ALİ TÜZÜN İNCE, Ebubekir ŞENATEŞ, Şenbayrak Seniha AKÇAY, Zeynep Satı TEKİN, Mesut SEZİKLİ, SÜLEYMAN COŞGUN, Mustafa Erhan ALTINÖZ

Hafif ve orta aktiviteli inflamatuvar barsak hastalarında toksin A/B sıklığı

Giriş ve Amaç: İnflamatuvar barsak hastalığı olan hastalar sık hastaneye yatış ve immünsüpresif/immünmodülatör ilaç ve antibiyotik kullanımı nedeniyle Clostridium difficile enfeksiyonu açısından artmış riske sahiptir. Clostridium difficile enfeksiyonu sıklığı hastalık aktivitesiyle paralel olarak artar. Bu çalışmadaki amacımız hafif ve orta aktiviteli inflamatuvar barsak hastalarında toksin A/B sıklığını araştırmaktır. Gereç ve Yöntem: Son üç ayda hastaneye yatış ve/ya antibiyotik kullanım öyküsü olmayan 100 inflamatuvar barsak hastası (48 kadın, 52 erkek) çalışmaya alındı. Her hastadan bir adet dışkı örneği alınıp EIA metoduyla Clostridium difficile toksin A/B açısından çalışıldı. Ek olarak dışkı örnekleri parazit açısından incelendi ve örneklerin kültürü yapıldı. Toksin A/B açısından pozitif ve negatif olan hastalar yaş, cinsiyet, hastalık tipi (Crohn hastalığı, ülseratif kolit), lokalizasyonu ve süresi, ektsraintestinal bulgular ve kullanılan ilaçlar (azatioprin, salazoprin, metotreksat, infliximab ve adalimumab) açısından karşılaştırıldı. Bulgular: Clostridium difficile toksin A/B pozitifliği sadece iki hastada saptandı (1 erkek, 1 kadın). İki grup arasında karşılaştırılan parametreler açısından anlamlı bir fark saptanmadı. Dışkı örneklerinde parazit saptanmadı ve dışkı kültürlerinde herhangi bir üreme olmadı. Sonuçlar: Hafif ve orta aktiviteli inflamatuvar barsak hastalarında Clostridium difficile toksin A/B pozitifliği normal popülasyonla benzerdir ve sıklığı daha önce düşünüldüğü kadar yüksek değildir.

Anahtar Kelimeler:

Clostridium difficile, toksin A ve B, inflamatuar barsak hastalığı

Toxin A and B frequency in mildly and moderately active inflammatory bowel disease patients

Background/aims: Inflammatory bowel disease patients are at an increased risk for Clostridium difficile infection because of frequent hospitalizations and usage of immunosuppressive/immunomodulator drugs as well as antibiotics. The frequency of Clostridium difficile infection increases in parallel with the increase in disease activity. We aimed to evaluate the frequency of Clostridium difficile toxin A/B in patients with mildly and moderately active inflammatory bowel disease because a search on PubMed revealed a scarcity of literature knowledge in this regard. Methods: One hundred inflammatory bowel disease patients (48 females, 52 males) with mild and moderate activity were consecutively enrolled in the study; none of the patients had a history of hospitalization and/or antibiotic usage for the last three months. A stool sample was investigated for Clostridium difficile toxin A/B with enzyme immunoassay method by a microbiologist who was blinded to the study. Additionally, samples were evaluated for parasites and culture. Toxin A/B-positive and -negative cases were compared according to age, gender, disease type (Crohn's disease, ulcerative colitis), duration and location, extraintestinal findings, and any drugs used (azathioprine, salazopyrin, methotrexate, infliximab, adalimumab). Results were evaluated statistically. Results: Clostridium difficile toxin A/B positivity was found in only two patients (1 female, 1 male) (2%). In comparisons, we found no significant differences between the two groups. There was no growth in stool cultures and no parasite was found in stool samples. Conclusions: Clostridium difficile toxin A/B positivity in mildly and moderately active inflammatory bowel disease patients is the same as in the normal population and not higher as hypothesized.

Keywords:

Clostridium difficile, toxin A and B, inflammatory bowel disease,

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