Last reviewed: 5 Oct 2024
Last updated: 23 Jul 2023
Summary
Definition
History and exam
Key diagnostic factors
- diarrhea
- abdominal pain
Full details
Other diagnostic factors
- fever
- abdominal tenderness
- nausea and vomiting
- abdominal distension
- symptoms of shock
Full details
Risk factors
- antibiotic exposure
- advanced age
- hospitalization 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
- hematopoietic stem cell transplant recipients
- chronic kidney disease
- HIV infection
- immunosuppressive agents or chemotherapy
- gastrointestinal surgery
- vitamin D deficiency
Full details
Diagnostic tests
1st tests to order
- CBC
- stool guaiac (fecal occult blood test)
- stool polymerase chain reaction (PCR)
- stool immunoassay for glutamate dehydrogenase
- stool immunoassay for toxins A and B
- abdominal x-ray
Full details
Tests to consider
- cell culture cytotoxicity neutralization assay
- CT abdomen
- sigmoidoscopy or colonoscopy
Full details
Emerging tests
- stool lactoferrin or calprotectin
Treatment algorithm
ACUTE
initial episode: nonsevere
initial episode: severe
initial episode: fulminant
ONGOING
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 diarrhea (AAD)
- Ischemic colitis
- Bacterial or viral gastroenteritis
More DifferentialsGuidelines
- Management of Clostridioides difficile infection (CDI) in hematopoietic cell transplant patients
- Clostridioides difficile infection: antimicrobial prescribing NICE guideline [NG199]
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