Toxic Clostridioides (formerly Clostridium) difficile colitis: No longer a diarrhea associated infection.

Abstract

BACKGROUND:

Clostridioides difficile infection (CDI) is traditionally taught to be an antibiotic associated diarrheal infection. This diagnosis is based on the presence of clinical symptoms (usually defined as more than 3 watery, loose or unformed stool within 24 h) coupled with a diagnostic test. There is now a new presentation of CDI, including progression to toxic megacolon, in patients without diarrhea.

METHODS:

We report a case series of 9 surgical patients from a single institution who developed CDI without preceding diarrhea.

RESULT:

All 9 patients had CDI with positive laboratory testing for C. difficile toxin. They, however, presented with a lack of or minimal bowel movements. Six patients had rapid development of abdominal distention, 1 patient had a single episode of watery stool in 3 days, while the other 2 patients presented with constipation. Seven patients received stool softeners, suppositories and/or enemas for presumed constipation. Four patients had a mild course of infection and were successfully treated medically. The other 5 patients developed toxic megacolon, and eventually required total abdominal colectomy. Out of the 5 patients that required total colectomy, 2 expired.

CONCLUSION:

CDI must be suspected in patients who rapidly develop abdominal distention, vague abdominal complaints or change in bowel function even in the absence of diarrhea, especially if coupled with multi-system organ failure.

• Authors: Emmanuel Nwachuku, Yizhi Shan, Prabhu Senthil-Kumar, Todd Braun, Ryan Shadis, Orlando Kirton, Thai Q Vu
• Journal: American journal of surgery (Am J Surg) Vol. 221 Issue 1 Pg. 240-242 (01 2021) ISSN: 1879-1883 [Electronic] United States
• PMID: 32680621 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Clostridioides difficile
• Clostridium Infections
• Colitis (microbiology)
• Diarrhea
• Female
• Humans
• Male
• Middle Aged