Clostridium difficile infection natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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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. Patients may present with:

• Severe abdominal pain and distension
• Severe diarrhea; diarrhea may be absent in patients with ileus
• Fever, chills
• Lethargy
• Tachycardia
• Leucocytosis, up to 40,000 mm3
• Metabolic acidosis

Toxic megacolon is an enlarged, dilated colon >7cm associated severe systemic toxicity. It may also present with:

• Small intestinal dilation
• Air-fluid levels
• Submucosal edema resulting in thumb-printing