Pseudomembranous colitis

Description

Pseudomembranous (SOO-doe-mem-bruh-nus) colitis is the inflammation of the colon associated with the growth of the bacterium Clostridioides difficile (formerly Clostridium difficile) — often called C. diff. Pseudomembranous colitis is sometimes called antibiotic-associated colitis or C. difficile colitis.

This excessive growth of Clostridioides difficile (C. difficile) is often related to a recent hospital stay or antibiotic treatment. C. difficile infections are more common in people over 65 years of age.

Symptoms

Symptoms of pseudomembranous colitis may include:

  • The watery diarrhea.
  • Stomach cramps, pain, or tenderness.
  • Fever.
  • Pus or mucus in the stool.
  • Nausea.
  • The dehydration.

Symptoms of pseudomembranous colitis may begin as early as 1 to 2 days after you start taking an antibiotic, or over a period of several months or more after you stop taking the antibiotic.

When to see a doctor

If you are currently taking or have recently taken antibiotics, and you develop diarrhea, contact your health care provider, even if the diarrhea is relatively mild. Also, refer to your supplier at any time you have severe diarrhea, fever, painful cramps in the stomach, or blood or pus in the stool.

Causes

Your body generally follows the many bacteria in the colon in a natural healthy balance. However, antibiotics and other medications can disrupt this balance. Pseudomembranous colitis occurs when certain bacteria, usually of C. difficile , pass quickly other bacteria that normally keep them under control. Certain toxins produced by C. difficile may rise to levels high enough to damage the colon.

While almost any antibiotic can cause pseudomembranous colitis, some of the antibiotics most commonly linked to colitis and pseudomembranous than others, including:

  • The fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin.
  • Penicillins, such as amoxicillin and ampicillin.
  • Clindamycin (Cleocin).
  • Cephalosporins, such as cefixime (Suprax).

Other causes

Other medications in addition to antibiotics can sometimes cause pseudomembranous colitis. The chemotherapy drugs used to treat cancer may alter the normal balance of bacteria in the colon.

Certain diseases that affect the colon, such as ulcerative colitis or Crohn's disease, it can also put people at risk of pseudomembranous colitis.

C. difficile spores are resistant to many common disinfectants and can be transmitted via the hands of health professionals to patients. More and more often, C. difficile is being reported in people without known risk factors, including the people with no recent health care contact or the use of antibiotics. This is called community-acquired C. difficile .

Emergence of a new strain

An aggressive strain of C. difficile has emerged, which produces a lot more toxins than other strains do. The new strain may be more resistant to certain drugs and has been reported in people who have not been in the hospital or taken antibiotics.

Risk factors

Factors that may increase your risk of pseudomembranous colitis include:

  • The taking of antibiotics.
  • The stay in the hospital or in a nursing home.
  • The increase of age, especially in patients older than 65 years.
  • Having a weakened immune system.
  • To have a disease of the colon, such as inflammatory bowel disease or colorectal cancer.
  • Undergoing intestinal surgery.
  • Receiving chemotherapy treatment for cancer.

Complications

Treatment of pseudomembranous colitis is usually successful. However, even with a timely diagnosis and treatment, pseudomembranous colitis can be life-threatening. Possible complications include:

  • The dehydration. Severe diarrhea can lead to a significant loss of fluids and electrolytes. This makes it difficult for your body to function and can cause blood pressure to drop to dangerously low levels.
  • The renal failure. In some cases, dehydration can occur so quickly that the renal function is deteriorating rapidly, causing kidney failure.
  • Toxic megacolon. In this rare disease, the colon is unable to get rid of gas and feces, causing it to become enormously distended. Left untreated, the colon may rupture, causing bacteria from the colon to enter in your abdominal cavity. Or increase in the size of the rupture of the colon requires emergency surgery and can be fatal.
  • A hole in the large intestine, called the perforation of the bowel. This is rare and the results of extensive damage to the lining of the large intestine or after toxic megacolon. A perforation in the bowel can spill of bacteria in the intestine back into the abdominal cavity, which leads to a life-threatening infection called peritonitis.
  • Death. Even mild to moderate infections by C. difficile can rapidly progress to a life-threatening disease if not treated quickly.

In addition, pseudomembranous colitis can sometimes return, days or even weeks after apparently successful treatment.

Prevention

To help prevent the spread of C. difficile , hospitals and other health care facilities follow strict infection-control guidelines. If you have a friend or family member in a hospital or nursing home, don't be afraid to remind caregivers to follow the recommended precautions.

Preventive measures include:

  • The washing of hands. Health care workers should practice good hand hygiene before and after treating each person in your care. In the case of C. difficile outbreak, using soap and warm water is a better option for hand hygiene, because alcohol-based hand sanitizers do not effectively destroy the spores of C. difficile. Visitors to the hospitals or nursing homes should also wash their hands with soap and warm water before and after you leave the room or use the bathroom.
  • Contact precautions. People who are hospitalized with C. difficile a private room or share a room with someone who has the same disease. Hospital staff and visitors wear disposable gloves and isolation gowns, while in the room until at least 48 hours after the diarrhea ends.
  • Thorough cleaning. In any scenario, all surfaces must be thoroughly disinfected with a product that contains chlorine to destroy the spores of C. difficile.
  • The use of antibiotics only when necessary. Antibiotics are sometimes prescribed for viral illnesses, which are not helped by these drugs. Take a " wait-and-see attitude with simple ailments. If you need an antibiotic, ask your health care provider to prescribe one that has a narrow range and that are taken for the shortest time possible.

Pseudomembranous colitis

Diagnosis

Tests and procedures used for the diagnosis of pseudomembranous colitis and to the search of the complications include:

  • Stool sample. There are a number of different samples of stool testing for the detection of Clostridioides difficile (C. difficile) infection of the colon.
  • Blood tests. These may reveal an unusually high count of white blood cells, called leukocytosis, which may indicate an infection, such as C. difficile if you also have diarrhea.
  • Colonoscopy or sigmoidoscopy. In both tests, the doctor uses a tube with a tiny camera at its tip to look inside the colon for signs of pseudomembranous colitis — raised, yellow plaques called lesions, as well as inflammation.
  • Imaging tests. If you have severe symptoms, your doctor can get an abdominal x-ray or abdominal computed tomography (CT) scan to look for complications such as toxic megacolon or two breaking points.

Treatment

Treatment strategies include:

  • Suspension of the antibiotic or other medication that you think is the cause of your symptoms, if possible. Sometimes, this may be enough to resolve your condition or at least relieve the symptoms, such as diarrhea.
  • From an antibiotic is likely to be effective againstC. difficile.If you still have symptoms, your doctor may use a different antibiotic to treatC. difficile. This allows typical of the bacteria to grow again, to restore the healthy balance of bacteria in the colon. Antibiotics may be given by mouth, through a vein or through a tube that is inserted through the nose into the stomach, it is called a nasogastric tube. Vancomycin or fidaxomicin (Dificid) is the most widely used, but the choice depends upon your condition. If these medications are not available or cannot be tolerated, then the metronidazole (Flagyl) can be used. For severe disease, the doctor may prescribe vancomycin orally, intravenously combined with metronidazole or vancomycin enema.
  • Have fecal microbial transplantation (FMT). If your condition is extremely severe, or that have had more than one recurrence of the infection, which may be submitted to a transplant of stool from a healthy donor to restore the balance of bacteria in the colon. The donor stool may be given through a nasogastric (ng) tube, which is inserted into the colon or is placed in a capsule to swallow. Doctors may use a combination of antibiotic treatment followed by fecal microbial transplantation (FMT).

From an antibiotic is likely to be effective againstC. difficile. If you still have symptoms, your doctor may use a different antibiotic to treat C. difficile . This allows typical of the bacteria to grow again, to restore the healthy balance of bacteria in the colon.

Antibiotics may be given by mouth, through a vein or through a tube that is inserted through the nose into the stomach, it is called a nasogastric tube. Vancomycin or fidaxomicin (Dificid) is the most widely used, but the choice depends upon your condition. If these medications are not available or cannot be tolerated, then the metronidazole (Flagyl) can be used.

For severe disease, the doctor may prescribe vancomycin orally, intravenously combined with metronidazole or vancomycin enema.

Once you start the treatment for pseudomembranous colitis symptoms may begin to improve within a few days.

The treatment of recurrent pseudomembranous colitis

The natural occurrence of new, more aggressive strains of C. difficile has become the treatment of pseudomembranous colitis increasingly difficult and recurrences are the most common. With each recurrence, your chance of having an additional recurrence increases.

Treatment options may include:

  • Repeat the antibiotics. You may need a second or third round of antibiotics to resolve your condition and may need a longer duration of therapy.
  • Surgery.Surgery may be an option in people who have progressive organ failure, rupture of the colon and the inflammation of the lining of the abdominal wall, called peritonitis. The surgery has generally meant the removal of all or part of the colon. This is known as a total or subtotal colectomy. A new surgery that involves laparoscopic creation of a loop of the colon and the cleaning is less invasive and has had positive results. This procedure is known as the loop ileostomy and colonic lavage.
  • Fecal microbial transplantation (FMT). FMT is used to treat recurrent pseudomembranous colitis. You will receive healthy, clean the feces in a capsule, through a nasogastric tube, or directly into the colon.
  • Bezlotoxumab (Zinplava). The Food and Drug Administration (FDA) has approved the use of human monoclonal antibody bezlotoxumab to reduce the risk of recurrence of C. difficile infection. It is used in combination with antibiotics, bezlotoxumab has been shown to significantly reduce the recurrence of the infection. However, the cost can be a limiting factor.

Surgery. Surgery may be an option in people who have progressive organ failure, rupture of the colon and the inflammation of the lining of the abdominal wall, called peritonitis. The surgery has generally meant the removal of all or part of the colon. This is known as a total or subtotal colectomy.

A new surgery that involves laparoscopic creation of a loop of the colon and the cleaning is less invasive and has had positive results. This procedure is known as the loop ileostomy and colonic lavage.

Self-care

Some research suggests that supplementation with concentrates of good bacteria and yeasts, called probiotics, may help to prevent C. difficile infection, but more studies are needed to determine its use in the treatment of recurrences. Are safe to use and available in capsule or liquid form without a prescription.

To deal with the diarrhea and dehydration that can occur with pseudomembranous colitis, try the following:

  • Drink plenty of fluids. The water is best, but the liquid with the addition of sodium and potassium, known as electrolytes, can also be beneficial. Examples include sports drinks (Gatorade, Powerade, others), oral rehydration solution (Pedialyte, Ceralyte®, others), decaffeinated beverages, wines and fruit juices. Avoid drinks with high sugar content, or that contain alcohol or caffeine, such as coffee, tea and cola drinks, which can make your symptoms worse.
  • Do not eat foods that may worsen the symptoms. Stay away from spicy, fatty, or fried foods, and other foods that make your symptoms worse.

Preparing for your appointment

Your primary care physician can treat pseudomembranous colitis. Based on your symptoms, you may be referred to a specialist in diseases of the digestive system, known as a gastroenterologist. If your symptoms are particularly severe, you might be looking for emergency treatment.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All medications, vitamins or supplements that you are taking, including the dosage.
  • Questions to ask your provider.

Some basic questions you might want to ask include:

  • What is the most likely cause of my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or long-term?
  • What treatments are available and what you recommend for me?
  • I have other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Don't hesitate to ask additional questions. And, if possible, take a family member or a friend to help you remember the information they give you.

What to expect from your doctor

Your provider is likely to ask several questions, such as:

  • When did you first start experiencing the signs and symptoms?
  • Do you have diarrhea?
  • There is blood or pus in the stool?
  • Do you have a fever?
  • Do you have abdominal pain?
  • The symptoms stayed the same or worsened?
  • During the last few weeks, have taken antibiotics, had a surgical procedure or have you been in hospital?
  • There is someone at home who is sick with diarrhea, or someone in the home has been hospitalized in the last few weeks?
  • Have you ever been diagnosed with diarrhea associated with C. difficile or antibiotics?
  • Do you have ulcerative colitis or Crohn's disease?
  • Are you being treated for any other medical condition?
  • You have recently traveled to an area with unsafe water supply?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

While you're waiting for your appointment, drink plenty of fluids to help prevent dehydration. Sports drinks, the oral rehydration solution (Pedialyte, Ceralyte®, others), decaffeinated beverages, wines and fruit juices are good choices.

Symptoms and treatment of Pseudomembranous colitis