A 26 year old male suffered from profuse watery stools,cramping abdominal pain and fever after 5 days after starting a Penicilllin group of Antibiotic.
Endoscopic picture of the colon is shown in the image.Regarding this condition,all of the following statements are true ,except:
A. It is caused by Clostridium Difficile.
B. Vancomycin may be used in the treatment
C. Blood in stools is a common feature
D. Caused by Enterotoxin and Cytotoxin
Ans:C. Blood in Stools is a common feature.
The patient is suffering from Pseudomembranous Colitis.Yellowish plaque-like Lesions seen in Colon.
- It is an inflammatory disease of the colon.
- In mild cases may appear as minimal inflammation or edema of the colonic mucosa.
- In more severe cases, the mucosa often is covered with loosely adherent nodular or diffuse exudates.
- These raised exudative plaques are 2-5 mm in size. Coalescence of these plaques generates an endoscopic appearance of yellowish pseudomembranes lining the colonic mucosa.
- The antibiotic-induced change in the balance of normal gut flora allows overgrowth of Clostridium difficile.
- The organism is a normal commensal of gut
- Clindamycin, lincomycin, ampicillin, and cephalosporin have been implicated in most of the reported cases.
- Colitis results from the bacterial production of large amount of toxins. The most important toxins are toxin A (enterotoxin) and toxin B (cytotoxin).
Symptoms include the following:
- Profuse, watery or mucoid, green, foul-smelling, liquid stool may contain small amounts of blood
- Cramping abdominal pain may occur
- The patient’s temperature may reach 103-105°F.
- Endoscopic visualization of the pseudomembranes shows classic pseudomembranes visible as raised yellow plaques, which range from 2-10 mm in diameter and are scattered over the colorectal mucosa.. When the pseudomembranes are manipulated, ulcerated mucosa is uncovered.
- Direct detection of toxins in the stool.
- Immediate cessation of the offending antimicrobial agent.
- Maintaining fluid and electrolyte intake.
- Oral treatment with antimicrobial agents effective against C difficile:Metronidazole,Vancomycin
- Reintroduction of normal flora by ingestion of probiotics
- Fulminant colitis, characterized by septicemia and/or evidence of perforation requires emergent laparotomy. A total abdominal colectomy with end ileostomy may be lifesaving