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C. difficile-associated reactive arthritis underdiagnosed, misdiagnosed among children
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Recent research in JAMA Pediatrics determined that Clostridium difficile infection-associated reactive arthritis is underdiagnosed and often misdiagnosed among children.
“While the condition is documented in the published literature, the epidemiology of [Clostridium difficile infection-associated reactive arthritis (CDIAReA)] is poorly understood, both in adult and pediatric populations,” Daniel B. Horton, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “Our study aims to objectively characterize the incidence, recognition and distinguishing clinical features of CDIAReA in children infected with C. difficile.”
Daniel B. Horton
The researchers conducted a case-control study with 148 children aged 2 to 21 years and compiled medical records from three pediatric health care networks. Participants included those with musculoskeletal disease associated with C. difficile. The researchers randomly matched 26 cases of CDIAReA with C. difficile infection controls without arthritis and compared their characteristics.
Study results showed that the estimated prevalence of CDIAReA was 5.0 cases (95% CI, 3.2-7.8) per million person-years. The researchers calculated an annual CDIAReA prevalence of 1.4% (95% CI, 0.8-2.3) among children with C. difficile infection. Children with CDIAReA were more likely to be treated in emergency care or hospital settings, despite a lower likelihood of having chronic conditions.
The researchers also found that only 35% of children with CDIAReA were correctly diagnosed by physicians, leaving a majority misdiagnosed and exposed to unnecessary, potentially harmful interventions.
“CDIAReA leads to high rates of health care usage even though many affected children are otherwise healthy and have community-associated C. difficile infection,” Horton and colleagues wrote. “As the incidence of C. difficile infections and CDIAReA increases in children, better recognition of CDIAReA is needed to initiate prompt treatment while avoiding unnecessary intervention.” -by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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