infectious diseases
Clostridioides (formerly Clostridium) difficile–Induced Diarrhea
Pathophysiology ofClostridioides difficile–Induced Diarrhea
Antibiotic-induced changes in gastrointestinal flora are the dominant predisposing factors. Although most antibiotics have been implicated, the following pose the highest risk: Cephalosporins (particularly 3rd-generation) Penicillins (particularlyampicillinandamoxicillin) Clindamycin Fluoroquinolones C. difficile–induced colitis may also follow use of certain antineoplastic medications. The organism secretes both an enterotoxin and a cytotoxin, typically referred to as toxins A and B. However, not all strains ofC. difficileproduce toxins, and some people are asymptomatic carriers of toxin-producing strains. The main effect of the toxin is on the colon, which secretes fluid and develops characteristic pseudomembranes—discrete yellow-white plaques that are easily dislodged. Plaques may coalesce in severe cases. Toxic megacolon, which rarely develops, is somewhat more likely after use of antimotility medications. Limited tissue dissemination occurs very rarely, as do sepsis and acute abdomen. Reactive arthritis rarely has occurred afterC. difficile–induced diarrhea. 