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Pseudomembranous colitis - Symptoms
Last reviewed: 04.07.2025
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The incubation period is unknown. One study showed that pseudomembranous colitis symptoms occurred on days 2–60 (mean 20.3) after hospitalization. C. difficile can cause a variety of clinical manifestations of varying severity, from asymptomatic carriage, moderate or severe diarrhea, to life-threatening colitis. The main symptoms of the disease are watery diarrhea (at least three times a day for several days), fever, loss of appetite, nausea, abdominal pain or tenderness. Moderate course is characterized by non-bloody diarrhea, no systemic manifestations, abdominal tenderness. Severe course is characterized by profuse watery diarrhea, abdominal pain and tenderness. Fever, dehydration, occult blood in the stool are often noted, but intestinal bleeding is uncommon.
Diarrhea
Typically, the stool is watery, more than 7 times per day. Diarrhea usually appears 4-9 days after the start of antibiotic use, but can occur during the first day and even after a single use of an antibiotic for prophylactic purposes. In about 20% of patients, diarrhea occurs 6 weeks or more after the end of antibiotic use. The stool may be mixed with blood. In about 50% of patients, a large number of leukocytes are detected in stool samples.
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Abdominal pain of a spastic nature
Typically, abdominal examination reveals pain without signs of peritoneal irritation.
Fever
The temperature can rise to 39-40 °C.
Laboratory data
Leukocytosis with leukemoid reaction and hypoalbuminemia often occur.
The course of the disease in the absence of treatment may vary. Some patients experience diarrhea of varying severity, which stops after discontinuing antibiotics. Some may experience chronic diarrhea that lasts for several weeks or months. Most patients experience fever, abdominal pain, leukocytosis, and hypoalbuminemia.
Complications of pseudomembranous colitis
In severe cases, pseudomembranous colitis, dynamic (paralytic) intestinal obstruction, toxic megacolon, colonic perforation, severe electrolyte disturbances, dehydration, hypoalbuminemia, and anasarca may occur. Some patients may have little or no diarrhea, but toxic megacolon, colonic perforation, and peritonitis may develop. In these cases, diarrhea may stop as signs of inflammation increase. Such patients require surgical consultation, since if toxic megacolon develops, about 60% of patients require surgery, and the mortality rate in this group increases to 32-50%.