DOI: https://doi.org/10.22263/2312-4156.2024.1.77
I.А. Rutskaya1,2
Ultrasound signs of enterocolitis caused by Clostridioides difficile with different severity of its course in patients with COVID-19
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Vitebsk Regional Clinical Infectious Diseases Hospital, Vitebsk, Republic of Belarus
Vestnik VGMU. 2024;23(1):77-87.
Abstract.
The relevance of Clostridioides difficile (Cl. difficile) colitis has increased with a widespread, often unjustified use of antibacterial drugs in COVID-19.
Objectives. To determine ultrasonographic signs of different severity of Cl. difficile colitis (pseudomembranous colitis) based on the intestine echographic images of patients with COVID-19.
Material and methods. 86 people with verified coronavirus disease (COVID-19) and Cl. difficile colitis (31 men and 55 women) were examined. The diagnosis of coronavirus infection was verified by isolating SARS-CoV-2 RNA by polymerase chain reaction from the mucous membrane of the upper respiratory tract. Clostridioides difficile infection was detected by means of an immunochromatographic test with the determination of microbial toxins in the feces of patients. Ultrasound investigation (US) was performed using convex 3.5-4.0 MHz and linear 9.0-10.0 MHz probes without special preparation of patients for the examination.
Results. According to the ultrasound data the increase of the colon wall thickness has been determined in patients suffering from Cl. difficile colitis with COVID-19. Thickening of the colon wall detected in the severe form of pseudomembranous colitis (PMC) in COVID-19 patients was more significant than in mild and moderate forms of PMC (Me=9.1 mm and Me=5.1 mm, respectively, p<0.0001). The main echographic criterion of severe Cl. difficile colitis in COVID-19 patients was the total colonic wall thickening more than 7.2 mm in any colon segment. The presence of this sign allows to diagnose the severe form of PMC with 90.3% sensitivity and 92.9% specificity. The additional echographic signs of severe Cl. difficile colitis in COVID-19 patients were the appearance of paracolic free fluid and ascitic fluid in various spaces of the abdominal cavity; increased echogenicity and volume growth of pericolic fat surrounding the inflamed colon; broken colonic wall stratification; small bowel wall thickening of more than 3.0 mm; dilatation and paresis of the colon; toxic megacolon.
Conclusions. Intestinal ultrasound in patients having PMC with COVID-19 makes it possible to identify the severe form of Cl. difficile infection.
Keywords: ultrasonography, COVID-19, SARS-CoV-2, pseudomembranous colitis, Clostridioides difficile, colon.
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Information about authors:
I.А. Rutskaya – ultrasound diagnostics doctor, Vitebsk Regional Clinical Infectious Diseases Hospital,
e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Irina А. Rutskaya.
