European Journal of Clinical Microbiology

, Volume 3, Issue 1, pp 10–13 | Cite as

Clostridium difficile colitis associated with the use of antineoplastic agents

  • S. D. Miller
  • H. J. Koornhof
Original Articles

Abstract

Eight patients are presented in whom treatment with antineoplastic agents, in particular the folic acid antagonist methotrexate, precipitatedClostridium difficile-related diarrhoea and pseudomembranous colitis. The clinical presentation of these patients was identical to that encountered in patients developing antibiotic associated diarrhoea and colitis.Clostridium difficile-related diarrhoea and colitis should be suspected in any patient developing diarrhoea during the course of antineoplastic chemotherapy or within three weeks of its cessation. This complication is effectively treated with oral vancomycin.

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References

  1. 1.
    Faber, S., Diamond, L. K., Mercer, R. D., Sylvester, R. F., Wolff, J. A.: Temporary remission in acute leukaemia in children produced by folie acid antagonist 4-aminopteroylglutamic acid (aminopterin). New England Journal of Medicine 1948, 238: 787–793.Google Scholar
  2. 2.
    Skeel, R. T., Costello, W., Bennet, J. M., Oken, M. M., Tobin, M. S., Bertino, J. R., Marsh, J. C., Garborne, P. P.: Cyclophosphamide, cytosine arabinoside and methotrexate versus cytosine arabinoside and thioguanine for acute non-lymphocytic leukaemia in adults. Cancer 1980, 45: 224–231.PubMedGoogle Scholar
  3. 3.
    Condit, P. T.: Studies on the folic acid vitamins II. The acute toxicity of aminopterin in man. Cancer 1960, 13: 222–228.PubMedGoogle Scholar
  4. 4.
    George, W. L., Sutter, V. L., Goldstein, E. J. C., Ludwig, S. L., Finegold, S. M.: Aetiology of antimicrobial agent associated colitis. Lancet 1978, i: 802–803.Google Scholar
  5. 5.
    Tedesco, F., Markham, R., Gurwith, M., Christie, D., Bartlett, J. G.: Oral vancomycin for antibiotic-associated pseudomembranous colitis. Lancet 1978, ii: 226–228.Google Scholar
  6. 6.
    Cudmore, M., Silva, J., Fekety, R.: Clostridial enterocolitis produced by antineoplastic agents in hamsters and humans. Archives of Internal Medicine 1982, 142: 333–335.PubMedGoogle Scholar
  7. 7.
    Holdeman, L. V., Cato, E. P., Moore, W. E. G.: Anaerobe Laboratory Manual. Virginea Polytechnic Institute and State University, Blacksburg, VA 1977, p. 80–106.Google Scholar
  8. 8.
    Price, A. B., Larson, H. E., Crow, J.: Morphology of experimental antibiotic associated enterocolitis in the hamster: a model of human pseudomembranous colitis and antibiotic-associated diarrhoea. Gut 1979, 20: 467–475.PubMedGoogle Scholar
  9. 9.
    Prolla, J. C., Kirsner, J. B.: The gastrointestinal lesions and complications of the leukaemias. Annals of Internal Medicine 1964, 61: 1084–1103.PubMedGoogle Scholar
  10. 10.
    Trier, J. S.: Morphological alterations induced by methotrexate in the mucosa of the human proximal intestine. Gastroenterology 1962, 42: 295–305.PubMedGoogle Scholar
  11. 11.
    Taylor, S. G., Hass, G. M., Crumrine, J. L., Slaughter, D. P.: Toxic reactions of 4-aminopteroylglutamic acid (aminopterin) in patients with far advanced neoplastic disease. Cancer 1950, 3: 493–503.PubMedGoogle Scholar
  12. 12.
    Miller, S. D., Blake, M., Miliotis, M., Still, C., Taubin, A., Koornhof, H. J.: Antibiotic associated diarrhoea and pseudomembranous colitis: a review of forty cases. South African Medical Journal 1983, 63: 936–939.PubMedGoogle Scholar
  13. 13.
    Kabins, S. A., Spira, T. J.: Outbreak of clindamycin-associated colitis. Annals of Internal Medicine 1975, 83: 830–831.PubMedGoogle Scholar
  14. 14.
    Tedesco, F.J., Barton, R. N., Alpers, D. H.: Clindamycin-associated colitis: A prospective study. Annals of Internal Medicine 1974, 81: 429–433.PubMedGoogle Scholar
  15. 15.
    Kim, R. H., Fekety, R., Batts, D. H., Brown, D., Cudmore, M., Silva, J., Waters, D.: Isolation ofClostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. Journal of Infectious Diseases 1981, 143: 42–49.PubMedGoogle Scholar

Copyright information

© Vieweg Publishing 1984

Authors and Affiliations

  • S. D. Miller
    • 1
  • H. J. Koornhof
    • 1
  1. 1.MRC Emergent Pathogen Unit and Department of MicrobiologySouth African Institute for Medical ResearchJohannesburgSouth Africa

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