Non-clostridium difficile induced pseudomembranous colitis

Abstract

Pseudomembranous colitis is severe inflammation of the inner lining of the colon due to anoxia, ischemia, endothelial damage, and toxin production. The majority of cases of pseudomembranous colitis are due to Clostridium difficile. However, other causative pathogens and agents have been responsible for causing a similar pattern of injury to the bowel with the endoscopic appearance of yellow-white plaques and membranes on the mucosal surface of the colon. Common presenting symptoms and signs include crampy abdominal pain, nausea, watery diarrhea that can progress to bloody diarrhea, fever, leukocytosis, and dehydration. Negative testing for Clostridium difficile or failure to improve on treatment should prompt evaluation for other causes of pseudomembranous colitis. Bacterial infections other than Clostridium difficile, Viruses such as cytomegalovirus, parasitic infections, medications, drugs, chemicals, inflammatory diseases, and ischemia are other differential diagnoses to look out for in pseudomembranous colitis. Complications of pseudomembranous colitis include toxic megacolon, hypotension, colonic perforation with peritonitis, and septic shock with organ failure. Early diagnosis and treatment to prevent progression are important. The central perspective of this paper is to provide a concise review of the various etiologies for pseudomembranous colitis and management per prior literature.

Keywords: Infections, Pseudomembranous colitis, Gastroenteritis, Gastrointestinal diseases, Non-Clostridium difficile, Enterocolitis, Digestive system diseases

Core Tip: Pseudomembranous colitis (PMC) is mostly caused by Clostridium difficile infection (CDI). The incidence of CDI-related PMC is 3%-8% and is increasing. Other than CDI, ischemia, infections, medications, and inflammatory conditions can cause PMC. Infections from S. aureus, E. coli, Klebsiella, and Strongyloidiasis may also cause PMC. Non-infectious causes of PMC include chemical endoscope cleaning agents, intestinal ischemia, drug abuse from cocaine, inflammatory bowel disease, and microscopic colitis. Understanding various causes of pseudomembranous colitis helps avoid over usage of antibiotics and focus on targeted therapy and early diagnosis. This is a concise review of non-CDI pseudomembranous colitis.