Clostridium difficile infection: clinical spectrum and approach to management.
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Date
2011-11
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Abstract
Clostridium difficile is recognized globally as an important enteric pathogen associated with considerable morbidity and mortality due to the widespread use of antibiotics. The overall incidence of C. difficile-associated
diarrhea (CDAD) is increasing due to the emergence of a
hypervirulent strain known as NAP1/BI/027. C. difficile
acquisition by a host can result in a varied spectrum of
clinical conditions inclusive of both colonic and extracolonic
manifestations. Repeated occurrence of CDAD,
manifested by the sudden re-appearance of diarrhea and
other symptoms usually within a week of stopping
treatment, makes it a difficult clinical problem. C. difficile
infection has also been reported to be involved in
exacerbation of inflammatory bowel diseases. The first step
in the management of a suspected CDAD case is the
withdrawal of the offending agent and changing the
antibiotic regimens. Antimicrobial therapy directed against
C. difficile viz. metronidazole for mild cases and vancomycin
for severe cases is needed. For patients with ileus,
oral vancomycin with simultaneous intravenous (IV)
metronidazole and intracolonic vancomycin may be given.
Depending on the severity of disease, the further line of
management may include surgery, IV immunoglobulin
treatment or high dose of vancomycin. Adjunctive measures
used for CDAD are probiotics and prebiotics,
fecotherapy, adsorbents and immunoglobulin therapy.
Among the new therapies fidaxomicin has recently been approved by the American Food and Drugs Administration for treatment of CDAD.
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Keywords
Clinical spectrum, Clostridium difficile, Diagnosis, Histopathological changes, Management
Citation
Vaishnavi Chetana. Clostridium difficile infection: clinical spectrum and approach to management. Indian Journal of Gastroenterology. 2011 Nov-Dec; 30(6): 245-254.