![]() ![]() Any patient with fulminant colitis or a worsening condition should be discussed urgently with colorectal surgery and critical care as appropriate. Managing acute CDI depends on severity, allergy status and underlying co-morbidities. This appears as numerous yellow plaques scattered over the mucosa due to toxin-induced ulcer formation that promotes inflammation.Īntimicrobial agents and excellent infection control measures are essential in every case. NOTE: endoscopic examination may reveal the classical pseudomembranous colitis associated with CDI. Required if alternative diagnosis suspected. Endoscopy (flexible sigmoidoscopy): avoided if typical clinical presentation, confirmed CDI on stool testing and/or response to treatment.CT abdomen and pelvis: indicated for clinical manifestations of severe disease, fulminant colitis or suspected complications.Plain film abdominal radiograph: assessment for mucosal wall thickening and bowel dilatation.Stool samples: CD testing, MC&S, OCP, virology.Investigations are important to determine both severity and complications associated with CDI. Therefore, an isolated positive NAAT test should always be interpreted with the clinical context.ĭepending on resources available locally, there are a number of different testing algorithms that can be employed. The main issue with NAAT testing is the inability to distinguish between asymptomatic carriage of a toxigenic strain and active CDI without a positive EIA test. difficile toxin A & B): detects toxin produced by toxigenic strains. Unable to distinguish between toxigenic and nontoxigenic strains. difficile enzyme glutamate dehydrogenase): detects enzyme produced by all strains. NAAT (PCR-based testing): detects one or more genes specific to the toxigenic strain.The main tests include nucleic acid amplification testing (NAAT) and enzyme immunoassay (EIA). To confirm CDI, stool testing is required to demonstrate CD toxin(s) or the toxigenic strain of CD. Fulminant: hypotension and shock, partial or complete ileus, toxic mega colon, CT evidence of severe disease.ĬDI is suspected clinically by the presence of an acute diarrhoeal illness and confirmed with stool testing.>133 umol/L), fevers > 38.5º, evidence severe colitis (abdominal or radiographic signs), bowel motions less reliable. Raised WCC but 15 x10 9/L, rising creatinine (e.g. Mild: diarrhoea without systemic features.SeverityĬDI should be graded according to the severity of the colitis, which is based on clinical features, biochemical tests and imaging (if indicated - severe disease). Patients with more severe disease may have evidence of haemodynamic instability (tachycardia and hypotension) and severe systemic symptoms (low GCS, poor urine output, peritonitis). Diarrhoea is classically watery, but a small amount of blood may be seen. Other features of CDI include abdominal pain, anorexia, nausea and fever. The principle symptom associated with CDI is diarrhoea.ĭiarrhoea is defined as the passage ≥3 loose bowel motions within 24 hours. ![]()
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