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==Overview==
==Natural History==
===1. Carrier Stage===
*Following ingestion of ''C. difficile'' spores, patients are colonized with the organism.
*Typically, young healthy individuals with adequate immune responses are able to clear the organism without development of any clinical manifestations.
*In contrast, patients with risk factors, such as recent antibiotic use, recent hospitalization, advanced age, or immunodeficiency, are more predisposed to persistent colonization and/or develop signs and symptoms of the infection.
*The carrier stage may be as short as 2 hours following antibiotic administration to several months.
===2. Clinical Manifestations===
*The onset of clinical manifestations may occur within 2 hours up to several months of antibiotic use.
*Patients typically develop watery diarrhea (possibly bloody) associated with colicky diffuse abdominal pain, nausea, malaise, and fever.
*Diarrhea typically persists for more than 2 days, and patients commonly develop colitis with or without pseudomembrane formation.
===3. Pseudomembranous Colitis===
*If left untreated, patients may develop pseudomembranous colitis, which is characterized by the development of yellowish plaques in the colorectal mucosa.
*Clinical manifestations include abdominal pain, watery diarrhea, and fever with worsening symptoms, dehydration, and further elevation in the concentration of inflammatory markers.
===4. Development of Complications===
*In the minority of patients (approximately 3%), clinical manifestations may persist, and ''C. difficile'' infection may have a complicated course.
*Fulminant colitis, extracolonic manifestations, and death have been more frequently reported since the emergence of the hypervirulent ''C. difficile'' strain.
====5. Recurrence/Reinfection====
*Approximately one-fourth of patients adequately treated with antimicrobial therapy develop recurrence within 4 weeks of therapy completion.
*Approximately 30-70% of patients experience recurrent ''C. difficile'' infection with a new strain following successul completion of antimicrobial therapy.


==Complications==
==Complications==
*Fulminant [[colitis]] is an uncommon complication that occurs in 2-3% of patients with ''C. Diff'', and can results in perforation, prolonged [[ileus]], [[megacolon]], and [[death]].
===Colonic Complications===
*Fulminant [[colitis]]: A relatively rare, but fatal, complication of ''C. difficile'' infection. Manifestations typically include worsening abdominal pain, prolonged [[ileus]], [[megacolon]], and fever.


*[[Toxic megacolon]] is an enlarged, dilated colon >7cm associated severe systemic toxicity.
===Extracolonic Complications===
*Pseudomembrane formation in small intestine
*Bacteremia
*Reactive arthritis
*Visceral or intra-abdominal abscess
*Appendicitis
*Osteomyelitis
*Empyema
*Death
 
==Prognosis==


==References==
==References==
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{{Reflist|2}}
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[[Category:Disease]]
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]
{{WH}}
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Revision as of 20:16, 21 April 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.

Overview

Natural History

1. Carrier Stage

  • Following ingestion of C. difficile spores, patients are colonized with the organism.
  • Typically, young healthy individuals with adequate immune responses are able to clear the organism without development of any clinical manifestations.
  • In contrast, patients with risk factors, such as recent antibiotic use, recent hospitalization, advanced age, or immunodeficiency, are more predisposed to persistent colonization and/or develop signs and symptoms of the infection.
  • The carrier stage may be as short as 2 hours following antibiotic administration to several months.

2. Clinical Manifestations

  • The onset of clinical manifestations may occur within 2 hours up to several months of antibiotic use.
  • Patients typically develop watery diarrhea (possibly bloody) associated with colicky diffuse abdominal pain, nausea, malaise, and fever.
  • Diarrhea typically persists for more than 2 days, and patients commonly develop colitis with or without pseudomembrane formation.

3. Pseudomembranous Colitis

  • If left untreated, patients may develop pseudomembranous colitis, which is characterized by the development of yellowish plaques in the colorectal mucosa.
  • Clinical manifestations include abdominal pain, watery diarrhea, and fever with worsening symptoms, dehydration, and further elevation in the concentration of inflammatory markers.

4. Development of Complications

  • In the minority of patients (approximately 3%), clinical manifestations may persist, and C. difficile infection may have a complicated course.
  • Fulminant colitis, extracolonic manifestations, and death have been more frequently reported since the emergence of the hypervirulent C. difficile strain.

5. Recurrence/Reinfection

  • Approximately one-fourth of patients adequately treated with antimicrobial therapy develop recurrence within 4 weeks of therapy completion.
  • Approximately 30-70% of patients experience recurrent C. difficile infection with a new strain following successul completion of antimicrobial therapy.

Complications

Colonic Complications

  • Fulminant colitis: A relatively rare, but fatal, complication of C. difficile infection. Manifestations typically include worsening abdominal pain, prolonged ileus, megacolon, and fever.

Extracolonic Complications

  • Pseudomembrane formation in small intestine
  • Bacteremia
  • Reactive arthritis
  • Visceral or intra-abdominal abscess
  • Appendicitis
  • Osteomyelitis
  • Empyema
  • Death

Prognosis

References

Template:WH Template:WS

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