Pseudomembranous enteritis, also known as Clostridium difficile enteritis, post-surgical enteritis, antibiotic enteritis, antibiotic-induced Clostridium difficile enteritis, etc. PMC often occurs after major surgery and in patients with critical and chronic wasting diseases.
Pseudomembranous enteritis is an acute fibrinous exudative inflammation that occurs mainly in the colon and small intestine, mostly after the application of antibiotics, resulting in the dysbiosis of the normal intestinal flora and the proliferation of Clostridium difficile, resulting in toxin production. The clinical manifestations vary from mild diarrhea to high fever, severe diarrhea, water-electrolyte disorders, toxic megacolon, and even life-threatening. The clinical manifestations may vary from mild diarrhea to high fever, severe diarrhea, water-electrolyte disorders, toxic megacolon and even life-threatening. The disease is serious and has a high mortality rate if not treated promptly. Due to the widespread use of broad-spectrum antibiotics and immunosuppressants, the incidence of this disease is on the rise.
Recent studies have confirmed that Clostridium difficile isolated from the feces of patients with pseudomembranous enteritis can produce cytotoxic toxin (Toxin B) and enterotoxic toxin (Toxin A), the former of which is an important causative factor in pseudomembranous enteritis. All these toxins can cause lethal ileocecal inflammation in hamsters. The toxins cause increased permeability of the local intestinal mucosal vascular wall, resulting in tissue ischemia and necrosis, and stimulate mucus secretion and the formation of pseudomembranes with inflammatory cells, etc. In the feces of healthy people, Clostridium difficile positive rate of 5%, inpatients carrying rate of about 13%, asymptomatic patients with clonorchiasis about 8%, in 50% of newborns and 15% to 40% of infant feces, although the bacteria can be isolated, and even toxin production, but there is no pathogenic effect.
General treatment 1, early diagnosis and timely treatment, to improve the cure rate and reduce mortality is extremely important. Once the diagnosis is confirmed, the original antibiotics should be immediately discontinued.
2.Supportive therapy: pay attention to rest. Infusion of fluids to correct water-electrolyte disorders. Correct hypoproteinemia. In recent years, it is found that watery diarrhea caused by extrapyrine can be replaced by oral glucose saline to replace the loss of sodium chloride and correct acidosis at the same time.
3.Support normal intestinal flora to inhibit the growth of Clostridium difficile (breeding): usually 5-10g of normal human feces, mixed with 200ml of saline, filtered and retained in enema, 1~2 times daily for 3~5 days. Can also be used with lactobacillus containing cow’s milk enema or oral vitamin C with vitamin B, folic acid, lactase raw, glutamate, etc.
4, drug treatment: vancomycin and non-absorbable sulfonamides, can effectively treat and prevent experimental pseudomembranous enteritis in voles and artificial pseudomembranous enteritis, can make the fecal indistinguishable (breeding) clostridium and its mycin disappear rapidly. Therefore, vancomycin is listed as the antimicrobial drug of choice. It is given orally 250-500mg each time, 4 times a day.