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#1
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| Pseudomembranous colitis is due infection by Clostridium difficle A gram-positive anaerobic bacillus Not identified until 1953 because it was 'difficult' to culture Spores are commonly found in the hospital environment Pathophysiology Normal stool contains >500 different bacteria at a concentration of 1012 per gram Antibiotic therapy can change the faecal flora Broad-spectrum antibiotics are main culprits Particular problem with lincomycin and clindomycin - but rarely used Allows colonisation by C. difficle transmitted by the faecal-oral route Exotoxins (Toxin A & B) produced by bacteria are cytotoxic Act via cell membrane receptors Produces mucosal inflammation and cell damage If severe epithelial necrosis a pseudo-membrane is formed Consists of mucin, fibrin, leucocytes and cellular debris Clinical features 50% of neonates are transient healthy carriers of C. difficle Only 1% of adults are also asymptomatic carriers 10% patients on antibiotics develop diarrhoea Only 1% develop pseudomembranous colitis The spectrum of symptomatic disease includes: Mild diarrhoea Colitis without pseudo-membrane formation Pseudomembranous colitis Fulminant colitis Diagnosis is confirmed by the detection of toxin in the stool by ELISA Treatment Asymptomatic carriers require no active treatment Those with mild diarrhoea should have their antibiotics stopped If colitis present need active treatment with oral antibiotics: Metronidazole - first line therapy Vancomycin - second line therapy Symptoms usually improve within 72 hours May take 10 days for diarrhoea to stop Pseudomembranous colitis requires aggressive resuscitation and treatment If fulminant colitis with toxic megacolon or perforation surgery may be necessary 10% patients relapse after initial treatment Due to either failure of eradication or re-infection Best wishes Dr Philip Hardo |
| الأعضاء الـ 2 التالية أسماؤهم قالوا شكراً لك يا Philip Hardo على هذه المشاركة المفيدة: | ||
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#2
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| Thanks a lot |
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#3
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| المشاركة الأصلية بواسطة walid Thank you too
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#4
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| this symptom some time seen as an adverse effect in the persons undergo treatment with clindamycin in addition to skin rashes, the ,most serious adverse effect is potentially fetal pseudomembranous colitis caused by overgrowth of C.difficile *administration of either metronidazole or vancomycine is usually effective in controlling this serious problem reference :Pharmacology Illustrated Reviews :3rd edition |