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Nosocomial Clostridium difficile Diarrhea in Patient with Malignancy Kurniawan, Andree; Syam, Ari Fahrial; Pratama, Nata; Sari, Resti Mulya; Chen, Khie
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Clostridium difficile (C. difficile) is the main pathogen causing antibiotics associated diarrhea and colitis. This bacterium increases with hospitalization with incidence of 20-60 cases per 100,000 patients/day. C. difficile is gram positive bacilli which produce toxins in 2,700 cases in every 100,000 exposures to particular antibiotics, such as clindamycin, cephalosporin, and ampicillin. These antibiotics disrupt the intestinal normal flora and predispose to colonization of C. difficile. This case described a 53-year old male patient with squamous cell carcinoma in his left ear who came to Department of Internal Medicine, Cipto Mangunkusumo Hospital, with the complain of diarrhea since two weeks after one month hospitalization in Department of Ear, Nose, and Throat. The characteristics of the diarrhea were 10 times per day ± 100 mL, watery consistency, green yellowish in color, and no blood in the feces. Additionally, the patient also complained of pain in all parts of his stomach, especially in the epigastric area. Earlier, patient was given ceftazidime for 30 days of hospitalization. The serology examination of C. difficile in the feces showed positive result (titer = 0.790 and control = 0.190). During the colonoscopy examination, pancolitis was found and the pathologic anatomy result was found appropriate for infective colitis. Thereafter, antibiotic administration was ceased and metronidazole was administered intravenously three times a day. The diarrhea stopped after seven days and the patient was discharged. Keywords: Clostridium difficile, nosocomial diarrhea, malignancy

PREVALENCE OF CROHNÂƒS DISEASE IN ENDOSCOPIC UNIT CIPTO MANGUNKUSUMO HOSPITAL Pratama, Nata; Abdullah, Murdani; Kansera, Dolly Dolven; Estherina, Jane; Yaruntradhani, Rizki; Hardi, Fransiska; Ista, Raden Nur; Simadibrata, Marcellus; Fauzi, Achmad; Daldiyono, Daldiyono; Rani, Abdul Aziz; Handjari, Diah Rini; Abineno, Pamela
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/122201185-88

Background: The cumulative number of inflammatory bowel disease patients in Asia has raised three times since early 1990s, although Crohn?s disease is still less common than ulcerative colitis. The objective of this study was to provide clinical and demographic data of Crohn?s disease patients seen in Endoscopic Unit Cipto Mangunkusumo Hospital and compare the Results with other Asian countries. Method: This study was done retrospectively cross-sectional descriptive from medical records of all patients underwent colonoscopy at Endoscopic Unit, Cipto Mangunkusumo Hospital, and histological evaluation in the Department of Anatomical Pathology, Faculty of Medicine, University of Indonesia, between 2007 and 2008. Data was analyzed using SPSS version 17. Results: Of 921 patients who underwent colonoscopy, 19 (2.1%) patients were diagnosed with Crohn?s disease. There was no sex preponderance. The mean age was 47.7 years with a peak age at presentation between 51 and 60 years. The main clinical complaints were diarrhea (42.1%), lower gastrointestinal bleeding (36.8%), abdominal pain (10.5%) and upper gastrointestinal bleeding (5.3%). Colonoscopic findings were hyperemia in 94.7%, edema in 57.9%, erosions in 63.2%, ulcerations in 89.5%, pseudopolyp in 31.6%, fragile lesion in 10.5%, stenosis, fistulation, and cobblestone appearance in 5.3%. Involvement of isolated left colon was 26.3%; other manifestations were isolated right colon (10.5%), pancolitis (57.9%), ileitis (5.3%), ileocolitis (36.8%) and skip lesion (5.3%). Conclusion: The prevalence of Crohn?s disease in this study was similar to the findings in previous studies in Asian countries, with diarrhea as the main clinical complaint, and pancolitis as the dominant finding in colonoscopy examination. Keywords: Crohn?s disease, prevalence, clinical complaints, colonoscopy description

Nosocomial Clostridium difficile Diarrhea in Patient with Malignancy Andree Kurniawan; Ari Fahrial Syam; Nata Pratama; Resti Mulya Sari; Khie Chen
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Clostridium difficile (C. difficile) is the main pathogen causing antibiotics associated diarrhea and colitis. This bacterium increases with hospitalization with incidence of 20-60 cases per 100,000 patients/day. C. difficile is gram positive bacilli which produce toxins in 2,700 cases in every 100,000 exposures to particular antibiotics, such as clindamycin, cephalosporin, and ampicillin. These antibiotics disrupt the intestinal normal flora and predispose to colonization of C. difficile. This case described a 53-year old male patient with squamous cell carcinoma in his left ear who came to Department of Internal Medicine, Cipto Mangunkusumo Hospital, with the complain of diarrhea since two weeks after one month hospitalization in Department of Ear, Nose, and Throat. The characteristics of the diarrhea were 10 times per day ± 100 mL, watery consistency, green yellowish in color, and no blood in the feces. Additionally, the patient also complained of pain in all parts of his stomach, especially in the epigastric area. Earlier, patient was given ceftazidime for 30 days of hospitalization. The serology examination of C. difficile in the feces showed positive result (titer = 0.790 and control = 0.190). During the colonoscopy examination, pancolitis was found and the pathologic anatomy result was found appropriate for infective colitis. Thereafter, antibiotic administration was ceased and metronidazole was administered intravenously three times a day. The diarrhea stopped after seven days and the patient was discharged. Keywords: Clostridium difficile, nosocomial diarrhea, malignancy

Prevalence of Crohns Disease in Endoscopic Unit Cipto Mangunkusumo Hospital Nata Pratama; Murdani Abdullah; Dolly Dolven Kansera; Jane Estherina; Rizki Yaruntradhani; Fransiska Hardi; Raden Nur Ista; Marcellus Simadibrata; Achmad Fauzi; Daldiyono Daldiyono; Abdul Aziz Rani; Diah Rini Handjari; Pamela Abineno
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Background: The cumulative number of inflammatory bowel disease patients in Asia has raised three times since early 1990s, although Crohn’s disease is still less common than ulcerative colitis. The objective of this study was to provide clinical and demographic data of Crohn’s disease patients seen in Endoscopic Unit Cipto Mangunkusumo Hospital and compare the Results with other Asian countries. Method: This study was done retrospectively cross-sectional descriptive from medical records of all patients underwent colonoscopy at Endoscopic Unit, Cipto Mangunkusumo Hospital, and histological evaluation in the Department of Anatomical Pathology, Faculty of Medicine, University of Indonesia, between 2007 and 2008. Data was analyzed using SPSS version 17. Results: Of 921 patients who underwent colonoscopy, 19 (2.1%) patients were diagnosed with Crohn’s disease. There was no sex preponderance. The mean age was 47.7 years with a peak age at presentation between 51 and 60 years. The main clinical complaints were diarrhea (42.1%), lower gastrointestinal bleeding (36.8%), abdominal pain (10.5%) and upper gastrointestinal bleeding (5.3%). Colonoscopic findings were hyperemia in 94.7%, edema in 57.9%, erosions in 63.2%, ulcerations in 89.5%, pseudopolyp in 31.6%, fragile lesion in 10.5%, stenosis, fistulation, and cobblestone appearance in 5.3%. Involvement of isolated left colon was 26.3%; other manifestations were isolated right colon (10.5%), pancolitis (57.9%), ileitis (5.3%), ileocolitis (36.8%) and skip lesion (5.3%). Conclusion: The prevalence of Crohn’s disease in this study was similar to the findings in previous studies in Asian countries, with diarrhea as the main clinical complaint, and pancolitis as the dominant finding in colonoscopy examination. Keywords: Crohn’s disease, prevalence, clinical complaints, colonoscopy description

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