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Medline ® Abstract for Reference 3

of 'Clostridium difficile infection in adults: Clinical manifestations and diagnosis'

Conditions associated with leukocytosis in a tertiary care hospital, with particular attention to the role of infection caused by clostridium difficile.
Wanahita A, Goldsmith EA, Musher DM
Clin Infect Dis. 2002;34(12):1585.
Few modern studies have enumerated the conditions associated with leukocytosis. Our clinical experience has implicated Clostridium difficile infection in a substantial proportion of patients with leukocytosis. In a prospective, observational study of 400 inpatients with WBC counts of>/=15,000 cells/mm(3), we documented>/=1 infection in 207 patients (53%). Of these 207 patients, 97 (47%) had pneumonia, 60 (29%) had urinary tract infection, 34 (16%) had soft-tissue infection, and 34 (16%) had C. difficile infection. C. difficile infection was present in 25% of patients with WBC counts of>30,000 cells/mm(3) who did not have hematological malignancy. Other causes of leukocytosis in the 400 patients included physiological stress, in 152 patients (38%); medications or drugs, in 42 (11%); hematological disease, in 22 (6%); and necrosis or inflammation, in 22 (6%). C. difficile infection is a prominent cause of leukocytosis and this diagnosis should be considered for patients with WBC counts of>/=15,000 cells/mm(3), even in the absence of diarrheal symptoms.
Infectious Disease Section, Medical Service, Veterans Affairs Medical Center, Houston, TX, 77030, USA. daniel.musher@med.va.gov