Pseudomembranous colitis
Pseudomembranous colitis is a disease caused by the spore-forming anaerobic microbe Clostridium difficile. The leading pathogenicity factors of Clostridium difficile are toxic substances produced by the bacterium: toxin A and toxin B, which cause a violation of the barrier function of the intestinal mucosa due to damage to epithelial cells and activation of fluid secretion into the intestinal lumen. Toxin B is 1000 times more powerful cytotoxin than toxin A, but its cytotoxic effect is due to a violation of the polymerization of intracellular filaments of actin.
Risk factors forClostridium difficile-related colitis include: age over 65, kidney failure, chronic obstructive pulmonary disease, malignant neoplasms, H2histamine receptor blockers and proton pump inhibitors, admission of patients from other hospitals, and the patient's stay in the intensive care unit.
Widespread and not always justified use of antibiotics often leads to the development of complications — allergic and toxic reactions, dysbiosis, diarrhea. Doctors often encounter diarrhea that develops in patients with or after the use of antibiotics. Antibiotic-associated diarrhea is one of the complications that occurs in 5-25 % of patients taking antibiotics. Clostridium difficile is the causative agent of the most severe forms of this complication - pseudomembranous colitis, up to the development of fulminant colitis and toxic dilatation of the colon.
The clinical picture of pseudomembranous colitis is dominated by diarrheal syndrome, which in some cases is the only manifestation of the disease. In some cases, the manifestation of the disease may begin with a fever.
In fact, simultaneously with the diarrheal syndrome, patients have abdominal pain of varying intensity, mainly of a spastic nature, which increases with palpation of the abdomen. Most often, the pain does not have a clear localization and is determined along the course of the intestine. In most cases, patients with pseudomembranous colitis have fever. Characteristic of pseudomembranous colitis is a fairly pronounced peripheral blood leukocytosis.
Given the long-term and persistent nature of diarrhea, patients with pseudomembranous colitis often have severe violations of water-salt metabolism (hypokalemia, hypocalcemia), metabolic disorders, the development of edema up to anasarca, and a decrease in blood pressure. This disease can be complicated by the development of toxic megacolon, perforation of the colon with the development of peritonitis, infectious and toxic shock.
Diagnostics
Diagnosis of pseudomembranous colitis is based on the detection of Clostridium difficile toxins in the feces. Endoscopic methods have not lost their diagnostic value. For sigmoidoscopy and colonoscopy note diffuse hyperemia and swelling of the intestinal mucosa with a thickening of the intestinal wall, on the surface there are characteristic fibrinous plaques of yellowish-white color in diameter from 2 mm to 2 cm or more covering ulcers of the intestinal mucosa. These plaques can merge to form pseudomembranous fields. The small intestine can also be involved in the pathological process.
