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[Pseudomembranous colitis: report of four cases]
J Solana de Lope1, E Aguilera, J I Vinageras
1Servicio de Gastroenterología, Hospital Español de México, México, D.F.
Background:
Clostridium difficile is the cause of 25-30% of cases of antibiotic-induced diarrhea. Pseudomembranous colitis is the most dramatic manifestation of C. difficile infection.
Methods:
We report four cases of pseudomembranous colitis and review the literature.
Results:
Three of the four patients, were over 80 years old and had other underlying illnesses. Before they developed colitis, all had received cephalosporins (cefuroxime, ceftriaxone, cefalexine) and one of them also clindamycin. All the patients had severe watery bowel movements, with mucus (one patient had also bloody stools), abdominal pain, nausea, vomit and fever. Blood tests disclosed leucocytosis with neutrophilia and increased band neutrophils in all patients. One patient had anasarca and hypo-albuminemia, suggestive of protein losing enteropathy. Sigmoidoscopy showed raised, yellow plaques covering the rectum, sigmoid and descendent colon mucosa. The response to oral metronidazole or vancomycin was good. The response to intravenous metronidazole was good in one patient and poor in another one. Two of our patients had relapses. The response of the relapses to oral metronidazole was good. One patient had two relapses eventually responding to oral metronidazole and Saccharomyces boulardii.
Conclusions:
Pseudomem-branous colitis has high morbility in debilitated elderly patients. Relapses are frequent in these patients. If other studies should confirm it, Saccharomyces boulardii could be useful in the prevention and treatment of relapses of this colitis.
Insights
Pseudomembranous colitis, often caused by Clostridium difficile, frequently affects elderly patients and can lead to relapses. Saccharomyces boulardii may help prevent and treat these recurrences.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Clostridium difficile infection causes 25-30% of antibiotic-associated diarrhea.
- Pseudomembranous colitis is a severe manifestation of C. difficile infection.
Observation:
- Four cases of pseudomembranous colitis in elderly patients receiving cephalosporins and/or clindamycin were observed.
- Patients presented with severe watery diarrhea, abdominal pain, nausea, vomiting, and fever.
- Sigmoidoscopy revealed characteristic raised, yellow plaques on the colonic mucosa.
Findings:
- Elderly, debilitated patients with pseudomembranous colitis have high morbidity and frequent relapses.
- Oral metronidazole and vancomycin showed good initial response.
- Saccharomyces boulardii showed promise in managing relapses.
Implications:
- Pseudomembranous colitis poses significant risks for the elderly and debilitated.
- Effective management of C. difficile infection relapses is crucial.
- Saccharomyces boulardii warrants further investigation for its role in preventing and treating recurrent colitis.