Clostridium difficile Characteristics v Now called Clostridioidis difficile

Clostridium difficile Characteristics v Now called Clostridioidis difficile v Gram - Positive v Shape – Bacillus v Motility – None v Oxygen Requirements Obligate anaerobe v Catalase – Negative v Forms endospores v Virulence Factors v Toxin A v Destroys the brush border of the gut mucosa causing diarrhea v Toxin B v Disrupts the cytoskeleton causing necrosis and formation of pseudomembranes Epidemiology and Risk Groups Ø Worldwide Ø Often normal flora of the GI tract Ø Endospores can be found in all hospital rooms Ø Associated with hospital stays Ø Associated with clindamycin and other antibiotic treatment Ø Associated with proton-pump inhibitors Transmission q Direct Contact with spores in environment q Often an normal flora resident, when the normal flora are killed this opportunistic bacteria will over grow causing symptoms Symptoms o Diarrhea o Often nosocomial infection, antibiotic-associated diarrhea, opportunistic infection o Severe watery diarrhea with a very distinctive smell o Mortality at <40% o Pseudomembranous colitis o Fever, abdominal pain, foul-smelling diarrhea o Exudates composed of fibrin, mucin, and PMNs attach to the mucosal surface o Consequence of the release of cytokines o Can lead to toxin megacolon, perforation, and death Diagnosis § Smell § Toxin detection in stool via ELISA § Glutamate dehydrogenase, Toxin A or Toxin B § No culture because this is often a normal flora resident Treatment ü Extremely difficult to treat and control ü 1. Metronidazole ü Recommended first line by European Society of Clinical Microbiology and Infectious Disease ü 2. oral vancomycin ü For severe cases ü Oral because IV doesn’t get into the gut well ü Recommended first line by most medical associations in the U. S. ü Stool transplant ü When antibiotics failed this is attempting to reestablish the normal flora ü Is 90% effective, but choosing the correct donor, timing, dosage is all still under investigation