COVID-19 and Fulminant Clostridium difficile Colitis Co-Infection
  • Abdul Ahad Ehsan Sheikh
    The Wright Center for Graduate Medical Education, Department of Internal Medicine, Scranton, PA, USA
  • Abu Baker Sheikh
    University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA
  • Ishan Shah
    University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA
  • Ali Hamza Khair
    Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  • Nismat Javed
    Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  • Rahul Shekhar
    Division of Hospital Medicine, University of New Mexico School of Medicine, Department of Internal Medicine, Albuquerque, NM, USA


COVID-19, antibiotics, microbial resistance, Clostridium difficile


The development of Clostridium difficile infection in COVID-19 patients is an understudied complication of the disease. Herein, we present the case of a 46-year-old man who developed severe healthcare-associated C. difficile infection leading to toxic megacolon and perforation in the setting of COVID-19 infection. It is important to continue to follow guidelines regarding antibiotics in healthcare settings to prevent such complications.



  • Khanna S, Kraft CS. The interplay of SARS-CoV-2 and Clostridioides difficile infection. Future Microbiol 2021;16:439–443.
  • Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, et al. Coronavirus disease 2019 case surveillance - United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765.
  • Tirlapur N, Puthucheary ZA, Cooper JA, Sanders J, Coen PG, Moonesinghe SR, et al. Diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to Clostridium difficile. Sci Rep 2016;6:24691.
  • Bentivegna E, Alessio G, Spuntarelli V, Luciani M, Santino I, Simmaco M, et al. Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection. Am J Infect Control 2021;49:640–642.
  • Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020;71:2459–2468.
  • Zuo T, Zhang F, Lui GCY, Yeoh YK, Li AYL, Zhan H, et al. Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. Gastroenterology 2020;159:944-955.e8.
  • Huttner BD, Catho G, Pano-Pardo JR, Pulcini C, Schouten J. COVID-19: don't neglect antimicrobial stewardship principles! Clin Microbiol Infect 2020;26:808-810.
  • Granata G, Bartoloni A, Codeluppi M, Contadini I, Cristini F, Fantoni M, et al. The burden of Clostridioides difficile Infection during the COVID-19 pandemic: a retrospective case-control study in italian hospitals (CloVid). J Clin Med 2020;9:3855.
  • Guh AY, Mu Y, Winston LG, Johnston H, Olson D, Farley MM, et al. Burden of Clostridioides difficile infection and outcomes. N Engl J Med 2020;382:1320-1330.
  • Ramalingam S, Gunasekaran K, Arora H, Muruganandam M, Padmanabhan P. Clostridium difficile and noncirrhotic hyperammonnemia in a patient with COVID-19 infection. Cureus 2021;13:e14533.
  • Rokkam VRP, Kutti Sridharan G, Vegunta R, Vegunta R, Boregowda U, Mohan BP. Clostridium difficile and COVID-19: novel risk factors for acute portal vein thrombosis. Case Rep Vasc Med 2021;2021:8832638.
  • Páramo-Zunzunegui J, Ortega-Fernández I, Calvo-Espino P, Diego-Hernández C, Ariza-Ibarra I, Otazu-Canals L, et al. Severe Clostridium difficile colitis as potential late complication associated with COVID-19. Ann R Coll Surg Engl 2020;102:e176-e179.
  • Sandhu A, Tillotson G, Polistico J, Salimnia H, Cranis M, Moshos J, et al. Clostridioides difficile in COVID-19 Patients, Detroit, Michigan, USA, March-April 2020. Emerg Infect Dis 2020;26:2272–2274.
  • Views: 1033
    HTML downloads: 289
    PDF downloads: 461

    Published: 2021-08-24
    Issue: 2021: Vol 8 No 8 (view)

    How to cite:
    Sheikh AAE, Sheikh AB, Shah I, Khair AH, Javed N, Shekhar R. COVID-19 and Fulminant Clostridium difficile Colitis Co-Infection. EJCRIM 2021;8 doi:10.12890/2021_002771.