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Etiological profile of diarrhea in solid organ transplant recipients at a tertiary care center in Southern India
Author(s) -
Vyas Viral Dineshchandra,
Parameswaran Sarojini Ashok,
Paramasivan Piramanayagam,
Sankaranarayanan Krishnan,
Palaniswamy Kallipatti Ramasamy,
Mohan Arumugam T,
Srinivas Usha,
Dhus Ubal,
Muthuswamy Hariharan,
Revathy Marimuthu S,
Natarajan Murugan,
Karunakaran Premkumar,
Venkatesh Seshadri,
Mahalingam Preethi,
Patel Ankit
Publication year - 2021
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13584
Subject(s) - medicine , diarrhea , etiology , gastroenterology , clostridium difficile , colonoscopy , transplantation , antibiotics , colorectal cancer , cancer , microbiology and biotechnology , biology
Background Diarrhea is one of the common gastrointestinal (GI) adverse events after solid organ transplantation. Diarrhea may be caused by infectious or non‐infectious etiology. The infectious etiology of diarrhea varies according to the location and duration of diarrhea. Non‐infectious etiologies include drugs, inflammatory bowel disease, neoplasia. The objective of this study was to evaluate the etiological profile of diarrhea in solid organ transplant recipients presenting to a tertiary care center in Southern India. Methods This was a retrospective analysis of prospectively collected data of all solid organ transplantation recipients referred to the Department of Medical Gastroenterology for evaluation of diarrhea from April 2012 till May 2014. All patients had stool evaluated by wet mount examination, modified acid fast (AFB) stain, trichrome stain, culture, and Clostridium difficile toxin assay. EDTA plasma was collected for quantitative Cytomegalovirus (CMV) detection by real‐time PCR. If the diarrhea was acute (<2 wk), and no etiological agent was identified, empirical antibiotic therapy was instituted and followed up. If persistent or chronic diarrhea (>2‐4 wk), endoscopic evaluation (upper GI endoscopy and/or colonoscopy with biopsies), depending on the clinical type of diarrhea was done. If no specific etiological diagnosis was established after endoscopic evaluation, breath test for SIBO and celiac serology were done. If no specific etiology was identified after the above investigations, dose of immunosuppressive drugs was reduced. If diarrhea responded to dose reduction, it was considered to be drug related. Results Fifty‐eight episodes of diarrhea occurred in 55 solid organ transplant recipients during the study period. Renal transplant recipients constituted the majority (70%). Most (79%) of patients included in the study had their transplant > 6 mo ago. Infective diarrhea was the etiology in 46%, drug‐related diarrhea in 29.3%. No specific etiology was identified in 22.4% of patients. Parasites accounted for 69% of all infective diarrhea. Stool evaluation was the main investigation in establishing diagnosis in acute diarrhea. Endoscopic evaluation was required in two thirds of patients to establish diagnosis in chronic diarrhea. Conclusion GI infections and drug‐related diarrhea were the common causes of diarrhea in solid organ transplant recipients. Parasites were the most common infectious etiology of diarrhea. Step‐wise evaluation was able to identify the etiology in ~ 77% of patients. Overall, 98% of diarrheal episodes resolved.