Clostridium difficule colitis

Royal Adelaide Hospital, Tarndarnya, South Australia, Australia
Australian and New Zealand journal of medicine 11/1984; 14(5):606-10. DOI: 10.1111/j.1445-5994.1984.tb05009.x
Source: PubMed


We reviewed all rectal biopsies performed on patients with proven C. difficile infection between 1977 and 1982 (36 patients). All patients were symptomatic and all had received antibiotic treatment recently, the commonest antibiotic treatment being ampicillin or amoxycillin. There was poor correlation between the histological appearances and the severity of symptoms.
A range of histological appearances was observed: normal (8%), congestion and edema (8%), nonspecific colitis (3%), infective colitis (28%) and pseudomembranous colitis (53%) (PMC). Most cases of PMC showed ‘early’ features, involving predominantly the surface epithelium, where attenuation and inflammation, intraepithelial microabscesses, and small eruptive lesions were seen. Recognition of these features, in the context of an acute infective-type colitis, may lead to early diagnosis of C. difficile colitis.

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    ABSTRACT: The clinical courses of 114 patients with positive Clostridium difficile cultures or toxin assays performed between 1981 and 1984 were reviewed to determine the relationship between outcome of treatment and quantitative bacteriologic test results. C. difficile culture was positive in 60 of 91 patients while toxin assay was positive in 99 of 114. One third of the patients received supportive therapy only, and 30 percent of these failed to resolve their symptoms. Ninety-one percent of the patients treated with vancomycin resolved, although 11 percent of these suffered relapse. Patients with high toxin titers receiving supportive treatment alone showed a lower response rate than patients with lower toxin titers. This effect was not seen in patients treated with specific therapy nor with different culture quantities. C. difficile colitis has a range of clinical and microbiologic manifestations. Endoscopy is not always diagnostic, both culture and toxin assays are needed for diagnosis, and toxin titer may help in planning treatment. Patients with low toxin titers may be treated supportively, but high toxin titers are an indication for specific therapy. Quantitative culture results have little diagnostic or therapeutic value.
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