An atypical case of infection by Clostridium difficile

Clostridium difficile is a Gram-positive human pathogenic bacterium and nosocomial pathogen; it is the causative agent diarrhoea, colitis and pseudo-membranous colitis associated with antibiotic therapy. The pathogenesis of diarrhoea linked to a Clostridium difficile infection is complex and only partly know. A 75 years old subject with biventricular defibrillator for atrial flutter-fibril slow dilated cardiomyopathy underwent, in february 2008, surgery of mitro-aortic replacement.The subject, in march 2009, followed a rehabilitation therapy with aspirin and esomeprazole, as an outpatient, to Pio Albergo Trivulzio. The patient appeared lucid, oriented in time and space, in good general conditions; objectivity shows mild abdominal bloating, rectal examination negative; reported bowel function tend constipated with 1-2 bowel movements per week with formed stools and recent episodes of melena. Blood tests showed anemia and positive research haemoglobin in stool.The patient underwent esophagogastroduodenoscopy and then rettosigmoidoscopia, and decided to carry out biopsies. The sigmoid-rectal endoscopic picture was compatible with a diagnosis of “pseudo-membranous colitis hospitalization, On the basis of symptoms reported was required to search for toxins and bacterial culture for Clostridium difficile, resulting both positive. In literature are reported with increasing frequency of Clostridium difficile associated diarrhoea in patients home. The clinical case presented shows that in patients from home with symptoms vanished, the presence of formed stool does not exclude the possibility of infection by Clostridium difficile and is therefore useful and absolutely advisable to search for toxins and bacterial culture for Clostridium difficile.