[Clostridium difficile-induced enterocolitis: pathogenesis, clinical course, epidemiology and laboratory diagnosis]

Clostridium difficile-induced enterocolitis almost exclusively occurs associated with antibiotic exposure. The organisms produce several exotoxins of which toxins A (enterotoxin) and B (cytotoxin) are of primary importance. It is assumed that preceding antibiotic therapy creates an ecological niche allowing massive proliferation of the organisms and production of their toxins. The clinical course varies from mild diarrhoea to severe pseudomembranous colitis. Patients over 40 years of age are primarily at risk, especially when suffering from severe underlying disease or abdominal surgery. The therapy includes discontinuation of the actual antibiotic treatment, substitution of fluid and electrolytes, and causal therapy with vancomycin. In contrast to adult persons 25-60% of healthy infants excrete C. difficile and/or its toxins with their faeces. Exogenous infection by direct contact or contaminated tools and equipment is common in the hospital. The diagnosis includes: antibiotic history of the patient, clinical diagnosis (endoscopy), isolation of the organisms and demonstration of toxin production, detection of C. difficile toxins in the patient's stool. For isolation and identification appropriate methods are available. Cell culture tests for toxin detection are reliable but require experienced personnel. Immunological methods (ELISA, latex agglutination test) have been described but are not yet commercially available.