Persistent and Recurrent Clostridium difficile Colitis

Abstract

Clostridium difficile infection (CDI) is the most frequent cause of nosocomial diarrhea. It has become a significant dilemma in the treatment of patients, and causes increasing morbidity that, in extreme cases, may result in death. Persistent and recurrent disease hamper attempts at eradication of this infection. Escalating levels of treatment and novel therapeutics are being utilized and developed to treat CDI. Further trials are warranted to definitively determine what protocols can be used to treat persistent and recurrent disease.

Keywords: BI/NAP1/027; fecal microbiota therapy; recurrent Clostridium difficile.

Fig. 1

A 67-year-old female with toxic megacolon, pseudomembrane development, and mucosal sloughing: (a) X-ray showing dilated transverse colon, (b) computed tomographic scan of dilated colon and thickened mucosa, (c) computed tomographic scan demonstrating mucosal thickening, and (d) colonoscopic image of pseudomembranes sloughing. (Image courtesy Anjali Kumar, MD, MedStar Washington Hospital Center.)

Fig. 2

Classic endoscopic findings of: (a) pseudomembranes and (b) thickened, hyperemic, and edematous mucosa. (Image courtesy Anjali Kumar, MD, MedStar Washington Hospital Center.)

Fig. 3

Vancomycin solution enema (250 mg in 250 mL) can be administered through the rectum via a standard enema set (pictured on the right), or into the proximal colon via the colonoscope (pictured on the left) irrigation channel. (Image courtesy Anjali Kumar, MD, MedStar Washington Hospital Center.)

Fig. 4

Surgical intervention (with total colectomy) is indicated for severe Clostridium difficile infection which causes toxic colitis. Specimen photos show severity of this patient's disease. (Image courtesy James FitzGerald, MD, MedStar Washington Hospital Center).