Microbiological Causes of Relapses in Pediatric Onset Inflammatory Bowel Disease

Abstract Background A bidirectional relationship exists between infections and the development of inflammatory bowel disease (IBD). Early diagnosis of infection in a relapse may reduce a patient’s unnecessary exposure to corticosteroids and/or immunosuppressive drugs and it may also hasten their time to recovery. Aim of the Work The aim of the present study is to assess the microbiological causes of relapses in IBD patients including clostridium difficile infection. Patients and Methods This was a cross sectional study included 50 known children with IBD who were following up at Pediatric Gastroenterology Unit, Children’s Hospital, Ain Shams University, and presented with acute relapse. All patients were subjected to history taking including socio- demographic data, symptoms and signs of IBD during relapse, and medications including IBD therapy and recent antibiotics, laboratory investigations including blood tests, stool analysis and culture and sensitivity. Clostridium difficile toxin A and B test was done via rapid chromatographic immunoassay in fecal specimens. Results The mean age (SD) of the studied patients were 12.45 (±3.2469) years. They were 30 males and 20 females. Stool culture and sensitivity showed no growth in 86% of the patients, E.coli, Salmonella and entamoeba histolytica were isolated in 10%, 2% and 2% respectively, but the serotype testing was not available. Clostridium difficile infection (CDI) was positive in 40% of included children. Children who were tested positive for CDI had high frequency of recent antibiotic use (P = 0.036), associated diabetes mellitus (DM) (p = 0.004) and presence of RBCs in stool (P = 0.038). Conclusion Clostridium difficile infection is an important infection in cases of relapsed IBD, which is often overlooked in pediatrics. This risk might be increased with previous intake of antibiotics and associated immunological diseases (DM).