Materiały źródłowe

• #1 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  Pseudomembranous colitis is an inflammatory condition of the colon characterized by elevated yellow-white plaques that coalesce to form pseudomembranes on the mucosa. […] Because pseudomembranous colitis is often associated with C. difficile infection, stool testing and empiric antibiotic treatment should be initiated when suspected. […] When results of C. difficile testing are negative and symptoms persist despite escalating empiric treatment, early gastroenterology consultation and lower endoscopy would be the next step in the appropriate clinical setting. […] If pseudomembranous colitis is confirmed endoscopically, colonic biopsies should be obtained, as histology can offer helpful clues to the underlying diagnosis. […] The less common non-C. difficile causes of pseudomembranous colitis should be entertained, as a number of etiologies can result in this condition.

• #2 Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10464797/

  Pseudomembranous colitis (PMC) is a potentially life-threatening acute infectious colitis caused by one or more toxins produced by an unopposed proliferation of Clostridium difficile bacteria. PMC is characterized by the presence of elevated, yellow-white plaques forming pseudomembranes on the colonic mucosa. […] Plain radiography, contrast enema studies, and computed tomography (CT) are useful in the evaluation of PMC. Plain radiography of the abdomen can demonstrate polypoid mucosal thickening, „thumbprinting” (wide transverse bands associated with haustral fold thickening), or gaseous distention of the colon. […] A contrast enema study is contraindicated in patients with severe PMC due to the danger of perforation. Common CT findings include wall thickening, low-attenuation mural thickening corresponding to mucosal and submucosal edema, the „accordion sign,” the „target sign” („double halo sign”), pericolonic stranding, and ascites. Familiarity with these imaging characteristics may allow early diagnosis and treatment and prevent progression to more serious pathologic conditions.

• #3 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  The diagnosis of C difficile colitis should be suspected in any patient with diarrhea who has received antibiotics within the previous 3 months, has been recently hospitalized, and/or has an occurrence of diarrhea 48 hours or more after hospitalization. […] However, more recent studies have shown that C difficile can be the cause of diarrhea in community dwellers without previous hospitalization or antibiotic exposure; therefore, the diagnosis should be suspected in this population as well. […] Once infected with C difficile, the rate of disease recurrence is 20-40% when using metronidazole and vancomycin antibiotics as first-line therapy. […] Fidaxomicin is now recommended as first-line treatment due to a lower risk of CDI recurrence. […] The use of oral metronidazole or vancomycin produces response rates of greater than 95% in mild to moderate cases, with symptomatic improvement (diarrhea) in as little as 3-4 days and complete resolution in 7-10 days.

• #4 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause. […] Pseudomembranous colitis is most often due to Clostridium difficile infection, but it has a variety of other causes, including other infections, ischemia, medications, and inflammatory mucosal diseases. […] When pseudomembranes are found, one should consider these other causes if tests for C difficile are negative or if anti-C difficile therapy does not produce a response. […] The initial evaluation of a patient with suspected or confirmed pseudomembranous colitis should include a comprehensive medical history with information on recent hospitalizations or procedures, antibiotic use, infections, exposure to sick contacts, recent travel, and medications taken.

• #5 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  The diagnosis of C difficile colitis should be suspected in any patient with diarrhea who has received antibiotics within the previous 3 months, has been recently hospitalized, and/or has an occurrence of diarrhea 48 hours or more after hospitalization. […] However, more recent studies have shown that C difficile can be the cause of diarrhea in community dwellers without previous hospitalization or antibiotic exposure; therefore, the diagnosis should be suspected in this population as well. […] Once infected with C difficile, the rate of disease recurrence is 20-40% when using metronidazole and vancomycin antibiotics as first-line therapy. […] Fidaxomicin is now recommended as first-line treatment due to a lower risk of CDI recurrence. […] The use of oral metronidazole or vancomycin produces response rates of greater than 95% in mild to moderate cases, with symptomatic improvement (diarrhea) in as little as 3-4 days and complete resolution in 7-10 days.

• #6 Pseudomembranous colitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/diagnosis-treatment/drc-20351439

  Tests and procedures used to diagnose pseudomembranous colitis and to search for complications include: […] There are a number of different stool sample tests used to detect Clostridioides difficile (C. difficile) infection of the colon. […] These may reveal an unusually high white blood cell count, called leukocytosis, which may indicate an infection such as C. difficile if you also have diarrhea. […] In both of these tests, your doctor uses a tube with a miniature camera at its tip to examine the inside of your colon for signs of pseudomembranous colitis raised, yellow plaques called lesions, as well as swelling. […] If you have severe symptoms, your provider may obtain an abdominal X-ray or an abdominal computed tomography (CT) scan to look for complications such as toxic megacolon or colon rupture.

• #7 Pseudomembranous Colitis: What It Is, Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/17718-pseudomembranous-colitis

  Pseudomembranous colitis (PMC) is a severe form of colitis. […] A healthcare provider will listen to your symptoms and ask you questions about your health history. They might order various tests to look for the cause of your symptoms, including blood tests, imaging tests and poop tests. […] Theyll test your poop for evidence of C. diff infection. If they find it, theyll start your treatment for it right away. […] Sometimes, signs of pseudomembranous colitis show up on an imaging test (radiology). Your provider might see a pattern in the images that suggests severe colitis or damage to the mucosa, such as the thumbprint sign or the accordion sign. […] To investigate further, the next step would be to look inside your colon for the cause of your symptoms. The exam to look inside your colon is called a colonoscopy. If your provider finds pseudomembranes during a colonoscopy, theyll take a tissue sample (biopsy) and send it to a lab to confirm it.

• #8 Clostridioides difficile infection – Wikipedia

  https://en.wikipedia.org/wiki/Clostridioides_difficile_infection

  Diagnostic method Stool culture, testing for the bacteria’s DNA or toxins. […] Diagnosis is by stool culture or testing for the bacteria’s DNA or toxins. […] The appearance of „pseudomembranes” on the mucosa of the colon or rectum is highly suggestive, but not diagnostic of the condition. […] Although colonoscopy and sigmoidoscopy are still employed, now stool testing for the presence of C. difficile toxins is frequently the first-line diagnostic approach. […] This test is not 100% accurate, with a considerable false-negative rate even with repeat testing. […] Assessment of the A and B toxins by enzyme-linked immunosorbent assay (ELISA) for toxin A or B (or both) has a sensitivity of 63-99% and a specificity of 93-100%, depending on detection assays. […] Previously, experts recommended sending as many as three stool samples to rule out disease if initial tests are negative, but evidence suggests repeated testing during the same episode of diarrhea is of limited value and should be discouraged.

• #9 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Because of the high prevalence of asymptomatic Clostridium difficile colonization in infants, the IDSA does not recommend testing for Clostridium difficile in children 12 months or younger who have diarrhea. […] When the prevalence of Clostridium difficile infection is low, no diagnostic test should be used alone because of low positive predictive values. […] The EIA for GDH has high sensitivity, which makes it a useful screening test because a negative result essentially rules out infection (negative predictive value = 94% to 100%). The EIA for toxins A and B has the highest specificity, whereas NAAT is both sensitive and specific. […] Repeat testing within seven days during the same episode of diarrhea is not recommended because the high sensitivity of the tests can lead to false-positive results.

• #10 Clostridioides difficile infection – Wikipedia

  https://en.wikipedia.org/wiki/Clostridioides_difficile_infection

  Testing of stool samples by real-time polymerase chain reaction is able to detect C. difficile about 93% of the time and when positive is incorrectly positive about 3% of the time. […] This is more accurate than cytotoxigenic culture or cell cytotoxicity assay. […] The screening specificity is relatively low because of the high number of false positive cases from asymptomatic infection.

• #11 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  A systematic review of rapid toxin detection kits for both toxins A and B, including EIA and similar testing modalities, reported overall sensitivities and specificities as 7595% and 8398% respectively, when compared to CCNA. […] Given these results, efforts have been made to standardize two- or three-step diagnostic algorithms or further the use of more accurate one-step tests. […] Once diagnosis of CDI is confirmed, it is important to immediately identify responsible antibiotic or chemotherapy agents and discontinue these drugs as soon as possible. […] The next step is to individualize the agent of choice for each case. […] Proposed criteria for severe disease include WBC count greater than 15,000/mm3, elevated creatinine (greater than 1.5 times baseline), advanced age, and/or hypoalbuminemia (serum albumin less than 3.0 g/dl).

• #12 Pseudomembranous Colitis Surgery Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/193031-workup

  Laboratory studies to be considered include the following: […] Stool assay for C difficile toxins (mostly toxin B) – This test requires 2 days and is considered positive when cultured cells undergo cytopathic changes when exposed to stool, with the result then confirmed by neutralizing these toxins with specific antitoxins; although this is the criterion standard test (sensitivity is 95% in patients with antibiotic-induced diarrhea and increases with the severity of the colitis), results are negative in 5-10% of patients with endoscopic evidence of pseudomembranous colitis […] Rigid proctosigmoidoscopy is diagnostic in 77% of patients. Endoscopic visualization of the pseudomembranes characteristic of the disease is the most rapid and definitive diagnostic method. […] Flexible sigmoidoscopy is diagnostic in 91% of the patients. […] Colonoscopy may be required in 10% of the cases where the disease is localized to the cecum or transverse colon with rectal sparing.

• #13 Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-consensus-on-prevention-diagnosis-treatment-articulo-S2255534X19300295

  In recent decades, Clostridium difficile infection (CDI) has become a worldwide health problem. […] A 2-step diagnostic algorithm was proposed, in which a highly sensitive test, such as glutamate dehydrogenase (GDH), is first utilized, and if positive, confirmed by the detection of toxins through immunoassay or nucleic acid detection tests. […] CDI should be suspected in a patient with diarrhea and a history of antibiotic use and/or immunosuppression, whose diarrhea is community-acquired, or presents after more than 48h of hospitalization, or within 8 weeks after hospital release. […] CDI should be diagnosed only when there is clinical suspicion based on the 2-step algorithm. […] The most useful method for making the diagnosis when there is clinical suspicion of CDI is the 2-step algorithm. A first high-sensitivity test, such as glutamate dehydrogenase (GDH) or nucleic acid amplification tests (NAATs) through the polymerase chain reaction (PCR) technique should be performed.

• #14 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Guidelines for the diagnosis and treatment of Clostridioides difficile infection have recently been updated. Testing in these patients should start with enzyme immunoassays for glutamate dehydrogenase and toxins A and B or nucleic acid amplification testing. […] A two-step algorithm should be used to guide diagnostic testing for Clostridioides difficile infection: enzyme immunoassay for glutamate dehydrogenase and toxins A and B, followed by nucleic acid amplification testing if initial results are indeterminate. […] The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America recommend limiting testing for Clostridium difficile infection to patients with unexplained onset of three or more unformed stools in 24 hours while not taking laxatives.

• #15 Pseudomembranous Colitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pseudomembranous-colitis

  Testing for C. difficile or its toxins should be performed only on diarrhoeal (unformed) stool, unless ileus due to C. difficile is suspected. Testing of stool from asymptomatic patients is not clinically useful. […] Sigmoidoscopy (or colonoscopy) shows the characteristic pseudomembranous plaque appearance in about half of affected patients. Biopsy may be required to confirm diagnosis. Is not used routinely but is usually performed if rapid diagnosis is needed or in a patient who has ileus (often as part of work-up for other colonic disease). […] Any of the following defines a C. difficile infection case in patients aged 2 years and above and must be reported to UKHSA or the equivalent agency in Northern Ireland, Scotland and Wales: Diarrhoeal stools where the specimen is C. difficile toxin-positive. Toxic megacolon or ileotomy where the specimen is C. difficile toxin-positive. PMC revealed by lower gastrointestinal endoscopy or computerised tomography. Colonic histopathology characteristic of CDI (with or without diarrhoea or toxin detection) on a specimen obtained during endoscopy or colectomy. Faecal specimens collected post-mortem where the specimen is C. difficile toxin-positive or tissue specimens collected post-mortem where pseudomembranous colitis is revealed or colonic histopathology is characteristic of CDI.

• #16 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  This article will review the many diverse etiologies of PMC. […] Although CDI is the most common cause, other less common etiologies of PMC will be described. […] Endoscopy is not routinely recommended in patients with typical CDI symptoms and positive laboratory testing due to its inherent risks and cost. […] However, it can be valuable in patients with consistent symptoms and negative testing, failure of conventional CDI therapy, or inability to obtain stool samples due to ileus. […] Endoscopy should be avoided when fulminant colitis or toxic megacolon is suspected, given the procedural risk of perforation and subsequent peritonitis. […] In mild cases of CDI, only signs of non-specific colitis may be seen, including erythematous, inflamed, or friable mucosa. […] In such cases, where clinical suspicion for CDI is high, biopsy is indicated to seek characteristic histologic findings of PMC.

• #17 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  As most patients with pseudomembranous colitis have C difficile infection, it should be excluded first. Empiric anti-C difficile treatment is recommended in seriously ill-appearing patients, ideally starting after a stool sample is obtained. […] Diagnosis of C difficile infection requires laboratory demonstration of the toxin or detection of toxigenic organisms. […] Colonoscopy or flexible sigmoidoscopy is the primary means by which pseudomembranous colitis is diagnosed. Lower endoscopy should be pursued as an adjunctive tool when C difficile infection remains strongly suspected despite negative testing, when presumed C difficile infection does not respond to medical therapy, and when non-C difficile diagnoses are considered. […] If pseudomembranes are demonstrated on lower endoscopy, obtaining biopsy samples of normal- and abnormal-appearing mucosa is recommended. Pseudomembranes are suggestive but not diagnostic of C difficile infection, and microscopic evaluation of the mucosa is warranted to explore causes of pseudomembranous colitis not related to C difficile.

• #18 Pseudomembranous Colitis Surgery Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/193031-workup

  Laboratory studies to be considered include the following: […] Stool assay for C difficile toxins (mostly toxin B) – This test requires 2 days and is considered positive when cultured cells undergo cytopathic changes when exposed to stool, with the result then confirmed by neutralizing these toxins with specific antitoxins; although this is the criterion standard test (sensitivity is 95% in patients with antibiotic-induced diarrhea and increases with the severity of the colitis), results are negative in 5-10% of patients with endoscopic evidence of pseudomembranous colitis […] Rigid proctosigmoidoscopy is diagnostic in 77% of patients. Endoscopic visualization of the pseudomembranes characteristic of the disease is the most rapid and definitive diagnostic method. […] Flexible sigmoidoscopy is diagnostic in 91% of the patients. […] Colonoscopy may be required in 10% of the cases where the disease is localized to the cecum or transverse colon with rectal sparing.

• #19 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  This article will review the many diverse etiologies of PMC. […] Although CDI is the most common cause, other less common etiologies of PMC will be described. […] Endoscopy is not routinely recommended in patients with typical CDI symptoms and positive laboratory testing due to its inherent risks and cost. […] However, it can be valuable in patients with consistent symptoms and negative testing, failure of conventional CDI therapy, or inability to obtain stool samples due to ileus. […] Endoscopy should be avoided when fulminant colitis or toxic megacolon is suspected, given the procedural risk of perforation and subsequent peritonitis. […] In mild cases of CDI, only signs of non-specific colitis may be seen, including erythematous, inflamed, or friable mucosa. […] In such cases, where clinical suspicion for CDI is high, biopsy is indicated to seek characteristic histologic findings of PMC.

• #20 Pseudomembranous Colitis Surgery Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/193031-workup

  Laboratory studies to be considered include the following: […] Stool assay for C difficile toxins (mostly toxin B) – This test requires 2 days and is considered positive when cultured cells undergo cytopathic changes when exposed to stool, with the result then confirmed by neutralizing these toxins with specific antitoxins; although this is the criterion standard test (sensitivity is 95% in patients with antibiotic-induced diarrhea and increases with the severity of the colitis), results are negative in 5-10% of patients with endoscopic evidence of pseudomembranous colitis […] Rigid proctosigmoidoscopy is diagnostic in 77% of patients. Endoscopic visualization of the pseudomembranes characteristic of the disease is the most rapid and definitive diagnostic method. […] Flexible sigmoidoscopy is diagnostic in 91% of the patients. […] Colonoscopy may be required in 10% of the cases where the disease is localized to the cecum or transverse colon with rectal sparing.

• #21 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  Pseudomembranous colitis is an inflammatory condition of the colon characterized by elevated yellow-white plaques that coalesce to form pseudomembranes on the mucosa. […] Because pseudomembranous colitis is often associated with C. difficile infection, stool testing and empiric antibiotic treatment should be initiated when suspected. […] When results of C. difficile testing are negative and symptoms persist despite escalating empiric treatment, early gastroenterology consultation and lower endoscopy would be the next step in the appropriate clinical setting. […] If pseudomembranous colitis is confirmed endoscopically, colonic biopsies should be obtained, as histology can offer helpful clues to the underlying diagnosis. […] The less common non-C. difficile causes of pseudomembranous colitis should be entertained, as a number of etiologies can result in this condition.

• #22 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  As most patients with pseudomembranous colitis have C difficile infection, it should be excluded first. Empiric anti-C difficile treatment is recommended in seriously ill-appearing patients, ideally starting after a stool sample is obtained. […] Diagnosis of C difficile infection requires laboratory demonstration of the toxin or detection of toxigenic organisms. […] Colonoscopy or flexible sigmoidoscopy is the primary means by which pseudomembranous colitis is diagnosed. Lower endoscopy should be pursued as an adjunctive tool when C difficile infection remains strongly suspected despite negative testing, when presumed C difficile infection does not respond to medical therapy, and when non-C difficile diagnoses are considered. […] If pseudomembranes are demonstrated on lower endoscopy, obtaining biopsy samples of normal- and abnormal-appearing mucosa is recommended. Pseudomembranes are suggestive but not diagnostic of C difficile infection, and microscopic evaluation of the mucosa is warranted to explore causes of pseudomembranous colitis not related to C difficile.

• #23 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  This article will review the many diverse etiologies of PMC. […] Although CDI is the most common cause, other less common etiologies of PMC will be described. […] Endoscopy is not routinely recommended in patients with typical CDI symptoms and positive laboratory testing due to its inherent risks and cost. […] However, it can be valuable in patients with consistent symptoms and negative testing, failure of conventional CDI therapy, or inability to obtain stool samples due to ileus. […] Endoscopy should be avoided when fulminant colitis or toxic megacolon is suspected, given the procedural risk of perforation and subsequent peritonitis. […] In mild cases of CDI, only signs of non-specific colitis may be seen, including erythematous, inflamed, or friable mucosa. […] In such cases, where clinical suspicion for CDI is high, biopsy is indicated to seek characteristic histologic findings of PMC.

• #24 Pseudomembranous colitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/diagnosis-treatment/drc-20351439

  Tests and procedures used to diagnose pseudomembranous colitis and to search for complications include: […] There are a number of different stool sample tests used to detect Clostridioides difficile (C. difficile) infection of the colon. […] These may reveal an unusually high white blood cell count, called leukocytosis, which may indicate an infection such as C. difficile if you also have diarrhea. […] In both of these tests, your doctor uses a tube with a miniature camera at its tip to examine the inside of your colon for signs of pseudomembranous colitis raised, yellow plaques called lesions, as well as swelling. […] If you have severe symptoms, your provider may obtain an abdominal X-ray or an abdominal computed tomography (CT) scan to look for complications such as toxic megacolon or colon rupture.

• #25 Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10464797/

  Pseudomembranous colitis (PMC) is a potentially life-threatening acute infectious colitis caused by one or more toxins produced by an unopposed proliferation of Clostridium difficile bacteria. PMC is characterized by the presence of elevated, yellow-white plaques forming pseudomembranes on the colonic mucosa. […] Plain radiography, contrast enema studies, and computed tomography (CT) are useful in the evaluation of PMC. Plain radiography of the abdomen can demonstrate polypoid mucosal thickening, „thumbprinting” (wide transverse bands associated with haustral fold thickening), or gaseous distention of the colon. […] A contrast enema study is contraindicated in patients with severe PMC due to the danger of perforation. Common CT findings include wall thickening, low-attenuation mural thickening corresponding to mucosal and submucosal edema, the „accordion sign,” the „target sign” („double halo sign”), pericolonic stranding, and ascites. Familiarity with these imaging characteristics may allow early diagnosis and treatment and prevent progression to more serious pathologic conditions.

• #26 Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10464797/

  Pseudomembranous colitis (PMC) is a potentially life-threatening acute infectious colitis caused by one or more toxins produced by an unopposed proliferation of Clostridium difficile bacteria. PMC is characterized by the presence of elevated, yellow-white plaques forming pseudomembranes on the colonic mucosa. […] Plain radiography, contrast enema studies, and computed tomography (CT) are useful in the evaluation of PMC. Plain radiography of the abdomen can demonstrate polypoid mucosal thickening, „thumbprinting” (wide transverse bands associated with haustral fold thickening), or gaseous distention of the colon. […] A contrast enema study is contraindicated in patients with severe PMC due to the danger of perforation. Common CT findings include wall thickening, low-attenuation mural thickening corresponding to mucosal and submucosal edema, the „accordion sign,” the „target sign” („double halo sign”), pericolonic stranding, and ascites. Familiarity with these imaging characteristics may allow early diagnosis and treatment and prevent progression to more serious pathologic conditions.

• #27 Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10464797/

  Pseudomembranous colitis (PMC) is a potentially life-threatening acute infectious colitis caused by one or more toxins produced by an unopposed proliferation of Clostridium difficile bacteria. PMC is characterized by the presence of elevated, yellow-white plaques forming pseudomembranes on the colonic mucosa. […] Plain radiography, contrast enema studies, and computed tomography (CT) are useful in the evaluation of PMC. Plain radiography of the abdomen can demonstrate polypoid mucosal thickening, „thumbprinting” (wide transverse bands associated with haustral fold thickening), or gaseous distention of the colon. […] A contrast enema study is contraindicated in patients with severe PMC due to the danger of perforation. Common CT findings include wall thickening, low-attenuation mural thickening corresponding to mucosal and submucosal edema, the „accordion sign,” the „target sign” („double halo sign”), pericolonic stranding, and ascites. Familiarity with these imaging characteristics may allow early diagnosis and treatment and prevent progression to more serious pathologic conditions.

• #28 Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10464797/

  Pseudomembranous colitis (PMC) is a potentially life-threatening acute infectious colitis caused by one or more toxins produced by an unopposed proliferation of Clostridium difficile bacteria. PMC is characterized by the presence of elevated, yellow-white plaques forming pseudomembranes on the colonic mucosa. […] Plain radiography, contrast enema studies, and computed tomography (CT) are useful in the evaluation of PMC. Plain radiography of the abdomen can demonstrate polypoid mucosal thickening, „thumbprinting” (wide transverse bands associated with haustral fold thickening), or gaseous distention of the colon. […] A contrast enema study is contraindicated in patients with severe PMC due to the danger of perforation. Common CT findings include wall thickening, low-attenuation mural thickening corresponding to mucosal and submucosal edema, the „accordion sign,” the „target sign” („double halo sign”), pericolonic stranding, and ascites. Familiarity with these imaging characteristics may allow early diagnosis and treatment and prevent progression to more serious pathologic conditions.

• #29 Acute Diarrhea Secondary to Pseudomembranous Colitis in the Adulthood, a Diagnostic Challenge: Case Report | ClinMed International Library | Clinical Medical Reviews and Case Reports |

  https://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-3-114.php

  Clostridium difficile is the main cause of nosocomial diarrhea in the USA with about 450,000 cases annually. […] Diagnostic is based on clinical signs, laboratory findings with toxin A and/or B in stool and colonic pseudomembranes identified by colonoscopy, this last with a sensibility and specificity of 97%. […] Direct stool cytotoxin with tissue culture and anaerobic culture for toxygenic C. Difficile detects B toxin, and have a sensibility of 80 and > 90% respectively, and specificity of 97% but take more than 48 hours. […] The better laboratory test is the quantitative real time polymerase chain reaction (qPCR), detecting the gen for toxin B, with sensibility > 97%, specificity > 97% and results in hours. […] Computed tomography has a sensibility of 70-80% and specificity of 50-80% with four basic criteria for C. Difficile infection diagnosis including: pericolonic wall fat > 4 mm, pericolonic fat thickening, colonic wall modularity and acordion sign (10-20% of severe colitis).

• #30 Pseudomembranous Colitis – The Gastrointestinalatlas – gastrointestinalatlas.com

  https://www.gastrointestinalatlas.com/english/pseudomembranous_colitis.html

  The diagnosis of pseudomembranous colitis by computed tomography. […] The colonic wall has a characteristic appearance on computed tomographic scans of the abdomen: it is diffusely thickened and the ascending or descending colon viewed on end has a donut-like appearance. […] The diagnosis can be a challenge. A patient presenting with toxic megacolon without a history of inflammatory bowel disease should be assumed to have C. difficile colitis until proven otherwise, and medical or surgical therapy administered accordingly. […] The diagnosis is typically made with stool assay for the C.difficile toxin or by stool culture.

• #31 Acute Diarrhea Secondary to Pseudomembranous Colitis in the Adulthood, a Diagnostic Challenge: Case Report | ClinMed International Library | Clinical Medical Reviews and Case Reports |

  https://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-3-114.php

  Clostridium difficile is the main cause of nosocomial diarrhea in the USA with about 450,000 cases annually. […] Diagnostic is based on clinical signs, laboratory findings with toxin A and/or B in stool and colonic pseudomembranes identified by colonoscopy, this last with a sensibility and specificity of 97%. […] Direct stool cytotoxin with tissue culture and anaerobic culture for toxygenic C. Difficile detects B toxin, and have a sensibility of 80 and > 90% respectively, and specificity of 97% but take more than 48 hours. […] The better laboratory test is the quantitative real time polymerase chain reaction (qPCR), detecting the gen for toxin B, with sensibility > 97%, specificity > 97% and results in hours. […] Computed tomography has a sensibility of 70-80% and specificity of 50-80% with four basic criteria for C. Difficile infection diagnosis including: pericolonic wall fat > 4 mm, pericolonic fat thickening, colonic wall modularity and acordion sign (10-20% of severe colitis).

• #32 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  A systematic review of rapid toxin detection kits for both toxins A and B, including EIA and similar testing modalities, reported overall sensitivities and specificities as 7595% and 8398% respectively, when compared to CCNA. […] Given these results, efforts have been made to standardize two- or three-step diagnostic algorithms or further the use of more accurate one-step tests. […] Once diagnosis of CDI is confirmed, it is important to immediately identify responsible antibiotic or chemotherapy agents and discontinue these drugs as soon as possible. […] The next step is to individualize the agent of choice for each case. […] Proposed criteria for severe disease include WBC count greater than 15,000/mm3, elevated creatinine (greater than 1.5 times baseline), advanced age, and/or hypoalbuminemia (serum albumin less than 3.0 g/dl).

• #33 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause. […] Pseudomembranous colitis is most often due to Clostridium difficile infection, but it has a variety of other causes, including other infections, ischemia, medications, and inflammatory mucosal diseases. […] When pseudomembranes are found, one should consider these other causes if tests for C difficile are negative or if anti-C difficile therapy does not produce a response. […] The initial evaluation of a patient with suspected or confirmed pseudomembranous colitis should include a comprehensive medical history with information on recent hospitalizations or procedures, antibiotic use, infections, exposure to sick contacts, recent travel, and medications taken.

• #34 Non-clostridium difficile induced pseudomembranous colitis

  https://www.wjgnet.com/2307-8960/full/v11/i5/979.htm

  Pseudomembranous colitis is severe inflammation of the inner lining of the colon due to anoxia, ischemia, endothelial damage, and toxin production. […] Negative testing for Clostridium difficile or failure to improve on treatment should prompt evaluation for other causes of pseudomembranous colitis. […] Early diagnosis and treatment to prevent progression are important. […] The absence of Clostridium Difficile on testing or failure of response to Clostridium difficile treatment in a patient with pseudomembranes on colonoscopy should encourage physicians to evaluate for other causes of colitis. […] Detailed history taking in patients can provide clues to causative factors and aid in diagnosis. […] Since CDI causes the majority of the cases of pseudomembranous colitis, Initial management includes workup for Clostridial infections.

• #35 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause. […] Pseudomembranous colitis is most often due to Clostridium difficile infection, but it has a variety of other causes, including other infections, ischemia, medications, and inflammatory mucosal diseases. […] When pseudomembranes are found, one should consider these other causes if tests for C difficile are negative or if anti-C difficile therapy does not produce a response. […] The initial evaluation of a patient with suspected or confirmed pseudomembranous colitis should include a comprehensive medical history with information on recent hospitalizations or procedures, antibiotic use, infections, exposure to sick contacts, recent travel, and medications taken.

• #36 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  FMT remains a viable option in patients with multiple relapses of CDI, although further studies are required to establish a more uniform protocol to optimize delivery method, amount of stool used, method and materials used in preparation, and time to repeat FMT. […] Ischemic colitis as a cause of PMC is not a novel concept, but it is often not recognized early in the course of disease, owing to the strong association of pseudomembranes with CDI. […] A randomized, retrospective analysis of 49 biopsies of PMC, 25 with clinical CDI and 24 with clinical IC, found hyalinization and hemorrhage of the lamina propria, atrophic micro-crypts, full-thickness mucosal necrosis and diffuse pseudomembranes (on biopsy sample) to be significantly more associated with ischemia. […] These particular studies highlight the importance of early endoscopy and biopsy when ischemic colitis is suspected.

• #37 Ischemic Colitis Presented as Pseudomembranous Colitis: An Untypical Case from Vietnam

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2022.023

  The microscopic features from colonic specimens were collected during the colonoscopy and surgery to differentiate IC from CDI-associated colitis and other types of colitis. […] In particular, in PMC, the presence of a hyalinized lamina propria was both a sensitive and specific diagnostic for IC. […] In summary, in tropical areas, the coexistence of infectious colitis can aggravate a preexisting ischemic condition. […] Raising physician awareness and vigilance about this disease is critical for establishing an early diagnosis and prompt management, particularly in elderly individuals presenting with abdominal pain, chronic diarrhea, rectal bleeding, and the presence of comorbid disease.

• #38 Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-consensus-on-prevention-diagnosis-treatment-articulo-S2255534X19300295

  In recent decades, Clostridium difficile infection (CDI) has become a worldwide health problem. […] A 2-step diagnostic algorithm was proposed, in which a highly sensitive test, such as glutamate dehydrogenase (GDH), is first utilized, and if positive, confirmed by the detection of toxins through immunoassay or nucleic acid detection tests. […] CDI should be suspected in a patient with diarrhea and a history of antibiotic use and/or immunosuppression, whose diarrhea is community-acquired, or presents after more than 48h of hospitalization, or within 8 weeks after hospital release. […] CDI should be diagnosed only when there is clinical suspicion based on the 2-step algorithm. […] The most useful method for making the diagnosis when there is clinical suspicion of CDI is the 2-step algorithm. A first high-sensitivity test, such as glutamate dehydrogenase (GDH) or nucleic acid amplification tests (NAATs) through the polymerase chain reaction (PCR) technique should be performed.

• #39 Clostridioides difficile-associated disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/230

  Testing should be limited to patients with unexplained, new-onset diarrhea (defined as 3 or more unformed stools in 24 hours). […] Molecular testing alone or as part of a multistep algorithm is recommended depending on local institutional protocols. […] May be evidence of pseudomembranes on sigmoidoscopy or colonoscopy in some patients. […] This topic focuses on the diagnosis and management of C difficile infection in adults only. […] Key diagnostic factors: diarrhea, abdominal pain. […] Diagnostic tests: 1st tests to order: CBC, stool guaiac (fecal occult blood test), stool polymerase chain reaction (PCR), stool immunoassay for glutamate dehydrogenase, stool immunoassay for toxins A and B, abdominal x-ray. […] Tests to consider: cell culture cytotoxicity neutralization assay, CT abdomen, sigmoidoscopy or colonoscopy. […] Emerging tests: stool lactoferrin or calprotectin.

• #40 Pseudomembranous Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/

  Pseudomembranous colitis is an inflammatory condition of the colon characterized by elevated yellow-white plaques that coalesce to form pseudomembranes on the mucosa. […] Because pseudomembranous colitis is often associated with C. difficile infection, stool testing and empiric antibiotic treatment should be initiated when suspected. […] When results of C. difficile testing are negative and symptoms persist despite escalating empiric treatment, early gastroenterology consultation and lower endoscopy would be the next step in the appropriate clinical setting. […] If pseudomembranous colitis is confirmed endoscopically, colonic biopsies should be obtained, as histology can offer helpful clues to the underlying diagnosis. […] The less common non-C. difficile causes of pseudomembranous colitis should be entertained, as a number of etiologies can result in this condition.

• #41 Clostridium difficile – WikEM

  https://wikem.org/wiki/Clostridium_difficile

  Low suspicion Send stool for C. diff toxin assay Positive treat (no further testing indicated) Negative do not treat (no further testing indicated). […] High suspicion Send stool for C. diff toxin assay AND treat empirically Positive treat (no further testing indicated) Negative Consider discussion with ID (false negative tests may occur); eval for other causes of diarrhea. […] Never a need for repeat testing within 7 days of a previous test. […] NO NEED to repeat positive tests as symptoms resolve as a test of cure. […] NO NEED to repeat test soon after initial negative test (more likely to be a false positive test than a true positive test). […] Severe Criteria Leukocytosis with a white blood cell count of 15000 cells/mL. […] Serum creatinine level 1.5 mg/dL. […] Serum lactate levels 2.2 mmol/l.

• #42 Clostridium difficile – WikEM

  https://wikem.org/wiki/Clostridium_difficile

  Low suspicion Send stool for C. diff toxin assay Positive treat (no further testing indicated) Negative do not treat (no further testing indicated). […] High suspicion Send stool for C. diff toxin assay AND treat empirically Positive treat (no further testing indicated) Negative Consider discussion with ID (false negative tests may occur); eval for other causes of diarrhea. […] Never a need for repeat testing within 7 days of a previous test. […] NO NEED to repeat positive tests as symptoms resolve as a test of cure. […] NO NEED to repeat test soon after initial negative test (more likely to be a false positive test than a true positive test). […] Severe Criteria Leukocytosis with a white blood cell count of 15000 cells/mL. […] Serum creatinine level 1.5 mg/dL. […] Serum lactate levels 2.2 mmol/l.

• #43 Clostridioides difficile-associated disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/230

  Testing should be limited to patients with unexplained, new-onset diarrhea (defined as 3 or more unformed stools in 24 hours). […] Molecular testing alone or as part of a multistep algorithm is recommended depending on local institutional protocols. […] May be evidence of pseudomembranes on sigmoidoscopy or colonoscopy in some patients. […] This topic focuses on the diagnosis and management of C difficile infection in adults only. […] Key diagnostic factors: diarrhea, abdominal pain. […] Diagnostic tests: 1st tests to order: CBC, stool guaiac (fecal occult blood test), stool polymerase chain reaction (PCR), stool immunoassay for glutamate dehydrogenase, stool immunoassay for toxins A and B, abdominal x-ray. […] Tests to consider: cell culture cytotoxicity neutralization assay, CT abdomen, sigmoidoscopy or colonoscopy. […] Emerging tests: stool lactoferrin or calprotectin.

• #44 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  As most patients with pseudomembranous colitis have C difficile infection, it should be excluded first. Empiric anti-C difficile treatment is recommended in seriously ill-appearing patients, ideally starting after a stool sample is obtained. […] Diagnosis of C difficile infection requires laboratory demonstration of the toxin or detection of toxigenic organisms. […] Colonoscopy or flexible sigmoidoscopy is the primary means by which pseudomembranous colitis is diagnosed. Lower endoscopy should be pursued as an adjunctive tool when C difficile infection remains strongly suspected despite negative testing, when presumed C difficile infection does not respond to medical therapy, and when non-C difficile diagnoses are considered. […] If pseudomembranes are demonstrated on lower endoscopy, obtaining biopsy samples of normal- and abnormal-appearing mucosa is recommended. Pseudomembranes are suggestive but not diagnostic of C difficile infection, and microscopic evaluation of the mucosa is warranted to explore causes of pseudomembranous colitis not related to C difficile.

• #45 Pseudomembranous Colitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pseudomembranous-colitis

  Testing for C. difficile or its toxins should be performed only on diarrhoeal (unformed) stool, unless ileus due to C. difficile is suspected. Testing of stool from asymptomatic patients is not clinically useful. […] Sigmoidoscopy (or colonoscopy) shows the characteristic pseudomembranous plaque appearance in about half of affected patients. Biopsy may be required to confirm diagnosis. Is not used routinely but is usually performed if rapid diagnosis is needed or in a patient who has ileus (often as part of work-up for other colonic disease). […] Any of the following defines a C. difficile infection case in patients aged 2 years and above and must be reported to UKHSA or the equivalent agency in Northern Ireland, Scotland and Wales: Diarrhoeal stools where the specimen is C. difficile toxin-positive. Toxic megacolon or ileotomy where the specimen is C. difficile toxin-positive. PMC revealed by lower gastrointestinal endoscopy or computerised tomography. Colonic histopathology characteristic of CDI (with or without diarrhoea or toxin detection) on a specimen obtained during endoscopy or colectomy. Faecal specimens collected post-mortem where the specimen is C. difficile toxin-positive or tissue specimens collected post-mortem where pseudomembranous colitis is revealed or colonic histopathology is characteristic of CDI.

• #46 Pseudomembranous colitis: Not always Clostridium difficile | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/5/361

  Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause. […] Pseudomembranous colitis is most often due to Clostridium difficile infection, but it has a variety of other causes, including other infections, ischemia, medications, and inflammatory mucosal diseases. […] When pseudomembranes are found, one should consider these other causes if tests for C difficile are negative or if anti-C difficile therapy does not produce a response. […] The initial evaluation of a patient with suspected or confirmed pseudomembranous colitis should include a comprehensive medical history with information on recent hospitalizations or procedures, antibiotic use, infections, exposure to sick contacts, recent travel, and medications taken.

• #47 Pseudomembranous Colitis – The Gastrointestinalatlas – gastrointestinalatlas.com

  https://www.gastrointestinalatlas.com/english/pseudomembranous_colitis.html

  Pseudomembranous colitis was suspected, starting with oral metronidazole one week later a colonoscopy was performed verifying the clinical suspicion. […] Pseudomembranous colitis is a life-threatening complication of broad spectrum antibiotic therapy caused by Clostridium difficile. […] The diagnosis can be confirmed by the isolation of C. difficile or its toxins in stool. […] The presence of pseudomembranes is virtually diagnostic of pseudomembranous colitis. […] The diagnosis is typically made with stool assay for the C.difficile toxin or by stool culture. […] The frequency of pseudomembranous colitis with potential fatal outcome is underestimated especially in elderly patients. […] Early diagnosis and treatment are essential for a good outcome, and early surgical intervention should be used in patients who are unresponsive to medical therapy.

• #48 Clostridioides difficile colitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/clostridioides-difficile-colitis?lang=us

  Clostridioides difficile colitis, also known as pseudomembranous colitis, is a common cause of antibiotic-associated diarrhea, and increasingly encountered in sick hospitalized patients. […] Definitive diagnosis is achieved by isolating C. difficile toxin from the stool sample. […] Untreated pseudomembranous colitis carries a high mortality from the sequelae of toxic megacolon and perforation.

• #49 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  Yet approximately 20-27% of patients treated for a first episode of C difficile colitis relapse after successfully completing therapy, typically 3 days to 3 weeks after treatment has ended. […] Patients who relapse once are at an even greater risk for further relapses; the relapse rate for patients with 2 or more relapses is 65%. […] The presence of all 3 factors resulted in a 57.1% mortality; in the absence of all 3, the mortality was 0%. […] The investigators concluded that despite awareness and treatment of fulminant C difficile colitis, this condition remains highly lethal.

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