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Pseudomembranous Colitis 3
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Fulminant postcesarean Clostridium difficile pseudomembranous colitis.Obstet Gynecol. 2007 Feb;109(2 Pt2):541-3. BACKGROUND: Pseudomembranous colitis due to Clostridium difficile infection is rarely reported in the obstetric literature. This disease process is associated with prior antibiotic exposure. CASE: A term primigravida was delivered by primary cesarean for failed vacuum extraction. She received Intravenous cefazolin after cord clamping, which was continued for 36 hours for a presumptive diagnosis of endometritis. On day 3, oral amoxicillin and clavulanate was started for suspected cellulitis of the incision. She was readmitted 1 day after her discharge with severe diffuse abdominal pain and distention. Proctoscopy showed pseudomembranous colitis. Colectomy with temporary ileostomy was performed for worsening symptoms and imminent perforation. CONCLUSION: The diagnosis of pseudomembranous colitis should be considered in postpartum women who have low-grade fever, abdominal and gastrointestinal symptoms, and recent antibiotic exposure. Pseudomembraneous colitis caused by a toxin B-positive and a toxin A-negative strain of Clostridium difficile. Ugeskr Laeger. 2006 Apr 24;168(17):1634-5. We describe a case of pseudomembraneous colitis (PMC) caused by a toxin A- B+ strain of Clostridium difficile (CD). In Denmark only a few laboratories investigate for toxin production, and if they do, the toxin A enzyme immunoassay (EIA) is the test generally used when testing for CD. This toxin A negative but toxin B positive strain thus remains undetectable. If CD-associated diarrhea is clinically suspected and tests for toxin A are negative, infection with a toxin A- B+ strain should be considered. Further diagnostic tests such as cellular cytotoxicity assays or toxin A/B EIA should be performed. The standard treatment of PMC in severely ill patients should be vancomycin, administered orally. |
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Clinical aspects of rifampicin-associated pseudomembranous
colitis.J
Clin Gastroenterol. 2007 Jan;41(1):38-40. Pseudomembranous colitis (PMC) is known to develop after antibiotic administration, but antituberculosis agents are rarely associated with this disorder. We report 6 cases of PMC after rifampicin administration; the clinical manifestations, laboratory findings, imaging findings, and clinical course are described. The median age of patients was 68 years (range, 54 to 82 y). All patients were diagnosed with active pulmonary tuberculosis by sputum smear and culture, and 2 suffered from type 2 diabetes mellitus. The average interval between initiation of antituberculosis therapy and the onset of diarrhea was 19.8 days. The anatomic distribution of PMC included the rectum and sigmoid colon in 5 cases and up to the hepatic flexure in 1 case. All patients were cured with medical treatment, which include discontinuation of rifampicin and oral metronidazole and vancomycin. PMC recurred in 1 patient after retreatment with rifampicin. Our findings suggest that patients who are treated with antituberculosis agents, who develop acute diarrhea during or after therapy, should be evaluated for PMC. |
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