Pseudomembranous colitis

Symptoms of pseudomembranous colitis may include:

• Watery diarrhea.
• Pus, mucus or blood in the stool.
• Severe belly cramps, pain or tenderness.
• Fever.
• Nausea.
• Thirst, dry mouth and other symptoms of low body fluids, called dehydration.

The beginning of symptoms is often related to recent antibiotic treatment. Symptoms may start during or after treatment. Most often, symptoms appear within two weeks of antibiotic treatment and rarely, after 10 weeks.

If you are currently taking or have recently taken antibiotics and you develop diarrhea, contact your healthcare professional. Also, see your healthcare professional anytime you have severe diarrhea with a fever, painful stomach cramps, or blood or pus in your stool.

C. difficile bacterium

The most common cause of pseudomembranous colitis is the bacterium Clostridioides difficile, also called C. diff. In some cases, a C. diff infection is mild to moderate. Pseudomembranous colitis is a sign of more serious disease.

C. diff bacteria enter the body through the mouth. When they reach the part of the large intestine, called the colon, the bacteria can release toxic spores that damage tissues. These toxins destroy cells, disrupt colon function and cause watery diarrhea.

Outside the colon, the bacteria aren't active. They can live for a long time in places such as:

• Human or animal feces.
• Surfaces in a room.
• Unwashed hands.
• Soil.
• Water.
• Food.

When bacteria once again find their way into a person's digestive system, they become active again and cause infection. Because C. diff can survive outside the body, the bacteria spread easily.

The role of antibiotics

Typically, the colon has many types of bacteria that play a role in digestion. They generally keep each other in check, and the colon has other means to protect from possibly harmful bacteria.

Antibiotics can kill the good bacteria and change other factors that protect the colon. If a person already has C. diff or is newly exposed to C. diff, the germs have a chance to thrive and cause disease.

Any antibiotic may create conditions that allow C. diff to grow. But antibiotics that fight many different types of bacteria, called broad spectrum antibiotics, are often linked to C. diff-related diarrhea. These include:

• Fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin.
• Penicillins, such as amoxicillin and ampicillin.
• Clindamycin (Cleocin).
• Cephalosporins, such as cefixime (Suprax).

Other factors in C. diff infection

Other factors can create conditions in the colon that make C. diff infection more likely. These include:

• Chemotherapy to treat cancer.
• Inflammatory bowel disease.
• Cancers or other diseases affecting the immune system.
• Kidney disease.
• Medicines that reduce stomach acid, called proton pump inhibitors.

Other causes

Less common causes of pseudomembranous colitis include:

• Other bacteria, including Klebsiella oxytoca or Staphylococcus aureus.
• Viruses, including cytomegalovirus and coronavirus.
• Parasites.
• Inflammatory bowel disease.
• Cocaine.
• Chemicals used in some medical procedures.
• Reduced blood supply to the colon related to blood vessel disease.

Factors that may increase the risk of pseudomembranous colitis include:

• Antibiotic use.
• Long stays in a hospital or nursing home.
• Older age, especially over 65 years.
• A weakened immune system.
• Intestinal surgery.
• Chemotherapy treatment for cancer.

Treatment of pseudomembranous colitis is usually successful. However, even with prompt diagnosis and treatment, pseudomembranous colitis can be life-threatening. Possible complications include:

• Dehydration. Diarrhea can lead to a serious loss of fluids and essential minerals. This condition, called dehydration, makes it difficult for your body to function and can cause dangerously low blood pressure. Serious dehydration can cause the kidneys or other organs to lose their ability to work.
• Toxic megacolon. In this rare condition, your colon is unable to get rid of gas and stool, causing it to become greatly enlarged. Left untreated, your colon may rupture, causing bacteria from the colon to spread. An enlarged or ruptured colon requires emergency surgery and may be fatal.
• A hole in your large intestine, called bowel perforation. This is rare and results from extensive damage to the lining of your large intestine or after toxic megacolon. A perforated bowel can spread bacteria, leading to a life-threatening infection.
• Death. Even mild to moderate C. difficile infections can quickly progress to fatal disease if not treated quickly.

In addition, pseudomembranous colitis may sometimes return, days or even weeks after apparently successful treatment.

To help prevent the spread of C. difficile, hospitals and other healthcare facilities follow strict infection-control guidelines. If you have a friend or family member in a hospital or nursing home, follow hygiene guidelines and ask questions if you see someone not following guidelines.

Preventive measures include:

• Handwashing. Healthcare workers should practice good hand hygiene before and after treating each person in their care. In the event of a C. difficile outbreak, using soap and warm water is a better choice for hand hygiene, because alcohol-based hand sanitizers do not effectively destroy C. diff spores. Visitors to hospitals or nursing homes also should wash their hands with soap and warm water before and after leaving the room or using the bathroom.
• Contact precautions. People who are hospitalized with C. difficile have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and isolation gowns while in the room until at least 48 hours after diarrhea ends.
• Thorough cleaning. In any setting, all surfaces should be carefully disinfected with a product that contains chlorine bleach, which kills C. diff spores.
• Use antibiotics only when necessary. Antibiotics are sometimes prescribed for an illness that may be caused by a virus, but antibiotics can't be treated with these illnesses. Take a wait-and-see attitude with simple ailments. If you do need an antibiotic, ask your healthcare professional if you can take one not likely to increase the risk of C. diff-related diarrhea.