Case 51: A surgical patient with watery, bloody foul smelling stools

Question 1

When are tests for clostridium difficile done?

Answer 1

In patients with watery bloody foul smelling stools

Question 2

What other pathogens are screened in a routine faeces culture?

Answer 2

Yersinia

Question 3

What does c. difficile in the colon cause?

Answer 3

Pseudomembranous colitis

Question 4

What is pseudomembranous colitis due to?

Answer 4

Overgrowth of Clostridium difficile as a result of the perturbation of the constituents of the gut microbiota

Question 5

What is visible on the colon mucosa in pseudomembranous colitis?

Answer 5

Pseudomembranes are visible as raised yellow plaques on the colorectal mucosa ranging from 2-10 mm in diameter

Question 6

Why is culture of c. difficile not routinely performed?

Answer 6

Because it’s too difficult and nucleic acid testing is much more sensitive

Strict anaerobe

Question 7

How can C. difficile causing pseudomembranous colitis develop?

Answer 7

Carier patient takes broad-spectrum antibiotics, wipes out normal flora and C. difficile takes over in the anaerobic and necrotic colon causing pseudomembranous colitis

Question 8

How is C. difficile/pseudomembranous colitis treated?

Answer 8

Metronidazole if mild

Add Gentamycin if bad

Use Vancomycin if severe