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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Bhupinder Anand, MD

Similar to other illnesses, a thorough medical examination by the doctor is necessary in evaluating for C. difficile colitis. A careful review of all medications, especially antibiotics, and recent hospitalization or nursing home admissions should be carried out.

Laboratory tests include blood work including a basic chemistry panel and complete blood count (CBC). An elevated white blood cell count (WBC), or leukocytosis, is very common in C. diff infection. The WBC is typically elevated in any type of bacterial infection, but in C. diff infection it is markedly elevated, often much higher than with other infections.

There are two ways to detect the presence of C. difficile.

1. Testing for the toxin produced by the organism (toxin assays)
2. Detecting the actual organism. Although the detection of the organism in stool cultures is the most sensitive way of diagnosing C. difficile, is takes a few days to make this determination, which makes this a less useful method.

Stool samples should be collected and analyzed. The presence of C. diff toxins in the stool is diagnostic of the infection, and the results of stool analysis are generally available within a day or so. The actual detection of Clostridium difficile bacterium by stool cultures may also be done. This, however, may take a few days, which may delay the diagnosis and treatment. C. diff culture may be positive in a carrier; however, the strain of the organism may be one that does not cause infection.

Other tests used to diagnose C. difficile colitis are a CT scan of the abdomen, which may show thickening of the wall of the colon, signifying inflammation. This finding is not specific as it may be present in other inflammatory diseases of the colon; however, it may add further evidence for C. difficile colitis in the proper clinical setting.

Sigmoidoscopy and colonoscopy are other procedures which may be useful in the evaluation of C. difficile colitis. These procedures involve inserting an endoscope (a tube), which has a camera and a light source at the tip, into the colon from the rectum. Visualization of pseudomembranes suggests C. diff infection. These tests are not always necessary to diagnose the infection, but they may have a role in cases where the diagnosis is in doubt due to nondiagnositc stool tests, unresponsiveness to appropriate treatment, or unusual presentation of the disease with little or no diarrhea and fever.

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