Epidemiology, Diagnosis and Treatment of Clostridium Difficile Infection

Matteo Bassetti; Giovanni Villa; Davide Pecori; Alessandra Arzese; Mark Wilcox


Expert Rev Anti Infect Ther. 2012;10(12):1405-1423. 

In This Article

CDI Clinical Diagnosis: The Role of Radiology & Endoscopy

Aside from the signs and symptoms of the disease, which have already been discussed above, and the use of the laboratory to diagnose CDI, radiology and endoscopy may provide helpful tools in the diagnosis of more severe forms.

CT scan is normally not required for diagnosing CDI, especially for mild-to-moderate disease, but it can be useful for recognizing more severe forms.

CT findings normally include colonic mural thickening with trapping of contrast material, pancolitis, pericolonic fat changes and ascites. Maximal thickness of the colonic wall and the presence of pleural effusion in CT scans are both associated with the development of more a severe form of CDI. Other factors that are associated with severe CDI and correlate with these CT findings are high white blood cells count, low albumin level and immunosuppression.[123] Small bowel enteritidis caused by CDI is a rare condition; in this scenario CT scans usually reveal mesenteric and retroperitoneal fatty stranding, with some degree of ascites, distension of the bowel and mural thickening, sometimes with intramural gas, which might represent a poor prognostic sign.[124]

As part of the diagnostic workup, lower GI endoscopy can be used to visualize the colonic mucosa, highlight the presence of inflammation or pseudomembranes and collect tissue or stool samples for diagnostic purposes.

In fact, thanks to GI endoscopy, other coexisting etiologies can be ruled out, such as Cytomegalovirus (CMV) colitis, graft-versus-host disease (GVHD) or, in the case of bloody diarrhea, ischemic colitis or inflammatory bowel disease. Moreover, in the case of high clinical suspicion, with inconclusive stool tests, endoscopy may be helpful in recognizing the diagnosis; it is also very helpful in cases of worsening clinical conditions, to confirm fulminant cases or other colonic pathologies.[125]