Editors' ChoiceInfectious Disease

Predicting Recurrent Clostridium difficile Infection

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Science Translational Medicine  24 Nov 2010:
Vol. 2, Issue 59, pp. 59ec183
DOI: 10.1126/scitranslmed.3001946

As physicians and scientists, we often forget how it feels to be a patient. I was acutely reminded of the patient perspective after the recent birth of my twins, when I became infected with Clostridium difficile—with multiple relapses. C. difficile infection (CDI) is a major cause of hospital-acquired diarrhea that is increasingly prevalent in the community-based setting. CDI is often associated with precedent antibiotic use, which is probably due to the eradication of competing bacteria. C. difficile, an anaerobic bacterium, secretes toxins that result in loss of cell-cell adhesion in the colon, as well as a robust inflammatory infiltrate that can lead to pseudomembranous colitis and toxic megacolon in a subset of cases. To date, prediction of which patients may develop symptomatic CDI and subsequent relapses has been challenging.

A recent article by Garey et al. addresses the role of interleukin-8 (IL-8) gene polymorphisms in predicting recurrent CDI—defined as the return of watery diarrhea associated with a positive toxin assay within 3 months of initial diagnosis—in a prospective cohort of 96 hospitalized patients who developed disease. IL-8 represents one of a number of cytokines that appear to influence the immune response after infection, promoting increased inflammatory/neutrophil infiltrate during disease. The current study reveals that patients with the A/A genotype at –251 of the IL-8 promoter have a significantly increased likelihood of recurrent CDI and represents a novel finding of host genetic influence on recurrence of C. difficile. In a disease that can follow a protracted course with unpredictable recurrences—and with effects as psychological as much as physical—the finding of a predictor for recurrence provides some “rhyme and reason” to patients and offers a unique opportunity for further understanding and potential treatment of this disease.

K. W. Garey et al., A common polymorphism in the interleukin-8 gene promoter is sssociated with an increased risk for recurrent Clostridium difficile infection. Clin. Infect. Dis. 51, 1406–1410 (2010). [Abstract]

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