Bulusu M, Narayan S, Shetler K, Triadafilopoulos G
Gastroenterology Section, Palo Alto Veterans Affairs Health Care System, California 94304, USA.
Am J Gastroenterol. 2000 Nov;95(11):3137-41. doi: 10.1111/j.1572-0241.2000.03284.x.
Clostridium difficile is the etiological agent of antibiotic-associated diarrhea and pseudomembranous colitis and is a leading cause of nosocomial diarrhea. The objective of the study was to examine if leukocytosis could be a harbinger and surrogate marker of C. difficile infection in hospitalized patients.
We retrospectively examined the medical records of 70 hospitalized patients who presented with diarrhea of variable severity and who underwent stool examination for enteric pathogens, including C. difficile. We specifically recorded the white blood cell count and the pattern and severity of leukocytosis in two groups of patients--those who were C. difficile-positive and those who were negative.
Leukocytosis was common in C. difficile-positive patients, compared to in C. difficile-negative patients (mean 15,800/mm3 vs 7700/mm3, p < 0.01). Review of the 35 C. difficile-positive patients revealed three patterns: Pattern A) sudden WBC increase coinciding with the onset of symptoms suggestive of C. difficile; Pattern B) unexplained leukocytosis preceding the appearance of C. difficile-related diarrhea and serving as a harbinger of the infection; and Pattern C) worsening of pre-existing leukocytosis as a surrogate marker of C. difficile infection. Treatment with metronidazole led to amelioration of symptoms and normalization of the leukocyte count in all cases.
Infection with C. difficile should be considered in the differential diagnosis of sudden onset of leukocytosis in hospitalized patients previously or concurrently treated with antibiotics. Doing so may obviate the need for expensive and time-consuming tests for other etiologies.
艰难梭菌是抗生素相关性腹泻和伪膜性结肠炎的病原体，也是医院内腹泻的主要原因。本研究的目的是检验白细胞增多是否可能是住院患者艰难梭菌感染的先兆和替代标志物。
我们回顾性检查了70例住院患者的病历，这些患者出现了不同严重程度的腹泻，并接受了包括艰难梭菌在内的肠道病原体粪便检查。我们特别记录了两组患者的白细胞计数以及白细胞增多的模式和严重程度，这两组患者分别是艰难梭菌阳性患者和阴性患者。
与艰难梭菌阴性患者相比，白细胞增多在艰难梭菌阳性患者中很常见（平均15,800/mm³ vs 7700/mm³，p < 0.01）。对35例艰难梭菌阳性患者的检查发现了三种模式：模式A）白细胞突然增加，与提示艰难梭菌感染的症状发作同时出现；模式B）在艰难梭菌相关性腹泻出现之前出现无法解释的白细胞增多，并作为感染的先兆；模式C）先前存在的白细胞增多加重，作为艰难梭菌感染的替代标志物。所有病例经甲硝唑治疗后症状均得到改善，白细胞计数恢复正常。
在对先前或同时接受抗生素治疗的住院患者突然出现白细胞增多进行鉴别诊断时，应考虑艰难梭菌感染。这样做可能无需对其他病因进行昂贵且耗时的检查。
