Facing Clostridioides difficile infection in a resource - Limiting setting

An HIV- positive patient with Kaposi's sarcoma and undergoing chemotherapy, had been on antibiotic therapy for around 14 days with ceftriaxone and imipenem. He was admitted with a 5-day evolution of watery diarrhea followed by rectorrhagia. His CD4 level was 226 cells/ mm3. Colonoscopy was done with visualization of scattered pseudomembranes separated by areas of healthy mucosa, covering the entire intestine. Due to low resources the diagnosis of Clostridioides difficile (C.D) infection was proposed and treatment with oral metronidazole were made. Diarrhea improved after 5 days of treatment. Endoscopic findings were suggestive of CD infection. Other less common causes of pseudomembranous colitis, were unlikely according to clinical history. The probability of CD infection increased due the combination of risk factors such as HIV immunosuppression, chemotherapy, antibiotic therapy and endoscopic findings. The lack of Polymerase chain reaction, enzyme immunoassay for CD glutamate dehydrogenase antigen and toxins A and B was a diagnosis limitation. All these diagnostic tools were not available in the hospital. Oral vancomycin is the treatment of choice, however it was not available in the hospital, so treatment with oral metronidazole was made and the previous antibiotics used were discontinued. The patient progressed with clinical improvement.