Journal Article

<i>Clostridium difficile</i> Colitis Associated with Infant Botulism: Near-Fatal Case Analogous to Hirschsprung's Enterocolitis

Robert Schechter, Bradley Peterson, James McGee, Olajire Idowu and Bradley Bradley

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 29, issue 2, pages 367-374
Published in print July 1999 | ISSN: 1058-4838
Published online July 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/520217
Clostridium difficile Colitis Associated with Infant Botulism: Near-Fatal Case Analogous to Hirschsprung's Enterocolitis

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We present the first five reported cases of Clostridium difficile-associated diarrhea (CDAD) in children with infant botulism caused by Clostridium botulinum. We compare two fulminant cases of colitis in children with colonic stasis, the first caused by infant botulism and the second caused by Hirschsprung's disease. In both children, colitis was accompanied by hypovolemia, hypotension, profuse ascites, pulmonary effusion, restrictive pulmonary disease, and femoral-caval thrombosis. Laboratory findings included pronounced leukocytosis, hypoalbuminemia, hyponatremia, coagulopathy, and, when examined in the child with infant botulism, detection of C. difficile toxin in ascites. CDAD recurred in both children, even though difficile cytotoxin was undetectable in stool after prolonged initial therapy. Four children who had both infant botulism and milder CDAD also are described. Colonic stasis, whether acquired, as in infant botulism, or congenital, as in Hirschsprung's disease, may contribute to the susceptibility to and the severity of CDAD.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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