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Infectious and noninfectious diarrheas are important complications in immunocompromised host (ICH) populations including hematologic stem cell (HSCT) and solid organ transplant (SOT) recipients. Adverse consequences of diarrhea, including fluid and electrolyte imbalances with resultant malabsorption of nutrition and medications, can lead to prolonged hospital stays or rehospitalizations. Clostridioides (formerly Clostridium) difficile is the most common infectious etiology of infectious diarrhea in hospitalized individuals, and the incidence of C. difficile infections (CDI) has steadily increased since 2000 (Lessa et al, Clin Infect Dis. 55 Suppl 2:S65–70, 2012; Balsells et al, J Glob Health. 9(1):010407, 2019). ICH populations are at increased risk of CDI and of experiencing severe or complicated clinical courses in both initial infection and subsequent recurrences. In addition to CDI risk factors identified in non-ICH populations, there are unique complicating risk factors in ICH patients. These include the use of therapies toxic to the gut mucosa (chemotherapy, mycophenolate, steroids), concurrent infection with cytomegalovirus which may directly damage gut mucosa and additionally alter immune responses to other pathogens, and the frequent need for concomitant antibiotic therapy. Consequences in ICH populations may include graft loss in SOT recipients, graft-versus-host disease (GVHD) in HSCT recipients, malnutrition, bacteremia from translocation of intestinal flora, and death. This chapter focuses on the epidemiology, clinical manifestations, diagnosis, and management of CDI in HSCT and SOT recipients.

DOI: 10.1007/978-3-030-01751-4_23-1