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Pseudomembranous colitis: diagnosis

Alexey Portnov, medical expert
Last reviewed: 23.04.2024

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Pseudomembranous colitis or diarrhea caused by C. Difficile is usually nosocomial, especially if it develops 3-4 days after admission.

trusted-source [1], [2], [3], [4]

Study of toxin on cell culture

This method was introduced first, but because of its complexity, it is not used for routine diagnostics. In addition, the toxin is very unstable, breaks down at room temperature for 2 hours after taking the stool samples for the study. To avoid false negative results, if the sample is not examined immediately, it should be stored in the refrigerator.

Cultivation of feces for the isolation of Clostridium difficile

This requires anaerobic conditions, a special selective medium, and the precise identification of this kind of clostridia can be difficult, especially in small microbiological laboratories. In addition, false positive results of the study may occur when C. Difficile strains that do not produce exotoxin are isolated. The result of the laboratory test can be obtained within 48-96 hours.

trusted-source [5], [6], [7], [8], [9], [10]

Express diagnosis of pseudomembranous colitis

Latex agglutination or immunochromatographic method of C. Difficile antigen detection. Quick test (less than 1 hour) for antigen detection. It is necessary to apply simultaneously with the test for exotoxin.
The enzyme immunoassay detects toxin A, toxin B, or both toxins. Results can be obtained within a working day. It is less sensitive than the test for cytotoxicity in tissue culture, adapted for hospital laboratories that do not use tissue cultures or can not isolate C. Difficile from feces.
Study of cytotoxicity on tissue culture. It is possible in principle to determine only toxin B. The most expensive method, the duration of the study is 24-48 hours before the final result is obtained. It has a low sensitivity and specificity, that is, it can not indicate that the cause of the disease was Clostridium difficile.
PCR - the possibility of detecting toxins A and B is currently at the stage of scientific development.

trusted-source [11], [12], [13], [14]

Endoscopy

This method is used in cases where it is necessary to differentiate diarrhea from another diagnosis, which can be confirmed by endoscopy. At endoscopy, yellowish color overlays are found in the distal part of the large intestine, sometimes they can be located proximally and can be missed (10-30% of cases) during routine sigmoidoscopy. Therefore, colonoscopy is considered a more adequate diagnostic method.

trusted-source [15], [16], [17], [18], [19], [20]

CT of abdominal cavity

Conducted in those cases where a colonoscopy is contraindicated, but there are no specific signs of colitis caused by C. Difficile. Usually indirect signs are the thickening of the intestinal wall with the filling of the contrasting substance with bends that have a characteristic appearance ("accordion symptom").

trusted-source [21], [22], [23], [24], [25]

Irrigoscopy with barium

In severe cases, you can identify megacolon, perforation and other complications, but this method is considered unsafe and therefore it is usually not recommended.