Question: C diff
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A 5 month old comes in with diarrhea x 3 days, 5 times per day initially now 3 times per day, non-bloody, no fever, no vomiting. The patient was seen in the ED the day before, and had stool culture sent which was negative, C. difficile toxin which was positive, and stool WBC negative.
Kelly June 5, 2018 - 9:29 am
Children under age 2 years have a high incidence of C. difficile carriage (37% for 0-1 month old, 30% for 1-6 months), which does not reach adult rates until 3 years of age. Testing for children younger than 12 months should only be performed in those with Hirschsprung or severe motility disorders and suspected disease. Testing in 1-3 year olds is difficult to interpret and should other causes for diarrhea should be ruled out first. A positive test after the third year of life is probably a true positive. In addition, per Harbor ID, testing should not be done unless the patient has at least 3 liquid bowel movements in the past 24 hours (in the absence of laxatives, enemas, or increased tube feeds), AND one or more of: fever > 38.5 C, WBC > 12,000, abdominal pain or tenderness. Donnatal should never be given to children, and probiotics are of unproven benefit, particularly since the patient is already improving.