Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- diarrhoea
- abdominal pain
Other diagnostic factors
- fever
- abdominal tenderness
- nausea and vomiting
- abdominal distension
- symptoms of shock
Risk factors
- antibiotic exposure
- advanced age
- hospitalisation or residence in a nursing home
- exposure to infected family member
- history of Clostridioides difficile-associated disease
- use of acid-suppressing drugs
- inflammatory bowel disease
- solid organ transplant recipients
- haematopoietic stem cell transplant recipients
- chronic kidney disease
- HIV infection
- immunosuppressive agents or chemotherapy
- gastrointestinal surgery
- vitamin D deficiency
Diagnostic investigations
1st investigations to order
- FBC
- stool guaiac (faecal occult blood test)
- stool polymerase chain reaction (PCR)
- stool immunoassay for glutamate dehydrogenase
- stool immunoassay for toxins A and B
- abdominal x-ray
Investigations to consider
- cell culture cytotoxicity neutralisation assay
- CT abdomen
- sigmoidoscopy or colonoscopy
Emerging tests
- stool lactoferrin or calprotectin
Treatment algorithm
initial episode: non-severe
initial episode: severe
initial episode: fulminant
first recurrence
subsequent recurrence
Contributors
Authors
Ali Hassoun, MD, FACP, FIDSA, AAHIVS
Clinical Associate Professor of Medicine
Alabama Infectious Diseases Center
Huntsville
AL
Disclosures
AH declares that he has no competing interests.
Peer reviewers
Julius Atashili, MD, MPH
Department of Epidemiology
Division of General Medicine and Epidemiology
UNC at Chapel Hill
Chapel Hill
NC
Disclosures
JA declares that he has no competing interests.
Satish Keshav, MBBCh, DPhil, FRCP
Consultant Gastroenterologist
Department of Gastroenterology
John Radcliffe Hospital
Oxford
UK
Disclosures
SK declares that he has no competing interests.
Ian Beales, MD, FRCP
Clinical Reader and Consultant Gastroenterologist
Norfolk and Norwich University Hospital
Norwich
UK
Disclosures
IB declares that he has no competing interests.
Differentials
- Antibiotic-associated diarrhoea (AAD)
- Ischaemic colitis
- Bacterial or viral gastroenteritis
More DifferentialsGuidelines
- Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults
- Strategies to prevent Clostridioides difficile infection in acute care facilities
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