Methods for diagnosis and prevention of complications Pseudomembranous colitis

Pseudomembranous colitis is a disease of concern. The disease is caused by the bacteria Clostridium diffilce. The disease can lead to a series of dangerous complications when it gets worse, such as intestinal perforation, diarrhea, dehydration, etc. Therefore, early diagnosis and treatment is essential. Let's learn more about this disease in the following article!

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• 1. Overview of pseudomembranous colitis
• 2. Signs of illness
• 3. Subjects at high risk of disease
• 4. What is the cause of the disease?
• 5. Dangerous complications
• 5. Diagnosis of pseudomembranous colitis
• 6. Treatment of pseudomembranous colitis
• 8. Precautions

1. Overview of pseudomembranous colitis

Pseudomembranous colitis is also known as antibiotic-associated colitis or C.Dificle colitis. The disease is related to the overgrowth of a bacteria called Clostridium difficle. Usually occurs in some people after taking a certain antibiotic.

Pseudomembranous colitis occurs when harmful bacteria in the colon release potent toxins. The most common bacteria C. difficile. The toxin irritates the intestines, causing the signs and symptoms of pseudomembranous colitis.

C. difficile  is an anaerobic, spore-forming bacterium . Therefore, they have good resistance when going outside as well as in the digestive tract. C.difficile bacteria will produce enterotoxins and cytotoxicity. When the toxin affects the colonic mucosa, it will cause inflammation, increase secretion to form white pseudomembranous. This pseudomembranous fascia is soft so it is easy to peel off. When it comes off, it will leave inflammation, ulcers and cause mucosal bleeding.

2. Signs of illness

Symptoms  of  pseudomembranous colitis may begin 1 to 2 days after you start taking antibiotics. Sometimes it can be longer, weeks, months after you finish a course of antibiotics.

Abdominal pain and nausea are common manifestations of pseudomembranous colitis.

Depending on the severity of the disease, the symptoms may vary. Signs and symptoms of pseudomembranous colitis include:

• Fever: Sometimes up to 38 - 39 degrees Celsius.
• Abdominal pain (which can be a dull ache or cramping or intermittent pain).
• Passing stools with pus or mucus in the stool.
• Nausea .
• Dehydration due to profuse diarrhea.

See more articles: Colon: Structure and function

3. Subjects at high risk of disease

For pseudomembranous colitis, people with higher risk factors include:

• People with recent hospital stay.
• Weakened immune system.
• Elderly, over 65 years old.
• Having some diseases such as: Inflammatory bowel disease, colorectal cancer.
• Undergo intestinal surgery.
• Undergoing chemotherapy for cancer.

4. What is the cause of the disease?

The human colon contains many types of bacteria. They exist peacefully with each other in a balance. The use of medications, including antibiotics, can upset this balance.

C. diff in the colon of 5–15% of healthy adults and 84.4% in neonates. However, other bacteria that live in the gut often keep C. diff levels in check.

 Pseudomembranous colitis  occurs when C. Difficle grows too quickly to overwhelm other bacteria. The number of toxins secreted by C. difficile is also much higher. This causes damage to the colon.

Any antibiotic can cause  pseudomembranous colitis . But there are actually some antibiotics that are more linked with the disease, including:

• Fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin.
• Penicillins, such as amoxicillin and ampicillin.
• Clindamycin (Cleocin).
• Cephalosporins, such as cefixime (Suprax).

C.diff is the main cause of pseudomembranous colitis.

Besides antibiotics, the use of other therapeutic agents also sometimes causes  pseudomembranous colitis . Drugs used in cancer chemotherapy can also upset the normal balance of bacteria in the colon.

Certain medical conditions also affect the colon. For example, ulcerative colitis or Crohn's disease can also cause  pseudomembranous colitis .

It can be spread by spores of bacteria resistant to common disinfectants and passed on to other people. Even C. difficile has been reported in people without any risk factors. These cases are called community acquired C. difficile.

5. Dangerous complications

Pseudomembranous colitis is usually treated successfully. However, even with prompt diagnosis and treatment, the disease can be life-threatening. Possible complications include:

• Dehydration: Severe diarrhea can lead to significant loss of fluids and electrolytes. This makes it difficult for the body to function properly and blood pressure to drop to dangerously low levels.
• Kidney failure : In some cases, dehydration can happen so quickly that kidney function declines rapidly.
• Toxic megacolon: This is rare. If left untreated, your colon can stretch to the point of rupture. It also allows bacteria from the colon to enter your abdominal cavity. A bulging or ruptured colon requires emergency surgery because it can be fatal.
• Intestinal perforation: This occurs due to damage to the lining of the large intestine or after toxic megacolon. A perforated colon can spill bacteria from the intestine into the abdominal cavity, leading to a life-threatening infection (peritonitis).
• Death: If not treated promptly, even mild to moderate disease can rapidly progress to severe, fatal.
• Recurrence: In addition, pseudomembranous colitis can sometimes recur, days or even weeks after successful treatment.

5. Diagnosis of pseudomembranous colitis

Tests and procedures used to diagnose the disease and to look for complications include:

• Stool test. This method uses several different stool samples to detect infectious C. difficile in the colon.
• Blood tests. Abnormally high numbers of white blood cells can determine if you have  pseudomembranous colitis  .
• Colonoscopy or sigmoidoscopy. In these two tests, the doctor uses a tube with a miniature camera on the end. To check the inside of the large intestine for signs of pseudomembranous colitis. This sign is usually yellow patches (plaques) and bumps.
• Imaging tests. If you have severe symptoms, your doctor may order an X-ray or CT scan of your abdomen. Thereby, to look for complications such as an enlarged colon or a ruptured colon. 

Diagnosis of pseudomembranous colitis by imaging.

6. Treatment of pseudomembranous colitis

Treatment of pseudomembranous colitis usually includes stopping the current antibiotic and starting an antibiotic effective for C. difficile. In some situations, surgery may be necessary. When treatment for pseudomembranous colitis is started, symptoms may begin to improve within a few days.

However, the situation of drug resistance and the emergence of new C.Difficle strains, makes treatment more and more difficult. Recurrence is more common. With each relapse, signs and symptoms evolve, and the likelihood of a second relapse increases.

6.1. The treatments

• Repeat antibiotics. You may need one to two more rounds of antibiotics to resolve pseudomembranous colitis. Antibiotics can be taken orally or injected or intravenously depending on the patient's condition.
• Surgery. This approach may be an option in people with advanced organ failure, colon rupture, and peritonitis. Surgery usually involves removing all or part of the colon. Newer surgical methods include laparoscopic surgery to create a loop of the colon and cleanse the colon. This method is less invasive and gives positive results.
• Microbial fecal culture (FMT). FMT is used to treat recurrent pseudomembranous colitis. Stool is cleaned, wrapped in a capsule, either through the nose or straight into the colon.

See also:  Signs and screening for colorectal cancer

6.2. A few things to note

• Drink a lot of water. Water is best, but solutions with added sodium and potassium (electrolytes) may also be beneficial. Examples: sports drinks, oral rehydration solutions, non- caffeinated soft drinks , fruit juices.
•  Avoid drinks that are high in sugar or contain alcohol or caffeine. Coffee, tea, and cola, for example, can worsen your symptoms.
• Avoid irritating foods. Stay away from spicy, fatty, fried foods, which can make your symptoms worse.
• Choose soft, easily digestible foods including apples, bananas, and rice. Avoid certain foods rich in fiber such as beans, nuts, and vegetables. If symptoms improve, slowly add fiber foods back into the diet. Try to eat many small meals instead of a few large ones.
• Some research suggests that a good bacteria and yeast (probiotic) supplement may help prevent C. difficile infections. They are safe and available in capsule or liquid form without a prescription.

6.3. Disease prognosis

Most C. diff infections respond well to treatment with oral antibiotics.

Once you start taking antibiotics, you'll notice your symptoms start to improve within a day or two. In more severe cases, you may need an additional intravenous antibiotic.

8. Precautions

The C. Diff bacteria that cause pseudomembranous colitis are resistant to many cleaning products. However, there are some things you can do to reduce your risk of infection, such as:

• Wash your hands often with soap and warm water. This is especially important after using the bathroom and before eating.
• Prophylactic antibiotics are not required. Remember that antibiotics are only effective for bacterial infections. It is not effective in treating viral infections, such as the flu or the common cold.
• Keep surfaces in the bathroom and kitchen areas clean at all times.

Above SignsSymptomsList has provided you with necessary and useful information about pseudomembranous colitis. If you suspect you have C. diff, try to see your doctor as soon as possible to avoid any dangerous complications. Hopefully, with this knowledge, it will help you and your loved ones in taking care of your health.

Doctor Dao Thi Thu Huong