Wang Liqian, Luo Yun, Huang Chen, Wu Shenghai, Ye Julian, Song Xiaojun, Jin Dazhi, Wang Xianjun
Department of Laboratory Medicine, Zhejiang Chinese Medical University Affiliated Hangzhou First Hospital Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention Department of Laboratory Medicine, Hangzhou First Hospital, Huansha road, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2018 Mar;97(13):e9946. doi: 10.1097/MD.0000000000009946.
Clostridium difficile infections (CDIs) have been reported in China, but detailed clinical symptoms of coinfection by 2 C difficile ribotypes have not been documented.
An 83-year-old male with a 10-day history of diarrhea and urinary tract infection was admitted to the hospital. The patient had received ofloxacin for several days, but his clinical response was poor. Laboratory workup revealed high white blood cell (WBC), serum creatinine (Scr), and C-reactive protein (CRP) levels. Based on these abnormal lab results, rapid detection of glutamate dehydrogenase and toxin A and B was performed.
Severe CDI.
Oral vancomycin was administered for 8 days.
Diarrhea symptoms improved and C difficile culture was negative after oral vancomycin administration for 8 days. Clostridium difficile was isolated from 3 consecutive stool samples at 2-day intervals because the patient was admitted to the hospital. Polymerase chain reaction ribotyping revealed ribotype (RT) 017 in the first 2 samples and RT 001 in the third sample. RT 017 caused significantly higher increases in the levels of WBC, Scr, and CRP than RT 001.
It is necessary to improve clinicians' awareness of CDI and reduce the severity of CDI caused by RT 017 in China.
中国已报告艰难梭菌感染（CDIs），但两种艰难梭菌核糖型合并感染的详细临床症状尚无文献记载。
一名83岁男性因腹泻和尿路感染10天入院。患者已接受氧氟沙星治疗数天，但临床反应不佳。实验室检查显示白细胞（WBC）、血清肌酐（Scr）和C反应蛋白（CRP）水平升高。基于这些异常实验室结果，进行了谷氨酸脱氢酶以及毒素A和B的快速检测。
严重艰难梭菌感染。
口服万古霉素8天。
口服万古霉素8天后腹泻症状改善，艰难梭菌培养结果为阴性。由于患者住院，每隔2天从连续3次粪便样本中分离出艰难梭菌。聚合酶链反应核糖分型显示前两个样本为核糖型（RT）017，第三个样本为RT 001。RT 017导致WBC、Scr和CRP水平升高的幅度明显高于RT 001。
在中国，有必要提高临床医生对艰难梭菌感染的认识，并降低由RT 017引起的艰难梭菌感染的严重程度。
