Diagnosis

Pseudomembranous colitis

Etiology

Cause [kht]

• Clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus responsible for the development of antibiotic-associated diarrhea and colitis

Pathophysiology [kht]

1. The gastrointestinal tract microbial community (microbiome) is vital for:

   • Food fermentation

   • Barrier against pathogens

   • Synthesizing vitamins

   • Regulating metabolism and immunity

2. Colonization of C difficile in 4% of healthy individuals without causing infections

3. Antibiotic usage (penicillin, cephalosporin, fluoroquinolone, clindamycin)

4. A disturbance of the normal bacterial flora of the colon

5. Overgrowth of C difficile --> dysbiosis ==> colonisation --> infection

6. Release of toxins that cause:

   • Mucosal inflammation and damage

   • Diarrhea: ≥3 loose stools within 24 hours

Risk factors [rts][kht]

• Broad-spectrum antibiotic exposure

• Hospitalization

• Increasing age

• Comorbidities

• Inflammatory bowel disease

• Immunodeficiency

• Proton pump inhibitors

Complications [kht]

• Pseudomembranous colitis

• Toxic megacolon

• Colonic perforation

• Septic shock

Epidemiology

Incidence per 100.000 [e3w][y3w][5oc][rqg][gm9]

Approach

• Blood test: WBC, electrolyte levels, creatinine, albumin, lactate

• Hemofec

• Feces culture

• Clostridium difficile toxin

• C difficile antigen: Glutamate dehydrogenase produced by C difficile or NAAT/PCR

• Colonoscopy with biopsy

• CT abdomen

Treatment

1. Replacement of fluid and electrolyte losses [1q2][v94][rts]

2. Avoidance of antiperistaltic agents: opiates, loperamide

3. Discontinuation of antimicrobial therapy if possible

4. If severe symptomatic disease --> Metronidazole 500mg x 3 or Vancomycim (oral)

   • Alternatives: Fidaxomicin, bacitracin, teicoplanin, oral fusidic acid

   • Fecal microbiota transplantation

5. Fulminant collitis --> subtotal or total colectomy

Differential diagnoses

Abdominal abscess, Cholera, Coliac disease, Crohn disease, Diverticulitis, Gastroenteritis, Gastrointestinal perforation, Irritable bowel syndrome, Peritonitis, Salmonellosis, Shigellosis, Toxic megacolon, Ulcerative colitis