Clostridium difficile infection natural history, complications and prognosis

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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

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.

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.

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.

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.

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.

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