Pseudomembranous colitis

Diagnosis

Diagnosis of pseudomembranous colitis may require several tests and procedure. It may include:

• Blood tests. An unusually high white blood cell count, known as leukocytosis, may be revealed through these tests. This can be an indication of an infection like C. difficile if there is also the presence of diarrhea.
• Imaging tests: An abdominal X-ray or an abdominal computed tomography (CT) scan can check for issues like toxic megacolon or colon rupture in severe cases.
• Stool sample: Feces or stool sample is tested in a laboratory for toxins produced by C. diff. The bacterium can be detected using a variety of stool sample techniques.
• Colonoscopy or sigmoidoscopy: A thin, flexible tube (sigmoidoscope) is used to allow the doctor to observe the interior of the large intestine. The test will check for elevated, yellow plaques called lesions, as well as swelling which could indicate pseudomembranous colitis.

Treatment

Several treatments are available to resolve pseudomembranous colitis. Symptoms of pseudomembranous colitis may improve within a few days of starting treatment. Treatments may include one or more of the following:

• Stopping the antibiotic or other medication: The first thing the doctor may advise is to discontinue the drug that caused the pseudomembranous colitis infection. This action may be enough to heal the illness, or at the very least, alleviate symptoms.
• Antibiotic effective against C. difficile: If symptoms of C. difficile persist, a different antibiotic may be prescribed by your healthcare provider to restore the balance of healthy bacteria in your colon. Antibiotics can be administered orally, intravenously or through a nasogastric tube. The specific antibiotic chosen may depend on the severity of the condition and the patient’s ability to tolerate the medication. Vancomycin and fidaxomicin are commonly used, but if these are not available or not well-tolerated, metronidazole may be an alternative. For severe cases, a combination of oral vancomycin and intravenous metronidazole or a vancomycin enema may be prescribed.
• Fecal microbial transplantation (FMT): In cases where the infection is severe or has recurred multiple times, doctors may recommend a treatment called fecal microbiota transplant (FMT). FMT involves transplanting stool from a healthy donor to help restore a healthy balance of bacteria in the colon. The donor stool can be administered through a nasogastric tube, inserted directly into the colon, or taken in capsule form. In some cases, doctors may use a combination of antibiotics and FMT to treat the infection.

Treating recurring pseudomembranous colitis:

Pseudomembranous colitis recurs in up to 20% of those who have been treated. The chances of having another recurrence of increases with each recurrence. Treating pseudomembranous colitis has become challenging with the emergence of new, more aggressive strains of C. diff. Treatment for recurring pseudomembranous colitis may include:

• Repeat antibiotics:  If the condition recurs, the doctor will give another antibiotic dose. The course of the treatment may be longer depending on the patients’ response to the treatment.
• Bezlotoxumab: Bezlotoxumab, a human monoclonal antibody, has been given the green light by the FDA for use in reducing the risk of C. difficile infection returning. Its combination with antibiotics has been found to be highly effective in reducing the likelihood of recurrence. Despite this, the cost of the drug may impede its widespread use.
• Fecal microbial transplantation (FMT): The treatment involves receiving a capsule containing sterilized and healthy stool, which can be administered through a tube inserted through the nose into the stomach or directly to the colon.
• Surgery: When someone’s organs start to fail, or their colon ruptures and the lining of their abdominal wall becomes inflamed (peritonitis), surgery may be considered as an option. The typical surgery for this situation involves the removal of either all or part of the colon, which is known as total or subtotal colectomy. However, a newer procedure known as loop ileostomy and colonic lavage has been developed, which is less invasive and has shown promising results. This procedure involves the creation of a loop of colon using laparoscopic techniques and cleaning it.