PSEUDOMEMBRANOUS COLITIS

Question 1

what is pseudomembranous colitis AKA?

Answer 1

clostridium difficile- induced diarrhea

Question 2

what is pseudomembranous colitis?

Answer 2

inflammation of colonic mucosa caused by toxins released by bacterium Clostridioides difficile, previouslt known s Clostridium difficile

Question 3

what are the majority of cases of pseudomembranous colitis d/t?

Answer 3

majority are hospital acquired

community acquired are increasing- 40%

Question 4

what kind of bacteria is clostridioides difficile?

Answer 4

gram- positive, obligate anaerobe

obligate= needs no O2

Question 5

what 2 forms does clostridioides difficile exist in?

Answer 5

1. spore from
2. vegetative from

Question 6

what is the spore form of clostridioides difficile?

Answer 6

outside the colon; resistant to heat, acid, and abx

Question 7

what is the vegetative form of clostridioides difficile?

Answer 7

in the intestine

Question 8

how are spores of clostridioides difficile transmitted?

Answer 8

via fecal-oral route

Question 9

is clostridioides difficile contagious?

Answer 9

HIGHLY

Question 10

what id the #1 RF of clostridioides difficile?

Answer 10

recent abx use
- clinda
- ceph 3rd and 4th gen -> cefipime, cefdinir, ceftriaxone
- fluoroquinolones ->floxacin

Question 11

what are the other RF of clostridioides difficile?

Answer 11

prior episodes of c. diff
advanced age >65
hospitalization
nursing home resident
severe medical comorbidities
use of PPI & H2 Blockers (gastric-acid suppression)
chemo

Question 12

what is the pathogenesis of clostridioides difficile?

Answer 12

disruption of normal flora using abx leads to overgrowth of c. diff
intestinal damage is d/t toxin release : enterotoxin A and cytotoxin B

Question 13

what is the epidemiology of clostridioides difficile?

Answer 13

5% healthy adults colonized
8-10% hospitalized adults colonized -> i think this means they have it w/no sx

Question 14

what is enterotoxin A?

Answer 14

targets brush border enzymes that leads to altered fluid secretion (watery diarrhea)

Question 15

what is cYtotoxin b?

Answer 15

10x more potent
disrupts cytoskeleton of enterocytes leading to apoptosis (pseudomembranous colitis) -> inflammation

Question 16

what is the clinical presentation of non-fulminant colitis?

Answer 16

1. foul smelling, watery diarrhea that is rarely bloody
2. cramping abdominal pain
3. Fever
4. N/V Rare

Question 17

what is the clinical presentation of fulminant colitis?

Answer 17

1. significant systemic toxic effects
   - acute abd pain w/ distention
   - signs of sepsis
   
   1. hypotension
   2. tachycardia
   3. change in mental status
2. toxic megacolon: large bowel dilation >7 cm; cecum >12 cm
3. colonic perforation, ischemia, and necrosis

Question 18

when should c. diff be suspected?

Answer 18

suspect c. diff in any patient who has developed diarrhea within 2 months of abx use or 72-hrs of hospital admission

Question 19

when should stool testing be done?

Answer 19

only in sx patients

Question 20

what are the 2 dx tests for c. diff?

Answer 20

1. enzyme immunoassay (EIA) for c. diff antigen
2. EIA for c. diff toxins A and B
3. nucleic acid amplification test using polymerase chain rxn (PCR) for c. diff toxin gene

Question 21

what is entailed in the enzyme immunoassay (EIA) for c. diff antigen?

Answer 21

looking for glutamate dehydrogenase antigen (GDH)
rapid test thats widely available
+ results confirms presence of organism, but not if it is toxigenic

Question 22

what happens after successful tx of c. diff in regards to rhe nucleic acid amp PCR test?

Answer 22

that test can remain positive after successful tx

Question 23

what will blood testing show in someone w/ C. diff?

Answer 23

leukocytosis (often >20k)
significant bandemia w/ fulminant colitis
hypokalemia d/t diarrhea

Question 24

what will an abd x-ray show in c. diff?

Answer 24

can show colonic dilation
free air in case of perforation

Question 25

what will CT show in c. diff?

Answer 25

can detect colitis, ileus, or toxic megacolon
can reveal complications such as perf

Question 26

what is the management of c diff?

Answer 26

1. iv fluid resuscitation
2. electrolyte correction
3. d/c offending abx if possible

Question 27

what is the pharmacotherapy for non-fulminant c. diff?

Answer 27

1st line: vanco
250-500 mg PO every 6 hrs for 10 days
can be given by enema in cases of ileus
2. fidaxomicin
alternative option
200 mg PO every 12 hours for 10 days
decreases risk of recurrence

Question 28

what is the pharmacotherapy tx for fulminant dz?

Answer 28

same as non-fulminant, just ass IV metronidazole if worsening

Question 29

what do you do in first recurrence of c. diff?

Answer 29

treat w/ same regimen as primary episode

Question 30

what do you do with multiple recurrences of c. diff?

Answer 30

• oral vanco or oral fidaxomicin to be dosed by ID
• FMT

Question 31

how do you prevent hosptial transmission of c. diff?

Answer 31

use gloves
isolation of patient w/ designated bathroom facilities
use of hypochlorite (bleach) solution to decontaminate rooms of pts
hand washing w/ soap (ALCOHOL- CONTAINING HAND GELS ARE NOT SPORICIDAL)
restricting the use of specific abx:
- clinda
- 3rd and 4th gen cephalosporins

Question 32

what is FMT?

Answer 32

fecal metter transplant
donor feces is introduced via NG tube, enema, or colonoscopy
resolution as the result of restoring normal fecal microbiota