Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Anorexia Nervosa Antibiotic-Associated Colitis 133

Prognosis

■Treatment success rate: <50% of pts fully recover from disorder

■Vocational functioning often preserved

■Mortality: 5–15%:

➣50% due to suicide, others to starvation & electrolyte abnormal-

ities

Antibiotic-Associated and Pseudomembranous Colitis.........

MARTA L. DAVILA, MD

history & physical

History

■Diarrhea a frequent adverse effect of antibiotics; can develop from a

few hours up to 2 months after antibiotic intake

■Only 10–20% of all cases of antibiotic-associated diarrhea caused by

infection with C. difficile

■Other infectious organisms: C. perfringens, Staphylococcus aureus,

Klebsiella oxytoca, Candida species, and Salmonella species

Signs & Symptoms

■Acute watery diarrhea, lower abdominal pain, fever and leukocytosis

■Reactive arthritis a rare complication of C. difficile infection

■Asymptomatic carrier state: 2/3 of infected hospitalized patients

asymptomatic; carrier state eliminated by treatment with van-

comycin

■Diarrhea without colitis: symptoms usually mild and resolve when

the initiating antibiotic discontinued

■Colitis without pseudomembrane formation: more serious illness

with systemic manifestations such as fever, malaise, anorexia and

leukocytosis; sigmoidoscopic examination – nonspecific erythema

without pseudomembranes

■Pseudomembranous colitis: sigmoidoscopy-classic pseudomem-

branes, which appear as raised yellow or off-white plaques covering

the mucosa

■Atypical or rare presentations: fulminant colitis with or without

megacolon, pseudomembranous colitis with protein-losing entero-

pathy, relapsing infection