Clostridium difficile colitis (CDC) is an infection of the intestine caused by the bacteria Clostridioides difficile. Symptoms may be mild, but life-threatening complications can develop. Those at risk are hospital patients and staff, the elderly or frail, and people on antibiotics or proton pump inhibitors (drugs used to reduce stomach acid production).
Antibiotics alter gut bacteria and this increases the risk of clostridium difficile multiplying and producing toxins that injure the lining of the colon. Proton pump inhibitors alter the bacteria in the stomach by changing the acidity, which can allow the bacteria to increase in numbers.
One of the earliest symptoms of CDC is mild to moderate diarrhea occurring two or three times a day. It does not contain blood at this stage but may have a foul odor. The Clostridium difficile bacteria kill the cells lining the colon, causing inflammation that results in watery diarrhea. If the infection is related to antibiotic use, diarrhea may appear within one to 10 days of starting the course or be delayed up to two months.
This is an early symptom that occurs with the diarrhea. It often presents as cramping with some associated tenderness. At this stage, the person experiencing these symptoms is unlikely to be able to carry on with their daily activities and may have to stay in bed.
Nausea is a generalized symptom that is likely to be present early in a Clostridium difficile colitis infection. There is a risk that it may contribute to dehydration if the unwell person is unable to drink adequate amounts of fluid to compensate for the losses due to diarrhea. Thirst indicates that more a person needs more fluids, as can other symptoms of dehydration, such as headaches.
This is another early symptom that may lead to generalized weakness and an inability to function normally. These early symptoms are non-specific, and a diagnosis of CDC is helped by an awareness of the medical history of the person, in particular, whether they have recently consumed antibiotics.
A raised temperature may be mild in the early stages. As the condition worsens, the fever can reach 105 degrees Fahrenheit (40.5 degrees Celsius) or more, indicating severe infection. At this stage, the white cell count may be very high. This is an indicator of worsening infection. By this stage, the infected individual should be seeking medical treatment.
More than 10 watery stools per day are common as Clostridium difficile colitis worsens. There may be visible blood or pus in the stool, indicating the inflammation has spread to the colon. Occult blood (blood in the stool that is not visibly apparent) may occur in up to 30% of cases in the earlier stages. Hospital treatment is a necessity at this stage to avoid rapid deterioration.
As a result of profuse diarrhea, there is a risk of dehydration secondary to fluid and electrolyte losses, especially if the fluid intake has been poor. This will cause low blood pressure and a rapid heart rate. An intravenous infusion will help with fluid replacement. The fever and white blood cell count will be further raised at this stage. The intestinal bleeding is likely to be more severe, exacerbating low blood pressure and increased heart rate.
This is a late symptom and another indication of the progression of the inflammatory process in the colon. It is likely to be associated with increased tenderness, especially if a doctor palpates the abdomen. By this stage of CDC, intensive care treatment is necessary.
If dehydration goes untreated, the patient is at risk of developing kidney failure. The kidneys rely on a rich blood supply, which low blood pressure impacts. If the fluids are replaced swiftly, then kidney failure may be averted.
Severe inflammation or toxic megacolon is a dangerous complication. The colon becomes very distended and is unable to pass stools or gas. It is at risk of rupturing, which would discharge stool and bacteria into the abdominal cavity, causing fecal peritonitis. Toxic megacolon requires prompt treatment, which usually involves surgery. Unfortunately, this severe complication of Clostridium difficile colitis is often fatal.
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