Summary about Disease
Pseudomembranous colitis (PMC), also known as Clostridioides difficile infection (CDI) or *C. diff* infection, is an inflammation of the colon caused by the bacterium *Clostridioides difficile* (*C. difficile*). This bacterium releases toxins that damage the colon, leading to diarrhea, abdominal pain, and fever. It is often associated with antibiotic use, which disrupts the normal gut flora, allowing *C. difficile* to thrive. The condition is characterized by the formation of pseudomembranes, which are plaques of inflammatory cells, fibrin, and necrotic cells lining the colon.
Symptoms
Common symptoms include:
Watery diarrhea (frequent, often 10-15 times a day)
Abdominal cramping and pain
Fever
Nausea
Dehydration
Loss of appetite
Blood or pus in the stool (less common)
Weight loss In severe cases, it can lead to toxic megacolon (severe colon distension) or sepsis.
Causes
Antibiotic use: This is the most common cause. Antibiotics disrupt the normal balance of bacteria in the colon, allowing C. difficile* to overgrow. Broad-spectrum antibiotics are more likely to cause CDI.
Hospitalization/Healthcare Settings: C. difficile spores are commonly found in healthcare settings, increasing the risk of transmission.
Advanced Age: Older adults are more susceptible.
Underlying Medical Conditions: Conditions that weaken the immune system or affect bowel function can increase the risk.
Proton Pump Inhibitors (PPIs): Some studies suggest a possible link between PPI use and increased CDI risk.
Chemotherapy: Cancer treatments weaken the immune system and disrupt the gut microbiome.
Medicine Used
Vancomycin: Oral vancomycin is a commonly used antibiotic specifically targeting C. difficile*.
Fidaxomicin: This antibiotic is also highly effective against C. difficile and may have a lower recurrence rate compared to vancomycin.
Metronidazole: While previously a first-line treatment, metronidazole is now typically used for milder cases or when vancomycin/fidaxomicin are not available, due to lower efficacy and increased resistance.
Fecal Microbiota Transplantation (FMT): This involves transplanting stool from a healthy donor into the patient's colon to restore the gut's natural balance. It's highly effective for recurrent CDI.
Bezlotoxumab: A monoclonal antibody that binds to C. difficile toxin B, reducing the risk of recurrence.
Probiotics: May be used to help restore the gut microbiome after antibiotic treatment, but their role in preventing or treating CDI is still debated.
Is Communicable
Yes, C. difficile is communicable. It spreads through the fecal-oral route. Spores of the bacteria can survive on surfaces for extended periods and are resistant to many common disinfectants. Transmission occurs when someone touches a contaminated surface and then touches their mouth, or through direct contact with an infected person's stool.
Precautions
Hand Hygiene: Frequent and thorough handwashing with soap and water is crucial, especially after using the toilet and before eating. Alcohol-based hand sanitizers are less effective against C. difficile* spores.
Environmental Cleaning: Thorough cleaning and disinfection of surfaces, especially in healthcare settings, using bleach-based disinfectants.
Contact Precautions: Patients with CDI should be placed on contact precautions in healthcare settings to prevent spread. This includes wearing gloves and gowns when entering the patient's room and removing them before leaving.
Judicious Antibiotic Use: Antibiotics should only be prescribed when necessary and for the shortest effective duration.
Avoid Sharing Personal Items: Avoid sharing towels, razors, and other personal items.
Proper Food Handling: Follow safe food handling practices to prevent fecal contamination.
How long does an outbreak last?
The duration of a C. difficile infection varies. With appropriate treatment, symptoms typically improve within a few days to a week. However, recurrence is common, occurring in up to 20-30% of cases. Recurrent infections may require longer treatment courses or alternative therapies like FMT. Without treatment or with severe complications, the infection can be life-threatening.
How is it diagnosed?
Stool Test: This is the primary diagnostic method. Stool samples are tested for C. difficile* toxins or the presence of the *C. difficile* bacteria.
Colonoscopy or Sigmoidoscopy: In some cases, a colonoscopy or sigmoidoscopy may be performed to visualize the colon and identify pseudomembranes.
Complete Blood Count (CBC): May show elevated white blood cell count, indicating infection.
Imaging Studies: X-rays or CT scans may be used to evaluate for complications such as toxic megacolon.
Timeline of Symptoms
During or after Antibiotic Use: Symptoms usually begin during or within a few weeks of antibiotic treatment. Sometimes, it can occur months later.
Initial Symptoms: Often start with mild diarrhea and abdominal discomfort.
Progression: Symptoms can worsen over a few days, leading to more frequent and watery diarrhea, severe abdominal pain, and fever.
Severe Cases: In severe cases, symptoms can rapidly progress to dehydration, shock, and toxic megacolon.
Important Considerations
Recurrence: C. difficile* infections have a high recurrence rate, necessitating careful monitoring and management.
Severity: The severity of CDI can range from mild diarrhea to life-threatening complications.
Antibiotic Stewardship: Promoting responsible antibiotic use is crucial in preventing CDI.
Hospital Infection Control: Strict adherence to infection control practices in healthcare settings is essential to prevent the spread of C. difficile.
Underlying Health: The overall health and immune status of the patient play a significant role in the outcome of CDI.
FMT Availability: Fecal Microbiota Transplantation (FMT) is emerging as a highly effective option for recurrent CDI, but access to FMT may vary.