Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Department of Gynecology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan.
Cancer Rep (Hoboken). 2019 Oct;2(5):e1200. doi: 10.1002/cnr2.1200. Epub 2019 Jul 22.
Although Clostridium difficile infection (CDI) often results in severe manifestations due to toxin-producing clostridium, the correlation between CDI and having a fever in gynecological malignancies is not completely understood.
The incidence, and clinical features, and clinical management of CDI in patients with gynecological malignancies who have fevers were investigated, and the clinical managements of this complication are discussed.
We retrospectively reviewed 485 patients newly diagnosed with invasive gynecological cancers who underwent anticancer treatment between July 2012 and December 2016. The diagnosis of CDI was performed using enzyme immunoassays for C difficile glutamate dehydrogenase and toxin A/B enzyme immunoassay. The cumulative risk of CDI was 9.5% (six of 63) in overall fever patients and 6.3% (six of 95) in patients with fever episodes. Two CDI patients (33.3%) did not show diarrheal symptoms, with the fever of unknown origin criteria prompting their CDI testing and diagnosis. CDI patients were treated using vancomycin or metronidazole without suffering from fatal clinical course. Overall, eight patients with gynecological malignancies were diagnosed with CDI, including two patients with fever lower than 38.5°C. The cumulative risk of CDI was 0.48% (eight of 1652) for all admitted patients and 1.6% (eight of 485) in those with gynecological malignancies. Of all the patients with confirmed CDI, only one had a history of administration of antibiotics prior to onset of CDI symptoms.
CDI does not always present with typical manifestations in malignancy patients. Investigation of CDI, regardless of gastrointestinal symptoms or history of antibiotic use, is warranted in cases of fever of unknown origin in gynecological malignancy.
尽管由于产毒梭状芽孢杆菌，艰难梭菌感染（CDI）常导致严重表现，但 CDI 与妇科恶性肿瘤发热之间的相关性尚未完全阐明。
研究妇科恶性肿瘤发热患者 CDI 的发生率、临床特征和临床处理方法，并讨论该并发症的临床处理方法。
我们回顾性分析了 2012 年 7 月至 2016 年 12 月期间接受抗癌治疗的 485 例新诊断为侵袭性妇科癌症患者。使用酶联免疫吸附法检测 C difficile 谷氨酸脱氢酶和毒素 A/B 酶联免疫吸附法诊断 CDI。总的发热患者中 CDI 的累积风险为 9.5%（63 例中的 6 例），发热患者中为 6.3%（95 例中的 6 例）。2 例 CDI 患者（33.3%）没有腹泻症状，因不明原因发热标准促使他们进行 CDI 检测和诊断。CDI 患者使用万古霉素或甲硝唑治疗，没有出现致命的临床病程。总体而言，1652 例住院患者中有 8 例诊断为妇科恶性肿瘤 CDI，其中 2 例发热低于 38.5°C。所有住院患者的 CDI 累积风险为 0.48%（1652 例中的 8 例），妇科恶性肿瘤患者为 1.6%（485 例中的 8 例）。所有确诊 CDI 的患者中，仅有 1 例在出现 CDI 症状前有使用抗生素的病史。
CDI 并不总是在恶性肿瘤患者中表现出典型的表现。对于妇科恶性肿瘤不明原因发热的患者，即使没有胃肠道症状或使用抗生素的病史，也应调查 CDI。
