Clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus. Toxins released after colonization with C difficile cause inflammation and damage of the colonic mucosa, a condition known as C difficile colitis.
Prior exposure to antibiotics (even brief exposure) is the major risk factor for C difficile colitis. The most common antibiotics implicated in C difficile colitis include cephalosporins, clindamycin, and ampicillin/amoxicillin. Tetracycline occasionally causes C difficile colitis.
C difficile infection commonly symptomatize with mild diarrhea, abdominal cramping and occasionally blood in stool. Sever forms of C difficile colitis results in acute abdomen and fulminant life-threatening colitis.
In addition to history and clinical examination, stool analysis is used to diagnose C difficile infection as follows:
The stool cytotoxin test is the test of choice but expensive and not rapid.
Enzyme immunoassays are more rapid, less expensive, if negative has to be repeated.
Stool culture is not helpful in C difficile diagnosis but is essential to exclude other organisms.
Treatment includes oral flagyl or Vancomycin for 10-14 days and symptomatic treatment . Symptomatic improvement is expected after 3 days.
Consultation of gastroenterologist and colonoscopy may be needed in complicated cases.
Your history starting from being on one of the antibiotics that are known to cause C difficile colitis and symptom improvement on flagyl is very suggestive. If the stool test that have been done was one of the enzyme immunoassays, it should be repeated and sometimes infection is discovered after three repeated tests.
Other types of infections to be excluded include a variety of parasites, protozoa and viruses e. g. Entamoeba histolytica and Salmonella.
Other causes to be excluded (less likely) include IBS and inflammatory disease.
IBS is one of the most common disorders that is seen in the clinic presents mainly with alternating diarrhea and constipation and rarely with blood in stools.
Inflammatory diseases like Crohn's disease and ulcerative colitis, chronic conditions that present mainly with bloody diarhhea.
I advise you to follow up with your doctor.
Please keep us updated.
This answer does not substitute for direct medical consultation.
Dr. Safaa Mahmoud.
MB BCh, MSc Internal Medicine. MD Medical Oncology.
PhD Experimental Medicine and Biochemical Science.