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Pseudomembranous colitis: causes
Last reviewed: 23.04.2024
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[How does pseudomembranous colitis develop?
There are four main reasons for the development of pseudomembranous colitis associated with C. Difficile.
Imbalance of bacteria in the large intestine
The suppression of the intestinal flora leads to an excessive reproduction of C. Difficile, which are capable of secreting exotoxin. This is usually due to the use of antibiotics, sometimes the use of antimicrobial chemotherapeutic drugs may lead to this, especially if they can suppress normal intestinal flora. All groups of antibiotics, with the exception of aminoglycosides, may be the cause of the disease. Diarrhea can occur with the use of antibiotics or for 4-6 months after it ends. Usually this disease occurs after application of clindamycin, ampicillin or cephalosporins. Significantly less likely to occur with the use of metronidazole, vancomycin, fluoroquinolones, co-trimoxazole and aminoglycosides.
The presence of C. Difficile in the colon as an endogenous flora (about 3% of healthy individuals) or exogenous flora
In 10-30% of patients a few days after admission from the stool can be identified this microorganism. Despite the fact that Clostridium difficille is often isolated from the stool of various healthy animals, they are not considered as a source of infection.
Endotoxin C products with difficile
About 25% of strains C difficile isolated from patients do not produce either toxin A or toxin B, they are considered to be nontoxigenic, and they never cause diarrhea and colitis. Toxin A is the cause of clinical manifestations of the disease, toxin B has cytopathic activity, which is detected by standard culture methods. Patients colonized by non-toxin-producing strains of Clostridium difficile have no clinical manifestations, and conversely, clinical signs of the disease only occur in patients colonized by strains producing toxin. Toxin can be detected in stools in 15-25% of patients with diarrhea and more than 95% of patients with pseudomembranous colitis.
Age of patients
For unknown reasons, people older than 50 years are most susceptible to infection. In neonates, the colonization of Clostridium difficile is noted in 60-70% of cases, however, no symptoms of the disease occur. Patients at high risk of disease are considered to be patients who underwent surgery (especially surgery on the abdominal organs) who are on treatment in the ICU with severe chronic diseases, with a nasogastric tube installed. The role of proton pump inhibitors and histamine receptor antagonists used to prevent the development of gastric ulcers in resuscitation patients in the pathogenesis of diarrhea associated with C difficile has not been fully established.