Clostridium Difficile–Associated Diarrhea and Disseminated Salmonella Coinfection: A Case Report from a Tertiary Cancer Hospital

1Moffitt Cancer Center, Tampa, FL
2Moffitt Cancer Center, Tampa, FL
3Moffitt Cancer Center, Tampa, FL

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 490

Case Presentation:

A 42‐year‐old woman with metastatic colon cancer presented from home to a tertiary cancer hospital's triage center with complaints of fevers up to 102°F, nausea with abdominal pain, new‐onset watery diarrhea and worsening fatigue. Approximately 6 months prior, she had completed FOLFOX and Avastin chemotherapy. Three weeks prior, the patient had undergone an exploratory laparotomy with colostomy reversal and segmental colon resection. She denied cough, dysuria, antibiotic use, sick contacts, or recent travel. Physical exam revealed a blood pressure of 114/65, heart rate 132, respiratory rate 28, temperature 101.7 degrees F and oxygen saturation 95% on room air. The patient was in mild respiratory distress with decreased breath sounds bilaterally at the lung bases. She was tachycardic but regular. Her abdomen was diffusely distended with normoactive bowel sounds but was tender to palpation with guarding but no rebound. A well‐healed midline incision was present without erythema or induration. Laboratory analysis was significant for leukocytosis of 23,130. CT scan of the chest, abdomen and pelvis were performed with positive findings of bilateral pleural effusions and large loculated fluid collections with air pockets in the abdomen. Diffuse bowel wall thickening, possible colitis, was also noted. Blood cultures from admission were positive for Salmonella. Stool studies were positive for Clostridium difficile and Salmonella spp. serogroup Z. Abdominal fluid collected via CT guided drainage had a gram stain positive for gram‐negative rods but cultures remained negative. The patient was ultimately treated with oral Vancomycin for C. difficile–associated diarrhea (CDAD) due to level of initial leukocytosis and Ciprofloxacin for Salmonella bacteremia. Leukocytosis resolved during the 14 day course of appropriate antibiotics.

Discussion:

Nontyphoid salmonellosis typically presents as an acute watery diarrhea, often with fever and in approximately 95% of cases is a result of food borne transmission from poultry. Recent outbreaks of disease have been seen with contaminated peanut butter and pistachios. Per CDC.gov, approximately 1.2 million cases are estimated per year in the United States. Salmonella tends to take advantage of abnormal gastrointestinal mucosa, for example in a C. difficile–infected patient, to cause bacteremia. This patient's only recent antibiotics, as the risk factor CDAD, was approximately 3 weeks prior to presentation as her preoperative prophylaxis for her aforementioned surgery.

Conclusions:

Despite scant antibiotic exposure, an immunosuppressed patient is at risk for complicated infections for example CDAD and coinfection with nontypoid salmonellosis. Because of concomitant infections, the patient has an increased risk of bacteremia thus requiring hospital admission with close monitoring and aggressive antibiotic treatment.

To cite this abstract:

Andreu A, Adams M, Baluch A. Clostridium Difficile–Associated Diarrhea and Disseminated Salmonella Coinfection: A Case Report from a Tertiary Cancer Hospital. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 490. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/clostridium-difficileassociated-diarrhea-and-disseminated-salmonella-coinfection-a-case-report-from-a-tertiary-cancer-hospital/. Accessed September 22, 2019.

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