TheAnswerPage/Hospital & Critical Care Medicine Monday 02/08/2010 This week: Clostridium difficile

Mrs. K. is a 78 year old female with COPD admitted with respiratory failure. She had noted several days of fatigue, shortness of breath, and cough productive of increasing amounts of brown sputum. There was no fever.

Vital signs: T 98.9, BP 110/72, HR 102, O2 sat. 89% on 2L NC.
Exam: moderate respiratory distress with diffuse wheezes.
ABG: pH 7.23 / pCO2 75 / HCO3 32 / pO2 63 (2L NC O2)
WBC 12.5
Chest Xray: chronic changes consistent with prior films

She was electively intubated and begun on nebulized albuterol, atrovent as well as intravenous methylprednisolone and cefuroxime. She improved and was extubated by hospital day five, but on hospital day 7, she developed profuse diarrhea associated with T 101.4, WBC 37,000, and crampy abdominal pain. A stool sample was submitted for Clostridium difficile testing and returned positive. Metronidazole therapy was initiated.

1. What is Clostridium difficile?
2. What are the clinical manifestations of C. difficile infection?

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