Pseudomembranous colitis results in a spectrum of clinical manifestations that vary from frequent, mucoid, watery stools to a toxic picture that includes profuse diarrhea (20 to 30 stools per day), crampy abdominal pain, fever, leukocytosis, dehydration, and hypovolemia. Examination of the stool may reveal the presence of fecal leukocytes. These are not generally found in more benign forms of antibiotic-induced diarrhea. Complications of the disease include severe electrolyte imbalance, hypotension, and anasarca from decreased serum albumin. Rarely, toxic megacolon or colonic perforation may occur in patients with pseudomembranous colitis. The disease typically begins 7 to 10 days after the institution of antibiotic therapy, although in some cases symptoms may be noted within a few days or up to 8 weeks after the antibiotic is discontinued. C. difficile colitis has now been established as a nosocomial infection in hospitals.
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