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182 Clostridial Enterocolitis

Clostridial Enterocolitis Client Education
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mucus, during digital rectal examination.
BASIC INFORMATION
Signs of systemic illness are uncommon. spores; numbers do not correlate with clinical
disease
Definition • Acute nosocomial diarrhea associated with • Rectal scraping for cytologic evaluation
Clostridial enterocolitis or clostridial entero- C. perfringens is often seen 1-5 days after to rule out histoplasmosis, lymphoma or
toxicosis is an intestinal disease that causes boarding or kenneling. This syndrome other neoplasia, histiocytic ulcerative colitis
diarrhea in dogs and cats and is suspected to appears to be self-limited and responds well (p. 1157)
be caused by Clostridium perfringens. It typically to supportive care. Typically, clinical signs
causes large-intestinal diarrhea, which may be last 5-7 days. Advanced or Confirmatory Testing
acute and self-limited, or chronic. C. perfringens • Chronic cases often have intermittent clinical • Abdominal radiographs or ultrasound are
may be associated with antibiotic-responsive signs that may recur every 4-6 weeks. often normal but can help rule out extra-
diarrhea. gastrointestinal diseases.
Etiology and Pathophysiology • Colonoscopy is rarely indicated to diagnose
Synonyms • C. perfringens is an anaerobic, spore-forming, this condition but, in severe cases, may be
Acute nosocomial colitis, canine nosocomial gram-positive bacillus that is also found in necessary to rule out other causes of colitis:
diarrhea, clostridia-associated diarrhea healthy dogs and cats. ○ Mucosal hyperemia or ulceration is typical.
• Sporulation of toxigenic strains causes release ○ Histopathologic evaluation of biopsies may
Epidemiology of enterotoxin A. This enterotoxin can cause indicate neutrophilic colitis, the presence
SPECIES, AGE, SEX mucosal damage and fluid secretion in the of other inflammatory bowel disease, or
Dogs are more commonly affected than cats. colon. may be normal.
Acute disease can occur in any age animal, • Other factors must also be involved. • Sporulating clostridial organisms, which have
whereas chronic disease occurs more commonly Enterotoxin-related damage cannot be the the appearance of safety pins, may be seen
in middle-aged to older animals. sole explanation for this disorder because on fecal cytology (3-5 organisms/field on oil
enterotoxin has been identified in the feces immersion). However, the presence of these
RISK FACTORS of normal animals. organisms does not confirm that Clostridium
Any stressors to the gastrointestinal (GI) tract, is the primary cause of the clinical disease.
abrupt dietary change, chronic antibiotic use DIAGNOSIS • Anaerobic fecal cultures will typically identify
or underlying GI disease high concentrations of C. perfringens.
Diagnostic Overview • Other available diagnostic tests include
CONTAGION AND ZOONOSIS Definitive diagnosis is challenging. The diag- ELISA enterotoxin assays and polymerase
May be contagious; zoonotic potential unknown nosis may be supported with fecal bacterial chain reaction (PCR) enterotoxin genotyping.
cultures, but in most cases, the transient nature
ASSOCIATED DISORDERS of the illness means that a definitive diagnosis TREATMENT
May be associated with other enteric diseases, is neither achieved nor clinically necessary.
including parvovirus (p. 760), inflammatory C. perfringens may be cultured from healthy Treatment Overview
bowel disease (p. 543), or acute hemorrhagic animals. The disease often presents as an Therapeutic goals are to provide supportive
diarrhea syndrome (p. 259) antibiotic-responsive diarrhea, but response is care and eliminate large-bowel diarrhea. Most
not sufficient for a diagnosis. can be treated as outpatients, but patients
Clinical Presentation that are systemically ill, dehydrated, or have
DISEASE FORMS/SUBTYPES Differential Diagnosis electrolyte abnormalities should be hospitalized.
C. perfringens type A • All causes of large-intestinal diarrhea, both Supportive care should be directed toward cor-
primary GI and systemic/nonprimary GI recting volume deficits, correcting electrolyte
HISTORY, CHIEF COMPLAINT forms, need to be considered (pp. 1213 disturbances, and reducing intestinal discomfort
Some or all may be present. and 1215). (including vomiting) so the patient will be more
• Large-intestinal diarrhea is most common. ○ Primary GI disease includes parasites, comfortable and eat.
Small volumes of feces, increased frequency inflammatory bowel disease, neoplasia,
of defecation, and straining are common, and fungal disease, idiopathic colitis, and Acute General Treatment
mucus and/or fresh blood may be visualized histiocytic ulcerative colitis. • Treatment with intravenous crystalloid
in the feces. Vomiting and flatulence may ○ Systemic/extraintestinal causes of acute solutions to correct volume deficits is very
be present in some patients. Many patients diarrhea include pancreatitis, anxiety/ important. In severe cases, colloids may also
show no clinical signs other than diarrhea. nervousness, other intraabdominal disorders, be used to complement crystalloid therapy.
• A small number of patients may also have and intoxications (e.g., organophosphates). • The use of antimicrobials is generally
small-bowel diarrhea marked by large beneficial. Options include amoxicillin or
volumes of watery feces and abdominal Initial Database ampicillin 20 mg/kg PO q 8h, clindamycin
discomfort. Fecal analysis is very important in all cases of 10-20 mg/kg PO q 12h, tylosin 5-10 mg/kg
• The majority of patients are not systemically large-bowel diarrhea and may yield important PO q 12h, or metronidazole 15-20 mg/kg
ill but have GI signs due to Clostridia or clues to the problem, even if the diagnosis is PO q 12h for 5-7 days.. Parenteral antibiotics
concurrent disease. elusive. with anaerobic bactericidal activity (e.g.,
• CBC, biochemical profile, urinalysis, fecal ampicillin 20 mg/kg IV q 6-8h) are indicated
PHYSICAL EXAM FINDINGS flotation: generally unremarkable if the patient is systemically ill.
• Findings are nonspecific and relate to large- • Fecal ELISA to rule out Giardia or other
intestinal diarrhea. There may be abdominal pathogens Chronic Treatment
discomfort during palpation. There may • Fecal smear with new methylene blue, Wright • Long-term antimicrobial therapy may be
also be signs of pain, along with blood and or Diff-Quick stain for safety-pin–appearing required along with dietary management.

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