Diagnostic Challenges: Clostridium difficile, A Case Report
Keywords:
Clostridium difficile; bacterial toxins; diagnosis.Abstract
Introduction: Clostridium difficile is a spore-forming, Gram-positive bacillus that produces toxins A and B. These toxins are responsible for serious intestinal infections, including diarrhea, pseudomembranous colitis, and toxic megacolon. The clinical case presented here highlights the importance of diagnosis in community settings, which differs from the more extensively documented hospital-acquired infections.
Objective: To describe the clinical presentation, diagnosis, and progression of a community-acquired Clostridium difficile infection in a patient with no clear history of hospital exposure.
Methods: An observational clinical case study of a 55-year-old female teacher who had been receiving pharmacological treatment for pharyngotonsillitis. Progressive gastrointestinal symptoms were evaluated through clinical history, physical examination, and laboratory testing, including stool analysis (with a count of polymorphonuclear leukocytes) and the detection of toxins A/B via immunochromatography.
Results: The patient presented with persistent, mucus-containing diarrhea (with pseudomembranes), colicky pain, rectal tenesmus, nausea, flatulence, weight loss, and asthenia over a 15-day period; the condition subsequently progressed to foul-smelling, bloody diarrhea. Testing confirmed the presence of toxins A and B, while ruling out Giardia lamblia.
Conclusions: Community-acquired Clostridium difficile infection presents diagnostic challenges due to its rapid progression outside of a hospital setting. Specific toxin testing is essential for an accurate diagnosis and timely treatment with metronidazole, leading to a successful resolution.
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References
1. Mounsey A, Lacy Smith K, Reddy VC, Nickolich S. Clostridioides difficile infection: Update on management. Am Fam Physician. 2020 [acceso 22/07/2025];101(3):168-75. Disponible en: https://www.aafp.org/pubs/afp/issues/2020/0201/p168.pdf
2. Whitaker R. Curbing C. difficile Infection in a Hospital. The Hospitalist. 2022 [acceso 22/07/2025]. Disponible en: https://www.the-hospitalist.org/hospitalist/article/33438/infectious-diseases/curbing-c-difficile-infection-in-a-hospital/
3. Schäffler H, Breitrück A. Clostridium difficile - From Colonization to Infection. Front Microbiol. 2018;9:646. DOI: http://dx.doi.org/10.3389/fmicb.2018.00646
4. McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-48. DOI: http://dx.doi.org/10.1093/cid/cix1085
5. De-la-Rosa-Martínez D, Villaseñor-Echavarri R, Vilar-Compte D, Mosqueda-Larrauri V, Zinser-Peniche P, Blumberg S. Heterogeneity of Clostridioides difficile asymptomatic colonization prevalence: a systematic review and meta-analysis. Gut Pathog. 2025;17(1):6. DOI: http://dx.doi.org/10.1186/s13099-024-00674-0
6. Johnson S, Lavergne V, Skinner AM, Gonzales-Luna AJ, Garey KW, Kelly CP, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis. 2021;73(5):e1029-44. DOI: http://dx.doi.org/10.1093/cid/ciab549
7. Ferretti P, Wirbel J, Maistrenko OM, Van Rossum T, Alves R, Fullam A, et al. C. difficile may be overdiagnosed in adults and is a prevalent commensal in infants. 2023. DOI: http://dx.doi.org/10.7554/elife.90111.1
8. Guh AY, Mu Y, Winston LG, Johnston H, Olson D, Farley MM, et al. Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes. N Engl J Med. 2020;382(14):1320-30. DOI: http://dx.doi.org/10.1056/NEJMoa1910215
9. Doll M, Marra AR, Apisarnthanarak A, Al-Maani AS, Abbas S, Rosenthal VD. Prevention of Clostridioides difficile in hospitals: A position paper of the International Society for Infectious Diseases. Int J Infect Dis. 2021;102:188-95. DOI: http://dx.doi.org/10.1016/j.ijid.2020.10.039
10. Markantonis JE, Fallon JT, Madan R, Alam MZ. Clostridioides difficile Infection: Diagnosis and Treatment Challenges. Pathogens. 2024;13(2):118. DOI: http://dx.doi.org/10.3390/pathogens13020118
11. Ford CD, Hoda D, Lopansri BK, Parra M, Sharma P, Asch J. An algorithm addressing the problem of overdiagnosis of Clostridioides difficile infections in hematopoietic stem cell transplantation recipients: Effects on C. difficile infection rates and patient outcomes. Transplant Cell Ther. 2023;29(7):471.e1-471.e7. DOI: http://dx.doi.org/10.1016/j.jtct.2023.04.010
12. Polage CR, Gyorke CE, Kennedy MA, Leslie JL, Chin DL, Wang S, et al. Overdiagnosis of Clostridium difficile Infection in the Molecular Test Era. JAMA Intern Med. 2015;175(11):1792-801. DOI: http://dx.doi.org/10.1001/jamainternmed.2015.4114
13. Managing community-onset C. difficile. ContagionLive; 2021 [acceso 22/07/2025]. Disponible en: https://www.contagionlive.com/view/managing-community-onset-c-difficile
14. Feuerstadt P, Theriault N, Tillotson G. The burden of CDI in the United States: a multifactorial challenge. BMC Infect Dis. 2023;23(1):132. DOI: http://dx.doi.org/10.1186/s12879-023-08096-0
15. CDC. About C. diff. C. diff (Clostridioides difficile); 2024 [acceso 22/07/2025]. Disponible en: https://www.cdc.gov/c-diff/about/index.html
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Copyright (c) 2026 Sandra Elizabeth Villacís Valencia, Jorge Luis Barrera Pilla, Emilia Alejandra Beltrán Villacís
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