C.diff diarrhoea

Question 1

pathogen in C.diff diarrhoea

Answer 1

Gram +ve spore-forming anaerobe
releases enterotoxins A & B
spores are very robust and can survive for >40 days

Question 2

epidemiology of C.diff diarrhoea

Answer 2

commonest cause of Abx associated diarrhoea

stool carriage in 3% of healthy adults & up to 30% of hospitals pts

Question 3

risk factors for C.diff dirrhoea

Answer 3

Abx (e.g. clindamycin, cefs, augmentin, quinolones)
increasing age
hospital (increases with length of stay and contact with C.diff pts)
PPIs

Question 4

clinical presentation of C.diff diarrhoea

Answer 4

asymptomatic
mild diarrhoea
colitis w/o pseudomembranes
pseudomembranous colitis
fulminant colitis
may occur up to 2 months post Abx

Question 5

symptoms of pseudomembranous colitis

Answer 5

severe systemic symptoms (fever, dehydration)

abdominal pain, bloody diarrhoea, mucous PR

Question 6

complications of pseudomembranous colitis

Answer 6

paralytic ileus
toxic dilatation -> perforation
multi-organ failure

Question 7

investigations for C.diff diarrhoea

Answer 7

Bloods: v. increased CRP, v. increased WCC, decreased albumin, dehydration
CDT Elisa
stool culture

Question 8

definition of severe C.diff diarrhoea

Answer 8

> or equal to 1 of:
WCC >15
Cr >50% above baseline
Temp >38.5
clinical/radiological evidence of severe colitis

Question 9

treatment of C.diff diarrhoea

Answer 9

General (stop causative Abx, avoid antidiarrhoeals & opiates, enteric precautions)
specific:
1st line = metronidazole ( 400mg TDS)
2nd line = vancomycin (125mg QDS)
severe = urgent colectomy if toxic megacolon or increased LDH