Original Article

Clostridium difficile: Association with Thrombocytosis and Leukocytosis

Authors: Werner C. Albrich, MD, MS, David Rimland, MD

Abstract

Background: Apart from leukocytosis, few laboratory markers suggestive of Clostridium difficile infections have been described.


Methods: We retrospectively analyzed the association between thrombocytosis, leukocytosis and C difficile infections at the Atlanta Veterans Affairs Medical Center.


Results: Of 162 patients with C difficile infection, 36 (22%) had thrombocytosis, and 97 (60%) had leukocytosis. C difficile toxin A ELISA was performed in 46/695 (6.6%) patients with thrombocytosis and was positive in 18 (39.1%). Leukocytosis was present in 16/18 (89%) of patients with positive C difficile toxin A ELISA and thrombocytosis, but also in 21/28 (75%) of patients with negative C difficile toxin A ELISA and thrombocytosis. Among patients with marked leukocytosis, C difficile toxin A was more frequently detected in those with concomitant thrombocytosis (P = 0.07).


Conclusions: The presence of thrombocytosis may be helpful to improve the pretest probability for C difficile infections.


Key Points


* Twenty-two percent of patients with Clostridium difficile infection had thrombocytosis and 60% had leukocytosis.


* C difficile toxin A ELISA was performed in 6.6% of patients with thrombocytosis and was positive in 39.1% of those.


* Patients with thrombocytosis and a positive C difficile toxin A ELISA had leukocytosis 89% of the time, compared to 75% when the C difficile toxin A ELISA was negative.


* Among patients with marked leukocytosis, C difficile toxin A was more frequently detected in those with concomitant thrombocytosis.

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References

1. Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 2002;346:334–339.
 
2. Pepin J, Valiquette L, Alary ME, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–472.
 
3. Bulusu M, Narayan S, Shetler K, et al. Leukocytosis as a harbinger and surrogate marker of Clostridium difficile infection in hospitalized patients with diarrhea. Am J Gastroenterol 2000;95:3137–3141.
 
4. Wahanita A, Goldsmith EA, Musher D. Conditions associated with leukocytosis in a tertiary care hospital, with particular attention to the role of infection caused by clostridium difficile. Clin Infect Dis 2002;34:1585–1592.
 
5. Wahanita A, Goldsmith EA, Marino BJ, et al. Clostridium difficile infection in patients with unexplained leukocytosis. Am J Med 2003;115:543–546.
 
6. De Toledo FG, Symes SN. Leukemoid reaction due to Clostridium difficile infection in acquired immunodeficiency syndrome: two case reports and a review of the literature. South Med J 2004;97:388–392.
 
7. Katz DA, Lynch ME, Littenberg B. Clinical prediction rules to optimize cytotoxin testing for Clostridium difficile in hospitalized patients with diarrhea. Am J Med 1996;100:487–495.
 
8. Flegel WA, Müller F, Däubener W, et al. Cytokine response by human monocytes to Clostridium difficile toxin A and toxin B. Infect Immun 1991;59:3659–3666.
 
9. Linevsky JK, Pothoulakis C, Keates S, et al. IL-8 release and neutrophil activation by Clostridium difficile toxin-exposed human monocytes. Am J Physiol 1997;273:G1333–1340.
 
10. Hamaguchi H, Takano N, Saito K, et al. Interaction of monocytes and T cells in the regulation of normal human megakaryocytopoiesis in vitro: role of IL-1 and IL-2. Br J Haematol 1990;76:12–20.
 
11. Hsu HC, Tsai WH, Jiang ML, et al. Circulating levels of thrombopoietic and inflammatory cytokines in patients with clonal and reactive thrombocytosis. J Lab Clin Med 1999;134:392–397.
 
12. Kaser A, Brandacher G, Steurer W, et al. Interleukin-6 stimulates thrombopoiesis through thrombopoietin: role in inflammatory thrombocytosis. Blood 2001;98:2720–2725.