Pseudomembranous Colitis - Causes, Symptoms, Risk Factors, and Treatment

What Is Pseudomembranous Colitis?

Pseudomembranous colitis also known as antibiotic-associated colitis or Clostridium difficile colitis is a potentially life-threatening acute infectious colitis causing inflammation of the colon due to an overgrowth of the bacterium Clostridium difficile. The overgrowth of the bacteria is often related to a recent hospital stay or antibiotic treatment and is more common among people over 65 years old.

What Are the Causes of Pseudomembranous Colitis?

The Clostridium difficile bacteria is a usual inhabitant of the intestine. However, abnormal growth of the bacteria may take place when antibiotics are taken. A potent toxin produced by the bacteria causes inflammation and bleeding in the lining of the colon.

Any antibiotic can cause pseudomembranous colitis. However, some antibiotics are more often associated with pseudomembranous colitis than others.

They are:

• Penicillins such as Amoxicillin and Ampicillin.

• Fluoroquinolones such as Ciprofloxacin and Levofloxacin.

• Clindamycin.

• Cephalosporins such as Cefixime.

Other medications such as chemotherapy drugs used to treat cancer can sometimes cause pseudomembranous colitis by disrupting the normal balance of bacteria in the colon.

Certain inflammatory diseases of the colon, such as ulcerative colitis or Crohn's disease, may also predispose people to pseudomembranous colitis.

The incidence of pseudomembranous colitis is uncommon among children and is rare in infants. It is most often seen among people who are in the hospital setup. Outside of a hospital, it is more common in people who take antibiotics. Clostridium difficile spores are resistant to many commonly used disinfectants and can be transmitted from patients to healthcare professionals and from healthcare professionals to other patients.

Recently, Clostridium difficile has been increasingly reported in people with no known risk factors, including those with no recent history of healthcare contact or use of antibiotics. This is referred to as community-acquired Clostridium difficile.

What Are the Risk Factors for Pseudomembranous Colitis?

• Older age, especially over 65 years.

• Antibiotic use.

• Staying in the hospital or a nursing home.

• History of pseudomembranous colitis.

• History of inflammatory bowel disorders like ulcerative colitis and Crohn's disease.

• Having a weakened immune system.

• Patients undergoing intestinal surgery.

• Patients receiving chemotherapy.

What Are the Symptoms of Pseudomembranous Colitis?

The signs and symptoms associated with pseudomembranous colitis are:

• Diarrhea is watery in consistency.

• Stool that contains pus or mucus.

• Pain, tenderness, and abdominal cramps.

• Fever.

• Nausea and dehydration.

The symptoms may present as soon as one to two days after taking the antibiotic and may last for as long as several months or longer after finishing the antibiotic course.

How Is Pseudomembranous Colitis Diagnosed?

Pseudomembranous colitis is diagnosed by the presence of Clostridium difficile toxins in the feces (stool) sample, which is examined in a laboratory. Pseudomembranous colitis is also diagnosed with a sigmoidoscopy – a procedure that uses a thin, flexible tube (sigmoidoscope) to view the interior of the large intestine.

How Is Pseudomembranous Colitis Treated?

• The first step would be to stop taking the antibiotic that led to the pseudomembranous colitis infection.

• Antibiotics that target the infection like Metronidazole, Vancomycin, or Fidaxomicin are used to treat pseudomembranous colitis. They are administered for a duration of 14 days.

• The recurrence rate for pseudomembranous colitis in people who have been treated is about 20 %. In case of recurrence, another dose of antibiotics is administered.

• Fecal Transplant- A new treatment that uses stool from a healthy donor to restore normal bacterial flora in an infected patient's intestine has been used to treat this condition lately.

What Are the Complications of Pseudomembranous Colitis?

In most cases the treatment of pseudomembranous colitis is successful. However, sometimes, pseudomembranous colitis can be life-threatening even with timely diagnosis and treatment. Possible complications include:

• Dehydration- Significant loss of fluids and electrolytes can occur due to severe diarrhea. This might lead to a dangerous drop in blood pressure, making it difficult for the body to function normally.

• Kidney Failure- This is often a sequel to loss of fluids that causes impaired kidney function.

• Toxic Megacolon- In this rare condition, the colon cannot expel gas and stool, leading to its enlargement. If left untreated, the colon may rupture, and the bacteria from the colon will enter the abdominal cavity. This situation requires emergency surgery and may be fatal.

• Bowel Perforation- This results from extensive damage to the gastric lining.

• Death- A mild to moderate infection can quickly progress to death if not treated properly.

How Can Pseudomembranous Colitis Be Prevented?

Preventive measures include:

• Hand-Washing- In the event of a Clostridium difficile outbreak, hand washing is recommended. Soap and warm water hand wash are better for hand hygiene than alcohol-based hand sanitizers as they do not effectively destroy Clostridium difficile spores. Healthcare workers and people visiting patients with Clostridium difficile infection should wash their hands with soap and warm water before and after leaving the room and while using the bathroom.

• Avoiding Contact With Infected People- People who are hospitalized with Clostridium difficile are kept in isolated environments. Hospital staff and visitors must wear disposable gloves and isolation gowns while in the room until at least 48 hours after the diarrhea stops.

• Undertaking Thorough Cleaning Measures- In any setting that hosts infected individuals, either home or hospital, all the surfaces should be carefully disinfected using chlorine bleach-based cleaning products.

• Avoiding Unnecessary Use of Antibiotics- The use of unnecessary antibiotics must be avoided, especially the use of the ones that predispose to the condition.

Conclusion:

Pseudomembranous colitis is caused by one or more toxins produced by an unopposed proliferation of Clostridium difficile bacteria in acute infectious colitis and usually occurs as a complication of antibiotic therapy. The clinical manifestation of Clostridium difficile infection varies from the complete absence of symptoms to extensive colitis. It is essential to recognize the imaging features of pseudomembranous colitis that may be useful in diagnosing the condition. Early diagnosis and treatment are crucial for preventing progression to more serious pathologic conditions.