Submited on: 02 Jun 2014 01:28:05 AM GMT
Published on: 02 Jun 2014 05:37:21 AM GMT
 
Review on Atypical Presentation of Clostridium Difficille Infection (CDI).
Posted by Dr. Ian L Beales on 29 Jul 2014 11:06:25 AM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    The authors remind readers that C difficile infection does not always present with copious diarrhoea. Severe disease can present with constipation and ileus. In this case it is difficult to be sure as to whether diarrhoea was present or not. To effectively assay the stool, the stool must usually be at least non-formed, if not watery and it may ber that stools were in fact looser but had not reached the epidemiologial limit of diagnosis of 3 stools per day.

    In this case the continue use of opiates was almost certainly the confounding factor. As this would be expected to cover up some of the diarrhoea symptoms.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The claims are not novel and it is disappointing that the authors have not provided any literature review of how common non-diarrhoeal clinical C difficile infection is, compared to more classical features.


  • Are the claims properly placed in the context of the previous literature?

    The literature review is very weak, almost absent and there are several larger series which should throw light onto the relative occurance on C diffcile infection without clinically obvious diarrhoea.


  • Do the results support the claims? If not, what other evidence is required?

    The literature review is very weak, almost absent and there are several larger series which should throw light onto the relative occurance on C diffcile infection without clinically obvious diarrhoea.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Not applicable


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Not applicable


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Not strictly applicable. It would be approparite to see more results including albumin and all haematology, as well as see the temporal trends in theee, in relation to diagnostic tests and treatments. Details on the length of follow-up woud also be the indices to support this need toi be provided.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    It is not outstanding.


  • Other Comments:

    The written English and grammar could be improved. Several "the" are missing from the text. This is a 77-year old female, not "77 years"

    Why was vancomycin used. United Kingdom guidelines would usually suggest using orla metronidazole first line.

    The authors state that parenteral metronidazole can be used to treat C difficile, although it is used clinically, the efficacy of this is unproven to my knowledge.

    The authors mention "severe" CD-associated infection, without any inference as to what "severe" is. Whilst there are not agreed criteria, there are some in widespread use.

    The references are all rather old and potentially out of date and also the reference list does not rally make sense. There appears to be a refereence (a) which does not relate to the text. Reference 2 is used to support a diagnostic strategy but this reference is a Cochrane review of treatments and I do not believe included diagnostic testing within its remit.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Gut 2002;51:456 doi:10.1136/gut.51.3.456 Intravenous immunoglobulin for recurrent Clostridium difficile diarrhoea

  • Experience and credentials in the specific area of science:

    Gastroenetrology Consultant with specific experience and interest in the managment of C difficile infection. PI for trials of novel agents for the managment of C diffcile

  • How to cite:  Beales I L.Review on Atypical Presentation of Clostridium Difficille Infection (CDI).[Review of the article 'Atypical Presentation of Clostridium Difficille Infection (CDI).' by Ghumman S].WebmedCentral 2014;5(7):WMCRW003087
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Some considerations about Atypical Clostridium difficile lnfection (CDl)
Posted by Prof. Paolo Sossai on 12 Jun 2014 05:00:38 AM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    Problem of diagnostic criteria for CDI(diarrhea always?). [Cohen SH et al. Clinical Practìce Guidelines for Clostridium Difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Disease Society of America (IDSA). Infection Control and Hospital Epidemiology 2010; 31: 431-4551].


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The topic is not new but the discussion about diagnostic criteria is very important [Dubberke ER et al. Impact of Clinical Symptoms on Interpretation of Diagnostic Assays for Clostridium Difficile lnfections, J Clin Microbiol 2011; 49: 2887 -2893].


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    It is necessary to explain the meaning of "stool cuture positive for Clostridium Difficile": type of culture.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    More elements about diagnosis: type of stool culture and Illustration 1 and 2 (abdominal x rays and abdomen CT) description data about iron deficinecy anemia, hypotirodism and type II diabetes.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Can the Authors exclude that the clinical setting is consistent with diverticulitis or coltis associated with diverticulosis? Report in Discussion


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes in a methodological and clinical setting.


  • Other Comments:

    No

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:

    None

  • Experience and credentials in the specific area of science:

    Chief of the Department of Medicine of Urbino (ltaly)

  • How to cite:  Sossai P .Some considerations about Atypical Clostridium difficile lnfection (CDl)[Review of the article 'Atypical Presentation of Clostridium Difficille Infection (CDI).' by Ghumman S].WebmedCentral 2014;5(6):WMCRW003071
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Clostridium Difficille Infection
Posted by Dr. William J Maloney on 10 Jun 2014 09:01:05 PM GMT Reviewed by Interested Peers

  • What are the main claims of the paper and how important are they?

    The purpose of this paper is to present a report of an atypical presentation of Clostridium Difficille Infection (CDI).


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes- It would be a great seminar fo medical residents.


  • Other Comments:

    CDI is usually identified by the presence of diarrhea. However, CDI can be present without any diarrhea and even constipation.  Empirical use of antibiotics should be avoided as much as possible. The treatment of CDI is selected according to severity criteria.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:

    None

  • Experience and credentials in the specific area of science:

    Clinical associate professor

  • How to cite:  Maloney W J.Clostridium Difficille Infection[Review of the article 'Atypical Presentation of Clostridium Difficille Infection (CDI).' by Ghumman S].WebmedCentral 2014;5(6):WMCRW003067
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