CLOSTRIDIUM DIFFICILE-ASSOCIATED COLITIS AS A CONSEQUENCE OF PROLONGED COMBINATION ANTIBIOTIC THERAPY (CLINICAL CASE)

Abstract

Summary. Different forms of C. difficile-associated infections ceased to be rare diseases, which the doctor used to read about in the textbook while studying at the university. A particular increase in the frequency of such cases was noted during the COVID-19 pandemic, when it was necessary to use long-term combined antibiotic therapy. Purpose: to analyze diagnostic and therapeutic tactics in the clinical case of C. difficile-associated infection. Material and methods. The actual clinical observation is given. A patient who suffered from diarrhea up to 15-20 times a day with admixtures of blood and mucus for 2 years turned to the center of clinical medicine of the university clinic of Ivano-Frankivsk National Medical University. The patient associated the onset of diarrhea with antibiotic therapy (azithromycin, cefepim, moxifloxacin, doxycycline) during the severe course of coronavirus disease. Previously, he was referred to an outpatient gastroenterologist, a short-term positive effect was noted during the use of mesalazine rectally and per os. Results. Fibrocolonoscopy did not confirm the presence of ulcerative colitis, which was considered as a preliminary diagnosis. The endoscopic picture corresponded to infectious colitis, this was confirmed by pathohistological studies. No endoscopic signs of pesevdomembranous colitis were found. Seeding for pathogenic intestinal flora showed a negative result. Verification of C. difficile-infection occurred by laboratory method. In response to the initiated treatment (metronidazole 1500 mg per day), a significant positive effect was achieved. Conclusions. In the presence of a typical history (relationship with atibiotherapy), the clinical picture of various clinical forms of C. difficile-infection (C. difficile-associated diarrhea, C. difficile-associated colitis, pseudomembranous colitis), doctors should prescribe laboratory tests to detect the pathogen more often. Our clinical case showed the importance of investigating toxins A, B even when endoscopy did not reveal typical signs of a classic variant of C. difficile-associated infection - pseudomebranous colitis - gray-yellow plaques ("pseudomembranes").