Whether C. difficile is indigenous or acquired is still a matter of some debate. There is no doubt that infection from external sources may occur, and outbreaks of disease with cross- infection are well documented in both adults and children. There is a wide range of clinical severity and findings in patients with pseudomembranous enterocolitis. Some patients may only have diarrhea, some will develop frank colitis, and others will have the full blown clinical picture. Symptoms usually begin 4- 10 days after initiation of antimicrobials, but they may start as early as during the first day of administration or as late as three weeks after discontinuation.
Diarrhea is uniformly present and is generally severe.
Dehydration, fever, vomiting, cramping abdominal pain, tenesmus, and abdominal distention are common. Toxic megacolon and perforation are complications. Hypoproteinemia is usual, and leukocytosis is impressive. The flat film of the abdomen is of some diagnostic help, especially if toxic megacolon is present. The diagnosis can best be made by the finding of C. difficile toxin in the stool along with characteristic changes in the colonic mucosa.