Open Access<i>Сlostridium difficile</i> Infection in a COVID-19 Patient
Author(s) -
А. А. Тимофеева,
Yu. O. Shulpekova,
Vladimir Nechaev,
М. Р. Схиртладзе
Publication year - 2021
Publication title -
rossijskij žurnal gastroènterologii, gepatologii, koloproktologii
Language(s) - English
Resource type - Journals
eISSN - 2658-6673
pISSN - 1382-4376
DOI - 10.22416/1382-4376-2021-31-3-68-73
Subject(s) - medicine , clostridium difficile , metronidazole , colitis , clostridium difficile colitis , diarrhea , vancomycin , exacerbation , gastroenterology , antibiotics , enterocolitis , staphylococcus aureus , microbiology and biotechnology , biology , genetics , bacteria
Aim. The clinical observation highlights plausible compound origins of diarrhoea, fever and neutrophilic leucocytosis in COVID-19 and the rationale to exclude Clostridium difficile infection in such patients. Key points. A 57-yo female patient was admitted in May 2020 with the complaints of 39 °C fever, general weakness, polymyalgia, diarrhoea to 3–4 times a day (mushy stool, no morbid inclusions). Initial diarrhoea was non-severe and likely triggered by the coronavirus infection. A background antibiotic and putative-immunosuppressive therapy proceeded with watery diarrhoea to 7–8 times a day and C. difficile toxins A and B detected in stool. The C. difficile infection relapsed on day 10 of vancomycin withdrawal and associated with elevated body temperature, diarrhoea and neutrophil leucocytosis; signs of colitis determined in ultrasound and CT. Exacerbation was successfully treated in a repeated metronidazole-combined vancomycin course. Conclusion. Patients with COVID-19 are at risk of clostridial colitis due to massive antibiotic, systemic glucocorticoid and biologics-based therapy they receive. The opportunistic bacterial infection of C. difficile often proceeds undetected due to its potential mirroring of COVID-19 presentation. A screening algorithm in COVID-19 patients with diarrhoea should imply steps for C. difficile detection.