Pseudomembranous Colitis

Inflammation of the large intestine (colon) is a condition called pseudomembranous colitis. This inflammation is usually caused by an excessive amount of a bacteria called Clostridioides difficile (often shortened to C. diff). Sometimes, this condition is also called antibiotic-associated colitis or C. diff colitis.

A rise in C. diff bacteria is frequently linked to a recent stay in a hospital or having taken antibiotics. People over 65 are more likely to get a C. diff infection.

Pseudomembranous colitis is a condition that can cause some unpleasant digestive problems. It's often linked to taking antibiotics.

The main signs of this condition usually show up in the form of:

• Loose, watery stools: This is a frequent and noticeable symptom.
• Belly pain: You might feel cramping, pain, or tenderness in your stomach area.
• Feeling feverish: A slight increase in body temperature is common.
• Changes in your stool: Sometimes the stool may contain pus or mucus.
• Nausea: You might feel queasy or sick to your stomach.
• Dehydration: This can happen because of the frequent diarrhea. Dehydration means your body doesn't have enough fluids, and you might feel dizzy or lightheaded.

These symptoms can appear as quickly as one or two days after you start taking antibiotics, or even several months later, possibly even after you've finished the antibiotic course. It's important to remember that not everyone who takes antibiotics will develop this condition.

If you've been taking antibiotics recently, or are currently taking them, and get diarrhea, talk to your doctor, even if the diarrhea isn't very bad. It's important to check in with your doctor if you have diarrhea that's severe, comes with a fever, painful stomach cramps, or if you see blood or pus in your stool.

Your gut naturally has a community of bacteria that helps keep you healthy. These bacteria usually balance each other out. But antibiotics and other medications can disrupt this balance. Pseudomembranous colitis happens when a type of bacteria, often called C. difficile, grows too quickly and overwhelms the other bacteria. This overgrowth produces harmful toxins that can irritate and damage the lining of the colon (large intestine).

Many different antibiotics can contribute to this problem, but some are more commonly associated with it than others. These include:

• Fluoroquinolones: These antibiotics are used to treat bacterial infections. Examples include ciprofloxacin (often called Cipro) and levofloxacin.
• Penicillins: Penicillins are another type of antibiotic. Common examples include amoxicillin and ampicillin.
• Clindamycin: This antibiotic is used to treat certain infections.
• Cephalosporins: Cephalosporins are a group of antibiotics, and cefixime (often called Suprax) is one example.

Essentially, these antibiotics can temporarily disrupt the normal balance of bacteria in your gut, allowing C. difficile to multiply and produce harmful toxins. This can lead to inflammation and damage in the colon.

Pseudomembranous colitis is a condition where inflammation develops in the colon. Several things can make you more likely to get this.

• Antibiotics: Taking antibiotics can disrupt the healthy bacteria in your gut. This imbalance can sometimes lead to the growth of harmful bacteria, like Clostridium difficile (C. diff), which can cause pseudomembranous colitis. It's important to note that not everyone who takes antibiotics gets this condition.

• Hospital or nursing home stays: Being in a hospital or nursing home increases your risk because these settings can expose you to more germs and increase the chance of infection with C. diff. Shared environments and close contact with others can play a role.

• Age: As you get older, especially if you're over 65, your immune system may not function as well. A weaker immune system can make it harder for your body to fight off infections, including C. diff.

• Weakened immune system: If you have a condition that weakens your immune system, such as certain diseases or treatments, you're more vulnerable to infections. This includes conditions like HIV/AIDS, cancer treatments, or autoimmune diseases.

• Colon problems: Having a condition that affects your colon, like inflammatory bowel disease (IBD) or colorectal cancer, can make you more susceptible to C. diff. These conditions can already be causing inflammation or damage to the colon, making it easier for harmful bacteria to take hold.

• Intestinal surgery: Surgery on your intestines can sometimes disrupt the normal balance of bacteria in your gut, increasing your risk of infection. This disruption can create an environment that encourages the growth of C. diff.

• Cancer treatment: Some cancer treatments, like chemotherapy, can weaken your immune system, making you more prone to infections like pseudomembranous colitis. The treatments can also affect the gut's microbiome.

It's important to remember that these factors increase your risk, but they don't guarantee you'll develop the condition. If you have concerns, talk to your doctor.

Pseudomembranous colitis is often treatable, but it can still be serious, even with quick diagnosis and treatment. Here are some of the potential problems:

• Dehydration: Frequent and severe diarrhea can cause you to lose a lot of water and essential salts (electrolytes). This can make your body struggle to function properly, and your blood pressure can drop dangerously low. Not having enough fluids can make you feel dizzy, weak, and confused.

• Kidney Problems: Severe dehydration can happen so fast that your kidneys can't keep up. This can lead to kidney failure, which is a serious condition that requires careful medical attention.

• Toxic Megacolon: In some rare cases, the large intestine (colon) can't move stool and gas normally. This causes the colon to swell significantly. Untreated, this can lead to a rupture (a tear) in the colon. A ruptured colon can release harmful bacteria into your abdomen, causing a potentially life-threatening infection. Surgery is often needed to fix this problem, and it could be fatal.

• Bowel Perforation: A hole in your large intestine (bowel perforation) is rare but can happen if the lining of the colon is severely damaged, or if toxic megacolon develops. A hole in the bowel can spill bacteria into your abdominal cavity, causing a dangerous infection called peritonitis. Peritonitis needs immediate medical attention and can be deadly.

• Death: Even if the infection seems mild at first, C. difficile (the bacteria that causes pseudomembranous colitis) can quickly become serious and life-threatening if treatment isn't started right away.

It's also important to know that pseudomembranous colitis can sometimes come back, even after treatment seems successful. This can happen a few days or even weeks later.

Hospitals and healthcare centers take precautions to stop the spread of Clostridium difficile (C. difficile). If you have a loved one in a hospital or nursing home, it's good to remind staff about these precautions.

To prevent the spread, several important steps are taken:

• Frequent handwashing: Healthcare workers must wash their hands thoroughly with soap and warm water before and after caring for each patient. This is especially important during a C. difficile outbreak, because regular hand sanitizer doesn't kill the C. difficile germs as well as soap and water. Visitors should also wash their hands with soap and water before and after entering or leaving a patient's room, and after using the restroom.

• Keeping people separate: People with C. difficile often have a private room, or share a room only with other people who also have C. difficile. Hospital staff and visitors should wear disposable gloves and gowns while in the room until at least 48 hours after the diarrhea stops. This is called "contact precautions." This helps to stop the spread of the infection from person to person.

• Deep cleaning: All surfaces in the area must be cleaned very thoroughly with a disinfectant that contains chlorine bleach. This kills the C. difficile germs.

• Using antibiotics wisely: Doctors should only prescribe antibiotics when absolutely necessary. Sometimes people get antibiotics for illnesses that don't need them. It's a good idea to wait and see if an illness gets better on its own. If an antibiotic is needed, ask your doctor for a narrow-spectrum antibiotic, and for the shortest possible course of treatment. This helps to prevent the development of antibiotic resistance, which can make infections harder to treat.

By following these precautions, hospitals and healthcare facilities can help protect patients from C. difficile. If you notice something that isn't right with these precautions, don't hesitate to speak up. Your loved one's well-being depends on it.

Diagnosing pseudomembranous colitis and checking for problems often involves these steps:

• Stool test: Doctors use various tests on a stool sample to look for Clostridioides difficile (C. diff), the bacteria that often causes this condition. This bacteria can lead to inflammation and irritation in the colon.

• Blood test: A blood test can check your white blood cell count. A higher-than-normal white blood cell count (leukocytosis) might suggest an infection, like C. diff, especially if you also have diarrhea. This is because your body's immune system is fighting the infection.

• Colon examination: A colonoscopy or sigmoidoscopy involves a thin, flexible tube with a camera at the end. The doctor uses this to look inside your colon. They are checking for signs of pseudomembranous colitis. These are small, raised, yellowish patches (lesions) and any swelling. A colonoscopy examines the entire colon, while a sigmoidoscopy focuses on the lower part.

• Imaging tests: If your symptoms are severe, your doctor might order an X-ray or CT scan of your abdomen. These tests help look for potential complications of pseudomembranous colitis, such as toxic megacolon (where the colon becomes abnormally large and swollen) or a ruptured colon. These serious complications need immediate medical attention.

Treating C. difficile Infection (Pseudomembranous Colitis)

C. difficile is a bacteria that can cause inflammation in the colon, leading to a condition called pseudomembranous colitis. This can cause severe diarrhea, abdominal pain, and other uncomfortable symptoms. Treatment strategies focus on restoring a healthy balance of bacteria in the colon and addressing the infection.

Antibiotic Treatment:

A common first step is starting antibiotics that are effective against C. difficile. Doctors often choose vancomycin or fidaxomicin (Dificid). These are usually taken by mouth, but can also be given intravenously (directly into a vein) or through a tube inserted into your nose and down to your stomach (nasogastric tube). If these aren't available or you can't tolerate them, metronidazole (Flagyl) might be used. For serious cases, a combination of medications, like vancomycin by mouth and metronidazole intravenously, or a vancomycin enema, might be needed. These antibiotics help kill the harmful C. difficile bacteria, allowing healthy bacteria to repopulate the colon and restore balance. Sometimes, a second or even a third round of antibiotics is necessary, and treatment may need to last longer than usual.

Addressing the Underlying Cause:

If possible, doctors will try to stop any medications that might be contributing to the infection. Sometimes, just stopping the medication is enough to resolve the problem.

Severe Cases and Surgery:

In severe cases of C. difficile, where organ failure, a ruptured colon, or inflammation of the abdominal lining (peritonitis) are present, surgery might be required. Historically, this often involved removing part or all of the colon (total or subtotal colectomy). However, newer, less invasive procedures like a loop ileostomy and colonic lavage, where a loop of the colon is cleaned, are becoming more common and have shown promising results.

Fecal Microbial Transplantation (FMT):

If the infection is severe or keeps coming back, a fecal microbial transplantation (FMT) might be recommended. This involves transferring healthy stool from a donor to reestablish a healthy balance of bacteria in the colon. The stool can be given in different ways, including through a nasogastric tube, directly into the colon, or in a capsule. This is sometimes used after a course of antibiotics.

Bezlotoxumab (Zinplava):

The FDA has approved a medication called bezlotoxumab to help prevent future C. difficile infections. This medication, used along with antibiotics, has shown to significantly reduce the risk of recurrence. However, the cost of this treatment can be a factor.

Recovery:

Symptoms usually start to improve within a few days of starting treatment. However, due to the development of more aggressive C. difficile strains, treating the infection and preventing recurrence has become more challenging. Each time the infection recurs, the chance of further recurrences increases. Your doctor will work with you to develop a personalized treatment plan.

Some studies show that taking probiotics, which are good bacteria and yeasts, might help prevent a harmful infection called C. difficile. However, more research is needed to see if they can help with repeat infections. Probiotics are generally safe and are available in pill or liquid form without a doctor's order.

If you have C. difficile and are experiencing diarrhea and losing fluids (dehydration), it's important to stay well-hydrated.

• Drink lots of fluids: Plain water is a good choice, but drinks with added salts like sodium and potassium (electrolytes) can also help. These include sports drinks (like Gatorade or Powerade), oral rehydration solutions (like Pedialyte or Ceralyte), clear broths, and some fruit juices. Avoid sugary drinks, alcohol, and drinks with caffeine (like coffee, tea, and cola). These can make your symptoms worse.

• Avoid foods that trigger your symptoms: Spicy, greasy, fried foods, and anything else that makes your diarrhea or other symptoms worse should be avoided.