Evaluation of Viral Co-infections Among Patients with Community-associated Clostridioides Difficile Infection

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Oct 19

PMID 33075113

Authors

Lauren Korhonen

Jessica Cohen

Nicole Gregoricus

Monica M Farley

Rebecca Perlmutter

Stacy M Holzbauer

Ghinwa Dumyati

Zintars Beldavs

Ashley Paulick

Jan Vinje

Brandi M Limbago

Fernanda C Lessa

Alice Y Guh

Affiliations

Soon will be listed here.

Abstract

We assessed viral co-infections in 155 patients with community-associated Clostridioides difficile infection in five U.S. sites during December 2012-February 2013. Eighteen patients (12%) tested positive for norovirus (n = 10), adenovirus (n = 4), rotavirus (n = 3), or sapovirus (n = 1). Co-infected patients were more likely than non-co-infected patients to have nausea or vomiting (56% vs 31%; p = 0.04), suggesting that viral co-pathogens contributed to symptoms in some patients. There were no significant differences in prior healthcare or medication exposures or in CDI complications.

References

Ludwig A, Sato K, Schirmer P, Maniar A, Lucero-Obusan C, Fleming C . Concurrent outbreaks with co-infection of norovirus and Clostridium difficile in a long-term-care facility. Epidemiol Infect. 2013; 141(8):1598-603. PMC: 9151590. DOI: 10.1017/S0950268813000241. View

Jangi S, Lamont J . Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. J Pediatr Gastroenterol Nutr. 2010; 51(1):2-7. DOI: 10.1097/MPG.0b013e3181d29767. View

Guh A, Adkins S, Li Q, Bulens S, Farley M, Smith Z . Risk Factors for Community-Associated Infection in Adults: A Case-Control Study. Open Forum Infect Dis. 2018; 4(4):ofx171. PMC: 5903408. DOI: 10.1093/ofid/ofx171. View

Koo H, Ajami N, Jiang Z, DuPont H, Atmar R, Lewis D . A nosocomial outbreak of norovirus infection masquerading as clostridium difficile infection. Clin Infect Dis. 2009; 48(7):e75-7. PMC: 3761966. DOI: 10.1086/597299. View

Chitnis A, Holzbauer S, Belflower R, Winston L, Bamberg W, Lyons C . Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med. 2013; 173(14):1359-67. DOI: 10.1001/jamainternmed.2013.7056. View

Bresee J, Marcus R, Venezia R, Keene W, Morse D, Thanassi M . The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States. J Infect Dis. 2012; 205(9):1374-81. DOI: 10.1093/infdis/jis206. View

Buss S, Leber A, Chapin K, Fey P, Bankowski M, Jones M . Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol. 2015; 53(3):915-25. PMC: 4390666. DOI: 10.1128/JCM.02674-14. View

El Feghaly R, Stauber J, Tarr P, Haslam D . Viral co-infections are common and are associated with higher bacterial burden in children with clostridium difficile infection. J Pediatr Gastroenterol Nutr. 2013; 57(6):813-6. PMC: 4098970. DOI: 10.1097/MPG.0b013e3182a3202f. View

Spina A, Kerr K, Cormican M, Barbut F, Eigentler A, Zerva L . Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis. Clin Microbiol Infect. 2015; 21(8):719-28. DOI: 10.1016/j.cmi.2015.04.007. View

10.

Pijnacker R, Van Pelt W, Vennema H, Kortbeek L, Notermans D, Franz E . Clinical relevance of enteropathogen co-infections in preschool children-a population-based repeated cross-sectional study. Clin Microbiol Infect. 2018; 25(8):1039.e7-1039.e13. DOI: 10.1016/j.cmi.2018.11.029. View

11.

Weng M, Adkins S, Bamberg W, Farley M, Espinosa C, Wilson L . Risk factors for community-associated Clostridioides difficile infection in young children. Epidemiol Infect. 2019; 147:e172. PMC: 6518485. DOI: 10.1017/S0950268819000372. View

12.

Shafiq M, Alturkmani H, Zafar Y, Mittal V, Lodhi H, Ullah W . Effects of co-infection on the clinical outcomes of infection. Gut Pathog. 2020; 12:9. PMC: 7041107. DOI: 10.1186/s13099-020-00348-7. View

13.

Nicholson M, Van Horn G, Tang Y, Vinje J, Payne D, Edwards K . Using Multiplex Molecular Testing to Determine the Etiology of Acute Gastroenteritis in Children. J Pediatr. 2016; 176:50-56.e2. PMC: 5215462. DOI: 10.1016/j.jpeds.2016.05.068. View

14.

Stockmann C, Rogatcheva M, Harrel B, Vaughn M, Crisp R, Poritz M . How well does physician selection of microbiologic tests identify Clostridium difficile and other pathogens in paediatric diarrhoea? Insights using multiplex PCR-based detection. Clin Microbiol Infect. 2015; 21(2):179.e9-15. PMC: 4330102. DOI: 10.1016/j.cmi.2014.07.011. View

15.

Valenzuela C, Legarraga P, Pena A, Arenas A, Berkowitz L, Ramirez G . Etiologic and clinical characterization of community acquired gastroenteritis in adult patients in a Chilean emergency room by the FilmArray GI panel. PLoS One. 2018; 13(11):e0207850. PMC: 6258233. DOI: 10.1371/journal.pone.0207850. View

16.

Stokely J, Niendorf S, Taube S, Hoehne M, Young V, Rogers M . Prevalence of human norovirus and Clostridium difficile coinfections in adult hospitalized patients. Clin Epidemiol. 2016; 8:253-60. PMC: 4934455. DOI: 10.2147/CLEP.S106495. View