Pseudomembranous colitis

Overview

 Pseudomembranous colitis, also known as antibiotic-associated colitis or C. difficile colitis, is an inflammatory condition of the colon. It is characterized by an overgrowth of the bacterium Clostridioides difficile (formerly known as Clostridium difficile), commonly referred to as C. diff. This bacterial overgrowth leads to the formation of pseudomembranes in the colon lining, causing symptoms such as watery diarrhea, abdominal pain, and fever.

Types of Pseudomembranous colitis

There is only one primary type of pseudomembranous colitis, which is associated with C. difficile infection. However, it’s essential to understand the severity and clinical presentation of the disease. The severity can range from mild to severe, with some cases progressing to life-threatening complications.

Causes of Pseudomembranous colitis

Pseudomembranous colitis primarily occurs due to the disruption of the normal balance of gut bacteria. Antibiotics are a common trigger, as they can upset this delicate balance. The following factors contribute to the development of pseudomembranous colitis:

1. Antibiotics: Almost any antibiotic can cause pseudomembranous colitis, but certain classes are more commonly linked to it. These include fluoroquinolones (e.g., ciprofloxacin, levofloxacin), penicillins (e.g., amoxicillin, ampicillin), clindamycin, and cephalosporins (e.g., cefixime).

2. Other Medications: Besides antibiotics, chemotherapy drugs used to treat cancer can disrupt the normal gut microbiota, increasing the risk of pseudomembranous colitis.

3. Colon Diseases: Conditions like ulcerative colitis or Crohn’s disease may predispose individuals to pseudomembranous colitis.

4. Hospitalization and Age: C. difficile infections are more common in people over 65 years old and those who have recently stayed in hospitals or nursing homes.

Risk Factors of Pseudomembranous colitis

Several risk factors increase the likelihood of developing pseudomembranous colitis:

1. Antibiotic Use: Taking antibiotics significantly raises the risk.

2. Hospital or Nursing Home Stay: Prolonged hospitalization or residence in a nursing home increases exposure to C. difficile spores.

3. Advanced Age: Individuals over 65 are more susceptible.

4. Weakened Immune System: Conditions like HIV, organ transplantation, or immunosuppressive therapy increase vulnerability.

5. Colon Diseases: Inflammatory bowel disease (ulcerative colitis or Crohn’s disease) predisposes individuals to pseudomembranous colitis.

6. Intestinal Surgery: Recent intestinal surgery can disrupt the gut microbiota.

Symptoms of Pseudomembranous colitis

Preventions of Pseudomembranous colitis

 To prevent pseudomembranous colitis, consider the following measures:

• Antibiotic Stewardship: Use antibiotics judiciously and only when necessary.
• Hand Hygiene: Proper handwashing reduces the risk of C. difficile transmission.
• Probiotics: Some evidence suggests that probiotics may help prevent C. difficile infection.

Diagnosis of Pseudomembranous colitis

To diagnose pseudomembranous colitis, healthcare providers consider the following:

1. Clinical Assessment: Based on symptoms and medical history.
2. Stool Tests: Detect C. difficile toxins or DNA in stool samples.
3. Colonoscopy or Flexible Sigmoidoscopy: Visual examination of the colon lining and pseudomembranes.
4. Imaging: Rarely, imaging studies may be used to assess the severity.

Treatment for Pseudomembranous colitis

1. Discontinuation of Offending Antibiotics: If possible, stop the antibiotic causing the infection.
2. Specific Antibiotics: Metronidazole or vancomycin is commonly used to treat C. difficile infection.
3. Probiotics: Some evidence suggests that probiotics may help restore gut balance.
4. Fluid Replacement: Maintain hydration, especially if diarrhea is severe.
5. Surgery: Rarely needed but considered in severe cases with complications.

When to seek medical attention ?

Seek medical attention promptly if you experience:

• Severe diarrhea or dehydration
• High fever
• Abdominal pain or cramps
• Blood in the stool
• Worsening symptoms despite treatment