Clostridioides (Clostridium) Difficile Colitis Clinical Presentation

Updated: Jun 07, 2023
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
  • Print


C difficile colonization results in a wide spectrum of clinical conditions, including an asymptomatic carrier state; mild, self-limited diarrhea; pseudomembranous colitis; and fulminant colitis. Most patients develop diarrhea during or shortly after starting antibiotics. However, 25-40% of patients may not become symptomatic for as many as 10 weeks after completing antibiotic therapy.

Symptoms often include the following:

  • Mild to moderate watery diarrhea that is rarely bloody

  • Cramping abdominal pain

  • Anorexia

  • Malaise

  • Fever, especially in more severe cases


Physical Examination

Physical examination is generally nonspecific in patients with mild C difficile infection. Fever, signs of dehydration, lower abdominal tenderness, and/or rebound tenderness (raising the possibility of colonic perforation and peritonitis) may be present.

More concerning signs include marked dehydration, marked abdominal tenderness, and distention, as well as marked rigidity and decreased bowel sounds. These may indicate the presence of complications such as toxic megacolon, and bowel perforation.