P0545 KLEBSIELLA OXYTOCA(KO) INFECTION, A POSSSIBLE CAUSE OF COLITIS IN INFANTS PRESENTING WITH MILK INDUCED (“ALLERGIC”) COLITIS(MIC)

Introduction: MIC is frequently diagosed clinically in infants when they present with rectal bleeding, diarrhea and varying degrees of pain. They respond to the change of protein in their formula or to total milk protein elimination in the mother’s diet in breast fed infants. Stool cultures are often not done most likely because the infections are asssumed to be uncommonin this age group. Endoscopy, biopsy and dietary challanges are not usually done. Recently, Y. Davies et al presented an older infant with chronic diarrhea, abdominal distension and abdominal pain. (VSL#3 Satellite Symposium NASPGHAN meetings Montreal,Oct 2,2003) The pateint was shown to have an enteric infection with toxigenic strain of Ko. Ko was cultured from the stool. The toxin was demonstrated. The patient responded to probiotic therapy. Here we report two infants who presented with apparent MIC and their stool cultures grew Ko. Methods: All stool cultutres from author’s(BB) practice done in the last 3 yrs were reviewed and two were found to be positive for Ko. Case Summaries: 1. L.A., a full term product of normal pregnancy and delevery presented at 4 wks of age with severe pains during feeding, irrirtability and foul gas with variable response to milk protein elimination in mother’ diet and conservative management. 3 wks later he developed severe diarrhea with cramping with blood flecks and mucus. Milk induced colitis was suspected; stool c/s grew Ko. 2. O.H. a full term product of normal pregnancy and delivery presented with 3 month history of intermittent rectal bleeding stariting at 10 wks of age with appparent temporary response to milk protein elimination in the mother’ diet and then soy protein elimination. Stools became more bloody with mucus. Stool c/s grew Ko. Results: Ko is generally considered a saprophyte in the bowel. On rare occassions it has been implicated to cause antibiotic induced diarrhea or colitis. Clinically isolated strains of Ko are shown to produce a low molecular weight cytotoxin that causes hemorrhagic colitis in rabbit ileal loop model and cytotoxic changes in cell cultures. Conclusion: This to our knowledge is the first report of assosciation of Ko with apparent MIC. Epidemiological and prospective clinical studies with the appropriate bacteriologic and toxin studies are needed to further define their role in MIC and are planned. Stool cultures should be considered in MIC and should include culture for all potential and rare pathogens, because of the relatively depressed immune state of the newborn. Reference(S): none

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