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Colitis (inflammation of the colon) can occur as a result of infection with the bacterium Clostridium difficile (also known as C difficile and C diff). The disease results from disruption or removal of normal healthy bacteria from the colon by antibiotics. The C difficile bacterium produces toxins (poisonous substances) that attack the lining of the colon and can cause severe damage to the colon itself. More commonly, C difficile toxins produce diarrhea and abdominal discomfort. Unfortunately, it is resistant to most antibiotics. Complications of C difficile colitis include bowel perforation (a hole in the colon) and pseudomembranous colitis (patches of severe inflammation and pus in the colon). C difficile is one of the most common infections that are typically acquired in health care institutions, along with MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant Enterococcus). Hand washing and disinfection, isolation of infected patients, and appropriate antibiotic use are the best ways to reduce spread of these types of infection. The March 4, 2009, issue of JAMA contains an article about Clostridium difficile colitis.
Treatment with antibiotics
Nursing home residency
Immune system depression (such as cancer, steroid treatment, HIV infection)
Age older than 65 years
Disease of the colon (such as inflammatory bowel disease)
Recent gastrointestinal surgery
Diarrhea, often watery
Abdominal pain and cramping
Nausea with or without vomiting
Diagnosing C difficile colitis relies on the patient's history of frequent diarrhea for several days, typically in a person who is taking or recently took antibiotics. A stool sample is tested for presence of C difficile toxins. Other tests may be required if complications are suspected, including blood counts, blood chemistry testing, abdominal x-rays, or computed tomography (CT) scanning.
Centers for Disease Control and Prevention http://www.cdc.gov
National Institute of Diabetes and Digestive and Kidney Diseaseshttp://www.niddk.nih.gov
American Gastroenterological Associationhttp://www.gastro.org
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on MRSA infections was published in the October 17, 2007, issue.
Sources: Centers for Disease Control and Prevention; National Institute of Diabetes and Digestive and Kidney Diseases; American Gastroenterological Association
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
TOPIC: INFECTIOUS DISEASES
Torpy JM, Lynm C, Glass RM. Clostridium difficile Colitis. JAMA. 2009;301(9):988. doi:10.1001/jama.301.9.988
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