Wanahita Anna, Goldsmith Elizabeth A, Marino Bernard J, Musher Daniel M
Medical Service, Infectious Disease Section, Veterans Affairs Medical Center, Houston, Texas 77030, USA.
Am J Med. 2003 Nov;115(7):543-6. doi: 10.1016/s0002-9343(03)00420-0.
To determine whether unrecognized Clostridium difficile infection is responsible for a substantial proportion of cases of unexplained leukocytosis in a tertiary care hospital setting.
We prospectively identified 60 patients who had unexplained leukocytosis (white blood cell count > or =15,000/mm3). Fecal specimens were tested for C. difficile toxin using an enzyme immunosorbent assay. We compared the clinical features of patients who had positive or negative assay results, as well as of 26 hospitalized control patients who did not have unexplained leukocytosis.
Thirty-five (58%) of the patients with unexplained leukocytosis had C. difficile toxin in at least one fecal specimen as compared with 3 (12%) of the controls (P <0.001). Symptoms of colitis were often mild or absent at the time the white blood cell count was first elevated or, if present, had not been recognized by the attending physicians. Leukocytosis resolved promptly in most patients who were treated with metronidazole. In the 25 patients (42%) who had a negative test for C. difficile toxin, leukocytosis also tended to resolve during empiric therapy with metronidazole; some of these patients may have had C. difficile infection.
The majority of patients in our hospital who had unexplained leukocytosis had C. difficile infection. Unexplained leukocytosis in hospitalized patients should prompt a search for symptoms and signs consistent with C. difficile infection and a study to detect C. difficile. Empiric therapy with metronidazole may be effective in the appropriate epidemiologic setting.
确定在三级医疗中心环境中，未被识别的艰难梭菌感染是否是导致相当一部分不明原因白细胞增多病例的原因。
我们前瞻性地确定了60例不明原因白细胞增多（白细胞计数≥15,000/mm³）的患者。使用酶免疫吸附试验检测粪便标本中的艰难梭菌毒素。我们比较了检测结果为阳性或阴性的患者以及26例无不明原因白细胞增多的住院对照患者的临床特征。
60例不明原因白细胞增多的患者中，35例（58%）至少一份粪便标本中检测到艰难梭菌毒素，而对照组中这一比例为3例（12%）（P<0.001）。在白细胞计数首次升高时，结肠炎症状通常较轻或不存在，或者即使存在，主治医生也未识别出来。大多数接受甲硝唑治疗的患者白细胞增多迅速缓解。在25例艰难梭菌毒素检测为阴性的患者（42%）中，在甲硝唑经验性治疗期间白细胞增多也趋于缓解；这些患者中的一些可能患有艰难梭菌感染。
我院大多数不明原因白细胞增多的患者患有艰难梭菌感染。住院患者不明原因的白细胞增多应促使医生寻找与艰难梭菌感染相符的症状和体征，并进行检测艰难梭菌的研究。在适当的流行病学环境中，甲硝唑经验性治疗可能有效。
