chu A and Michail S contributed equally to this work. Chu A wrote most of the manuscript, Michail S conceptualized idea and supervised work.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sonia Michail, MD, Department of Pediatrics, 2801 Atlantic Ave, Long Beach CA 90806 United States. sonia.michail@hotmail.com
Telephone: +1-7143787230
Received: April 22, 2019
Peer-review started: April 22, 2019
First decision: June 10, 2019
Revised: June 13, 2019
Accepted: July 26, 2019
Article in press: July 26, 2019
Published online: July 31, 2019
Abstract
BACKGROUND

Recurrent Clostridium difficile infection (CDI) in children can be difficult to manage and may represent an unidentified underlying pathology. Recurrence can be frequently encountered in immunodeficiency disorders and inflammatory bowel disease (IBD).

AIM

To report cases of a select population of children with recurrent CDI who are immunocompetent and do not have an identified IBD and examine the potential for any underlying risk factors, disease course and disease outcome.

METHODS

Review of charts for children aged 1-21 years with recurrent CDI referred to see pediatric gastroenterology service was performed. All subjects with known immunosuppression or IBD were excluded. Subjects were followed for at least 24 mo.

RESULTS

Twelve children seen consecutively were identified. All patients were treated with antibiotic courses for CDI prior to their referral. Five out of 12 patients had an underlying pathology that was not previously identified, including eosinophilic colitis and IBD. CDI symptoms resolved after treatment of underlying colitis without the need to target therapy for CDI. There were 9 patients that failed antibiotic treatment of CDI and required fecal microbiome transplant, which was safe and highly effective in preventing recurrence (100% efficacy). The gut microbial changes after fecal transplant were characterized by a remarkable and durable increase in diversity and in abundance of Bacteroides.

CONCLUSION

Pediatric patients with frequent recurrence of CDI may have an unidentified underlying gastrointestinal pathology that may warrant further investigation by a specialist who can identify these diseases and help optimize management. Many of these children may benefit from fecal microbial transplant which appears to be a safe, highly effective therapy that results in long term changes in the gut microbiome.

Keywords: Recurrent Clostridium difficile infection, Eosinophilic colitis, Inflammatory bowel disease, Fecal microbiome transplant

Core tip: Children with recurrent Clostridium difficile infection who do not have known immunodeficiency or inflammatory bowel disease deserve a thorough workup as many may have an underlying gastrointestinal disease.