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    Pseudomembranous Colitis

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    Dr-Mohammad Ali-Fayiz Al Tamimi
    This document outlines pseudomembranous colitis, caused by Clostridioides difficile bacteria. It discusses risk factors like antibiotic use, clinical manifestations ranging from diarrhea to fulminant colitis, diagnosis through stool testing, and management through antibiotic treatment and sometimes surgery.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Pseudomembranous Colitis

    Uploaded by

    Dr-Mohammad Ali-Fayiz Al Tamimi
    19 views39 pages
    This document outlines pseudomembranous colitis, caused by Clostridioides difficile bacteria. It discusses risk factors like antibiotic use, clinical manifestations ranging from diarrhea to fulminant colitis, diagnosis through stool testing, and management through antibiotic treatment and sometimes surgery.

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    Pseudomembranous-colitis

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    This document outlines pseudomembranous colitis, caused by Clostridioides difficile bacteria. It discusses risk factors like antibiotic use, clinical manifestations ranging from diarrhea to fulminant colitis, diagnosis through stool testing, and management through antibiotic treatment and sometimes surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    19 views39 pages

    Pseudomembranous Colitis

    Uploaded by

    Dr-Mohammad Ali-Fayiz Al Tamimi
    This document outlines pseudomembranous colitis, caused by Clostridioides difficile bacteria. It discusses risk factors like antibiotic use, clinical manifestations ranging from diarrhea to fulminant colitis, diagnosis through stool testing, and management through antibiotic treatment and sometimes surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 39

    Pseudomembranous

    colitis
    Outlines
    • Pseudomembranous colitis
    • Causative agent
    • Risk factors
    • Pathogenesis
    • Clinical manifestation
    • Diagnosis
    • Management
    Definition
    • Pseudomembranous colitis is an inflammatory condition of the colon
    characterized by elevated yellow-white plaques that coalesce to form
    pseudomembranes on the mucosa.
    • Clostridioides (formerly Clostridium) difficile is the causative organism
    of antibiotic-associated colitis

    • Colonization of the intestinal tract occurs via the fecal-oral route and
    is facilitated by disruption of normal intestinal flora (often due to
    antimicrobial therapy)
    • C. difficile is an anaerobic gram-positive, spore-forming, toxin-
    producing bacillus
    first described in 1935
    NAP1/BI/027 strain
    • Produces larger quantities of toxins A and B

    • Resistant to fluoroquinolones in vitro

    • Produces binary toxin, an additional toxin that is always absent in


    other C. difficile strains
    • Antibiotic-associated diarrhea and colitis were well established soon
    after widespread use of antibiotics

    • In 1978, C. difficile was identified as the causative pathogen in the


    majority of cases of antibiotic-associated colitis
    • Dramatic increases in the incidence and severity of health care-
    associated CDI have occurred since 2000, particularly in patients over
    age 65.
    Risk factors
    • Antibiotic use

    • Advanced age

    • Gastric acid suppression


    CLINICAL MANIFESTATIONS
    • Diarrhea with colitis

    • Nonsevere disease

    • Severe and fulminant colitis


    • Recurrent disease

    • Asymptomatic carriage
    • Nonsevere CDI – White blood cell count ≤15,000 cells/mL and serum
    creatinine <1.5 mg/dL

    • Severe CDI – White blood cell count >15,000 cells/mL and/or serum
    creatinine ≥1.5 mg/dL

    • Fulminant colitis: Hypotension or shock, ileus, or megacolon


    Unusual presentations
    • Protein-losing enteropathy

    • Extracolonic involvement: Appendicitis, Small bowel involvement,


    cellulitis, soft tissue infection, bacteremia, and reactive arthritis
    DIAGNOSIS
    • should be suspected in patients with acute diarrhea (≥3 loose stools
    in 24 hours) with no obvious alternative explanation (such as laxative
    use), particularly in the setting of relevant risk factors (including
    recent antibiotic use, hospitalization, and advanced age)
    • The diagnosis of C. difficile infection is established via a positive
    laboratory stool test for C. difficile toxin(s) or C. difficile toxin B gene.

    • Ileus and suspected C. difficile infection??


    • EIA screening for glutamate dehydrogenase (GDH) antigen and toxins
    A and B

    • Radiographic imaging: severe illness or fulminant colitis


    Lower gastrointestinal endoscopy?

    In general, endoscopy may be pursued for circumstances in which an


    alternative diagnosis is suspected that requires direct visualization
    and/or biopsy of the bowel mucosa.

    • May also be helpful for patients with ileus or fulminant colitis in the
    absence of diarrhea since it may allow visualization of
    pseudomembranes
    • Nucleic acid amplification test
    • Enzyme immunoassay for C. difficile glutamate dehydrogenase
    • Enzyme immunoassay for C. difficile toxins A and B
    • Cell culture cytotoxicity assay
    • Selective anaerobic culture
    Management
    • Antibiotic management

    • Infection control

    • Diarrhea management?
    Surgical management
    • Total abdominal colectomy

    • Partial colectomy?

    • Diverting loop ileostomy

    • Colonic lavage
    Thank you

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