Clostridium Difcile in Children- A Multfaceted Infecton Costantino De Giacomo * and Elena Borali Division of Pediatrics, Department of Mother and Child Health, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy * Corresponding author: Costantno De Giacomo, Division of Pediatrics, Department of Mother and Child Health, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy, Email: costantno.degiacomo@ospedaleniguarda.it Received date: April 29, 2016; Accepted date: May 02, 2016; Published date: May 06, 2016 Citaton: De Giacomo C, Borali E (2016) Clostridium Difcile in Children- A Multfaceted Infecton. P edia tric In f ect Dis 1:12. doi: 10.21767/2573-0282.100012 Copyright: © 2016 De Giacomo C, et al. This is an open-access artcle distributed under the terms of the Creatve Commons Atributon License, which permits unrestricted use, distributon, and reproducton in any medium, provided the original author and source are credited. Abstract Two case reports of children with muco-hemorrhagic diarrhea positve for Clostridium difcile introduce into the world of Clostridium difcile infecton in the pediatric age. Epidemiological, clinical, and microbiological fndings represent pieces of the puzzle of one of the most emerging infectons at all the ages. Keywords: Clostridium difcile, Children, Multfaceted infecton Abbreviatons CDI: Clostridium Difcile Infecton, HA-CDI: Hospital Acquired Clostridium Difcile Infecton, CA-CDI: Community Acquired Clostridium Difcile Infecton, FMT: Faecal Microbiota Transplantaton, IBD: Infammatory Bowel Disease, PPI: Proton pump inhibitors Commentary Two children were referred to our Pediatric Gastroenterology Unit for muco-hemorrhagic diarrhea. Patent 1: The frst one was a 13-month-old boy, with a medical history started since the third trimester of pregnancy when a moderate bilateral dilaton of urinary tract was demonstrated at ultrasonography. Afer a normal delivery he underwent to recurrent episodes of urinary tract infectons caused by E.coli and treated with amoxicillin when, at age of 6 months, a urinary cistography showed a 3rd degree bilateral vesicouretheral refux. At 9 months of age, he developed fever, vomitng and diarrhoea, and he was treated with IV cephalosporin for pyelonephrits. Successively, a prophylactc therapy with amoxicillin was started. Two months later, when he was 1-year-old, he developed progressively irritability, feeding refusal, associated with failure to thrive; an urine analysis showed the presence of an infecton by E.coli resistant to amoxicillin and iv cephalosporin therapy was administrated at home. Afer a few days of clinical improvement, the reappearance of symptoms suggested to refer the child to a Hospital, where gentamicin was added to treatment. Five days later, a picture of mild diarrhoea appeared, and stools analysis for common viral and bacterial pathogens, revealed the presence of Rotavirus infecton. Three days later, diarrhoea increased with progressive appearance of mucous and blood, fever and worsening of general conditons. For this reason the child was referred to our Hospital, where he arrived febrile (39 degrees Celsius of temperature), with mild dehydraton , dilated abdomen, 5 to 7 muco-hemorrhagic evacuatons daily, and laboratory evidence of leukocytosis (16000/mmc), and raised serum CRP (9.1 mg/L; n.v. <0.5 mg/L) . Urine, blood and faecal cultures were negatve, but a search for toxigenic Clostridium difcile (CD) came back positve suggestng a presumptve diagnosis of Clostridium difcile infecton (CDI). Discontnuaton of cephalosporin and gentamicin and prompt administraton of oral metronidazole (25-30 mg/kg/day qid x 10 days) induced an amelioraton of clinical picture within 36 hours with complete remission afer 3 days of such a treatment. Patent 2: The second patent was a 14-year-old girl, without any signifcant clinical history, who developed a severe diarrhoea with more than 8 loose stools for day with mucous and blood, fever and abdominal pain. Laboratory analysis showed anaemia (8.3 g/dl), thrombocytosis (580000/mmc), raised ESR (75 mm/hr) and CRP (7 mg/L; n.v. <0.5 mg/L), and the presence of toxigenic C. difcile in the stools. A treatment with metronidazole alone frst and combined with IV later, didn’t improve the clinical picture. For this reason a systemic steroid therapy with methylprednisolone (1 mg/kg/day in 2 doses) was started and the patent was referred to our Division. At admission the clinical picture was very complicated, with radiologic evidence of dilaton of the colon (Figure), suggestng the need to alert surgeons for possible colectomy. According with the ECCO guidelines for managing acute severe ulceratve colits in children a rescue treatment with ant-TNFα resulted in a dramatc improvement and the patent was successively Commentary iMedPub Journals http://www.imedpub.com/ DOI: 10.21767/2573-0282.100012 Pediatric Infectious Diseases: Open Access ISSN 2573-0282 Vol.1 No.2:12 2016 © Under License of Creative Commons Attribution 3.0 License | This article is available from: http://dx.doi.org/10.21767/2573-0282.100012 1