Clinical case of severe pseudomembranous colitis caused by pathogenic infection Clostridium Difficile

Abstract

Objective. Literature review of pseudomembranous colitis caused by pathogenic Clostridium difficile infection and description of a clinical case of pseudomembranous colitis.

Materials and methods. A clinical case of a patient with pseudomembranous colitis is presented.

Results. In a patient with multiple injuries and grade II shock, whose condition required numerous surgical interventions and intensive antibiotic therapy, after the completion of antibiotic therapy there appeared signs of pseudomembranous colitis – loose stools (up to 5 times a day), fever up to 39 ° C, signs of endogenous intoxication, A C. difficile toxin was found in faeces. Antibiotic-associated colitis was diagnosed; metronidazole 500 mg 3 times a day, activated charcoal, infusion therapy were prescribed – on the 12th day, the therapy led to recovery. During the subsequent reconstructive operation, lincomycin 600 mg was administered by infusion for prophylactic purposes, after which, 6 hours later, the patient developed a clinical picture of severe pseudomembranous colitis. A laboratory study of faeces again revealed toxin A C. difficile. The recurrence of the disease required a long-term treatment in the gastroenterology department.

Conclusions. Pseudomembranous colitis is certainly a complex pathology that is a serious hospital-acquired infection. Accurate diagnosis requires correct assessment of the patient’s condition through clinical and laboratory diagnostic methods, correct prescription of conservative treatment and choice of surgical intervention tactics.

Keywords

colitis / colon / dysbacteriosis / infection

References

[1] Zakharova N.V., Phil T.S. Microbiological and clinical features of Clostridium difficile infection. Infectious diseases 2015; 3: 81–86.

[2] Захарова Н.В., Филь Т.С. Микробиологические и клинические особенности инфекции Clostridium difficile. Инфекционные болезни 2015; 3: 81–86.

[3] Sheptulin A.A. Refractory and recurrent forms of colitis associated with Clostridium difficile. Russian Journal of Gastroenterology, Hepatology, Coloproctology 2011; 2: 50–53.

[4] Шептулин А.А. Рефрактерные и рецидивирующие формы колита, ассоциированного с Clostridium difficile. Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2011; 2: 50–53.

[5] Nemtsov L.M. Pseudo-membranous colitis as a multidisciplinary problem. Bulletin VGMU 2014; 3.

[6] Немцов Л.М. Псевдомембранозный колит как мультидисциплинарная проблема. Вестник ВГМУ 2014; 3.

[7] Ivashkin V.T., Yushchuk N.D., Maev I.V., Lapina T.L., Poluektova E.A., Shifrin O.S., Tertychny A.S., Trukhmanov A.S., Sheptulin A.A., Baranskaya E.K., Lyashenko O.S., Ivashkin K.V. Recommendations of the Russian Gastroenterology Association for Diagnosis and Treatment of Clostridium difficile-associated disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology 2016; 5: 56–65.

[8] Ивашкин В.Т., Ющук Н.Д., Маев И.В., Лапина Т.Л., Полуэктова Е.А., Шифрин О.С., Тертычный А.С., Трухманов А.С., Шептулин А.А., Баранская Е.К., Ляшенко О.С., Ивашкин К.В. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению Clostridium difficile-ассоциированной болезни. Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2016; 5: 56–65.

RIGHTS & PERMISSIONS

Styazhkina S.N., Kapustin B.B., Malchikov A.Y., Valinurov A.A., Gabdrakhmanov D.I., Borisova E.A., Grichik A.S.