Pseudomembranous colitis 2

Colonoscopic finding in a patient with colitic syndrome that developed two weeks after the course of antibiotic therapy with clindamycine. Clostridium difficile toxin A/B test was positive. Treatment with metronidazole led to rapid resolution of symptoms.

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Pseudomembranous colitis

• is infectious disease caused by Clostridium difficile
• Clostridium difficile is a gram-positive, anaerobic spore-forming bacillus
• Clostriudium difficile is the commonest enteric nosocomial infection
• the most significant risk factor for development of the disease is prior antibiotic exposure (any antibiotic, but "high risk" antibiotics are clindamycine, cephalosporins, amoxicillin and fluoroquinolones)
• toxin A and toxin B, which are produced by Clostriudium difficile are the major pathogenicity factors
• Clostridium difficile-associated disease (CDAD) ranges in severity from mild diarrhea to fulminant colitis
• pseudomembranous colitis is term that specifically describes the presence of pseudomembranes in the colon
• diagnosis:

1. History of antibiotic therapy
2. Clostridium difficile toxin A/B test (a negative test, however, does not eliminate the possibility of disease)
3. Stool culture
4. Endoscopy (not obligatory for the diagnosis): presence of pseudomembranes is pathognomonic, pseudomembranes are white or yellow elevated plaques on edematous and erythematous colonic mucosa
5. Other causes of diarrhea must be ruled out (not all diarrhea cases after antibiotic therapy are CDAD)

• therapy depends on disease severity, antibiotics are the mainstay of treatment:

1. Metronidazole
2. Vancomycin

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