Clostridium Difficile

Clostridium Difficile
Laura W. Lamps, MD
Endoscopic photograph shows characteristic pseudomembranes in a C. difficile infection. (Courtesy W. Webb, MD.)
Hematoxylin & eosin illustrates a low-power view of pseudomembranous colitis, showing dilated crypts that give rise to a laminated, volcano-like, mucopurulent exudate.
TERMINOLOGY
Abbreviations
  • Clostridium difficile (C. difficile)
Synonyms
  • Pseudomembranous colitis
Definitions
  • Infection by Clostridium difficile, potent toxigenic bacteria
    • Produces 2 toxins: Toxin A and toxin B
    • Causes colitis, most often pseudomembranous colitis
ETIOLOGY/PATHOGENESIS
Recent Prior Antibiotic Exposure
  • Usually orally administered antibiotics
  • Bacteria cannot infect in presence of normal gut flora
  • Most common nosocomial GI pathogen
Other Risk Factors
  • Elderly patients
  • Severe comorbid illness/admission to ICU
    • Inflammatory bowel disease
  • Indwelling nasogastric tubes
  • GI procedures
  • Antacids
  • Long hospitalization
CLINICAL ISSUES
Presentation
  • Diarrhea
    • Ranging from mild to severe
    • Initially watery
    • Variably bloody
  • Fever
  • Leukocytosis
  • Abdominal pain
  • Symptoms can occur weeks after stopping antibiotics
  • Complications
    • Toxic megacolon
    • Perforation
    • Reactive polyarthritis
  • Variant presentations
    • May be superimposed on IBD
    • Rare patients are asymptomatic
    • Patients with fulminant disease may have signs of acute abdomen but lack diarrhea
Treatment
  • Antibiotics, supportive care
  • Fulminant cases may require surgery
Prognosis
Jul 6, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Clostridium Difficile

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