C. difficile seen in patients lacking usual risk factors.(Clinical Rounds)

The diagnosis of Clostridium difficile--associated disease should be considered in patients with severe diarrhea, even if they don't have traditional risk factors such as recent hospitalization or antimicrobial use, the Centers for Disease Control and Prevention advised.

During May and June 2005, a total of 10 peripartum and 23 C. difficile--associated disease (CDAD) cases from previously healthy individuals in the community were voluntarily reported from four U.S. states following a request from the CDC. The findings suggest that the epidemiology of the disease might be changing to include features that have been uncommon in the past, such as close-contact transmission, high recurrence rate, young patient age, bloody diarrhea, and lack of antimicrobial exposure, the CDC warned (MMWR 2005;54:1201-5).

All but 1 of the 33 cases occurred during 2004-2005. Hospitalization was required for 15 (46%), and relapses occurred in 13 (39%). Transmission to close contacts was evident in four cases. Eight of the 33 patients (24%)--including 5 children--reported no exposure to antimicrobial agents within 3 months prior to CDAD onset. Of those eight, two reported close contact with a person who had diarrheal illness.