PSEUDOMEMBRANOUS COLITIS

It is an acute diarrhea due to toxins produced by the overgrowth of Clostridium difficile after antibiotic therapy.

Pseudomembranous colitis is a manifestation of severe colonic disease that is usually associated with Clostridium difficile infection, but can be caused by a number of different etiologies. Pseudomembranous colitis refers to swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridioides difficile (C difficile) bacteria.

Clostridium difficile is a Gram positive, anaerobic, spore forming bacillus. It produces toxin A (enterotoxin) and toxin B (cytotoxin, more potent).

It is also often seen in immunocompromised patients and patients who are on cancer chemotherapy.

• Incidence is 2%.
• Mortality is 30%.

RISK FACTORS

• Older age
• Antibiotic use
• Use of medicines that weaken the immune system (such as chemotherapy medicines)
• Recent surgery
• History of pseudomembranous colitis
• History of ulcerative colitis and Crohn disease

CLINICAL FEATURES:

• Abdominal cramps (mild to severe)
• Bloody stools
• Fever
• Urge to have a bowel movement
• Watery diarrhea (often 5 to 10 times per day)

INVESTIGATION:

• Colonoscopy or flexible sigmoidoscopy - Colonoscopy is ideal as right side involvement is more common.
• Immunoassay for C difficile toxin in the stool
• Polymerase chain reaction (PCR) for C difficile toxin in the stool
• ELISA test for toxins is also useful.

HOMOEOPATHIC MANAGEMENT :

MERCURIUS CORROSIVUS -mucus are passed along with stool. There is a constant urge to pass stool but only little stool passes. The stool is hot, bloody, offensive, with cutting pain accompany the passage of stool. After passing the stool , the urge reappears and the patient gets no satisfaction.

ARSENICUM ALBUM -tenesmus, burning pain and pressure in rectum and anus.There is gnawing , burning pain in abdomen like coals of fire, relieved by heat.Abdomen swollen and painful.There is a thirst for small amount of water at frequent intervals.Mentally the patient expresses great anxiety and restlessness.

PHOSPHORUS -C. diff infection where the stool is offensive which contain blood and greenish mucus, worse in the morning. The patient prefers cold drinks, ice creams, and juicy things.

ARGENTUM NITRICUM -Noisy, flatulent diarrhea with much offensiveness of stool. Colicky pain in abdomen. Urging for stools immediately after eating or drinking. Argentum nitricum patients are very nervous and impulsive in nature.

ALOE  SOCOTRINA -bearing down in rectum. Bleeding per rectum may occur, rectum feels sore and hot, and is relieved by cold water. Lot of mucus and wind is expelled with stools and the pain remains in the rectum after passing stools.

BAPTISIA TIN -loose stool is seen. There are fetid stools with toxemia. Stools very offensive, thin, dark and bloody. There is fullness and distension of abdomen. Abdominal muscles sore on pressure.

COLOCYNTHIS -cutting pains and cramping occur , making the person bend double or need to lie down and press on the abdomen.Pain is likely to be worse just before the diarrhea passes, and after eating fruits or drinking water.

LYCOPODIUM CLAVATUM -constant sensation of fermentation in the abdomen.There is much tightness and pressure in the abdomen. Lycopodium patients prefers sweets and hot food and drinks.

NUX VOMICA -Frequent ineffectual urging for stools. Strain hard at stools. Unfinished sensation after stools. Colicky pain in abdomen.