Clostridium Difficile
Laura W. Lamps, MD
Key Facts
Terminology
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Infection by Clostridium difficile, most common nosocomial GI infection
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Causes colitis, most often pseudomembranous colitis
Etiology/Pathogenesis
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Usually associated with recent antibiotic use, most commonly oral antibiotics
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Elderly, debilitated, hospitalized patients also at increased risk
Clinical Issues
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Typical symptoms
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Diarrhea, initially watery but variably bloody
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Fever
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Leukocytosis
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Abdominal pain
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Recurrence common despite successful therapy
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Patients with fulminant disease may have signs of acute abdomen but lack diarrhea
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Incidence of severe or life-threatening infection is increasing
Macroscopic Features
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Yellow-white exudates or pseudomembranes
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Distribution: Entire colon or segmental/patchy
Microscopic Pathology
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Ballooned or dilated glands
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Intercrypt necrosis
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Degenerating surface or glandular epithelial cells
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Pseudomembranous exudate
TERMINOLOGY
Abbreviations
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Clostridium difficile (C. difficile)
Synonyms
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Pseudomembranous colitis
Definitions
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Infection by Clostridium difficile, potent toxigenic bacteria
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Produces 2 toxins: Toxin A and toxin B
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Causes colitis, most often pseudomembranous colitis
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ETIOLOGY/PATHOGENESIS
Recent Prior Antibiotic Exposure
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Usually orally administered antibiotics
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Bacteria cannot infect in presence of normal gut flora
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Most common nosocomial GI pathogen
Other Risk Factors
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Elderly patients
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Severe comorbid illness/admission to ICU
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Inflammatory bowel disease
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Indwelling nasogastric tubes
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GI procedures
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Antacids
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Long hospitalization
CLINICAL ISSUES
Presentation
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Diarrhea
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Ranging from mild to severe
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Initially watery
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Variably bloody
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Fever
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Leukocytosis
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Abdominal pain
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Symptoms can occur weeks after stopping antibiotics
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Complications
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Toxic megacolon
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Perforation
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Reactive polyarthritis
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Variant presentations
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May be superimposed on IBD
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Rare patients are asymptomatic
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Patients with fulminant disease may have signs of acute abdomen but lack diarrhea
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Treatment
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Antibiotics, supportive care
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Fulminant cases may require surgery
Prognosis
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Recurrence common
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Up to 50% of cases recur despite successful therapy
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Incidence of severe or life-threatening infection is increasing
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Epidemic strain of C. difficile, BI/NAP1
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