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

Thanks a lot

المشاركة الأصلية بواسطة walid

Thanks a lot

Thank you too

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