Clinical manifestations of Clostridium difficile infection

Clinical manifestations of Clostridium difficile infection

Type of infection	Diarrhea	Other symptoms	Physical examination	Sigmoidoscopic examination
Diarrhea with colitis	• Multiple loose bowel movements per day • Occult bleeding may be seen • Hematochezia rare	Nausea, anorexia, fever, malaise, dehydration, leukocytosis with left shift	Abdominal distention, tenderness	Diffuse or patchy nonspecific colitis
Fulminant colitis	• Diarrhea may be severe OR diminished (due to paralytic ileus and colonic dilatation) • Surgical consult required; colectomy can be life saving	Lethargy, fever, tachycardia, abdominal pain; dilated colon/paralytic ileus may be demonstrated on plain abdominal film	May present as acute abdomen; peritoneal signs suggest perforation	Sigmoidoscopy and colonoscopy contraindicated; flexible proctoscopy with minimal air insufflation may be diagnostic
Asymptomatic carriage	Absent	Absent	Normal	Normal

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