Clostridium Difficile (C. difficile, C. diff) (cont.)
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C. diff Diagnosis
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.
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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