Clostridium Difficile Enteritis
- Kidney failure: In some cases, dehydration can occur so quickly that kidney function deteriorates (kidney failure).
- A hole in your large intestine (bowel perforation): This results from extensive damage to the lining of your large intestine. A perforated bowel can spill bacteria from the intestine into your abdominal cavity, leading to a life-threatening infection (peritonitis).
- Toxic megacolon: In this condition, the colon becomes grossly distended when it's unable to expel gas and stool. Left untreated, your colon can rupture, causing bacteria from the colon to enter your abdominal cavity. A ruptured colon requires emergency surgery and may be fatal.
- Death: Even mild to moderate C. difficile infections can quickly progress to a fatal disease if not treated promptly.
- Diarrhea - acute and severe.
- Loss of appetite.
- Vomiting - rare.
- Are 65 years of age or older. The risk of becoming infected with Clostridium difficile is 10 times greater for people age 65 and up compared with younger people.
- Are or have recently been hospitalized, especially for an extended period.
- Live in a nursing home or long term care facility.
- Have a serious underlying illness or a weakened immune system as a result of a medical condition or treatment (such as chemotherapy).
- Have had abdominal surgery or a gastrointestinal procedure.
- Have a colon disease such as inflammatory bowel disease or colorectal cancer.
- Have had a previous C. difficile infection.
- Albumin: Hypoalbuminemia and anasarca may accompany severe disease.
- CBC count: Leukocytosis may be present.
- The stool cytotoxin test has high sensitivity and specificity and is the test of choice. Diarrheal stool is filtered and then added to cultured fibroblasts. A positive test result is the demonstration of a cytopathic effect that is neutralized by specific antiserum. This test result is reported only as positive or negative, it is expensive, and it requires an overnight incubation and a tissue culture facility.
- Several commercial enzyme immunoassays are now available and provide more rapid results at less cost with reasonable sensitivity and specificity. Because of the lower sensitivity, repeating this test may be necessary in patients in whom the pretest probability of C difficile infection is high and an initial test result is negative.
- The latex agglutination test cannot be used to detect toxins but instead detects the presence of glutamate dehydrogenase produced by C difficile. The sensitivity of this test is 48-59%, and the specificity is 95-96%. This test is not recommended.
- Stool cultures are not helpful because nontoxigenic strains of C difficile exist.
- Rehydration with electrolyte solutions may be necessary if dehydration occurs.
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