CLOSTRIDIUM

Question 1

What kind of pathogen is Clostridium?

Answer 1

Bacteria

Question 2

Is Clostridium gram positive or gram negative?

Answer 2

Gram positive

Question 3

What would Clostridium look like on a microscope slide?

Answer 3

Purple bacillus (rods)

Question 4

Does Clostridium require oxygen?

Answer 4

No, it’s anaerobic

Question 5

What are the different strains of Clostridium?

Answer 5

C. Tetani
C. Botulinum
C. difficile
C perfringens
C. septicum
C. sordelli

Question 6

Where does C. tetani originate?

Answer 6

Soil and feces, it is an obligate anaerobe (grows and survives only in absence of O2)

Question 7

How does C. tetani infect the host?

Answer 7

-Toxin mediated, will enter through wounds and travels through the bloodstream/nerves to the CNS
*Rare in the US <100

Can infect:
-Umbilical stump
-Soft tissue injury
-Secondary infection from IV drug use
-Burns
-Septic abortions

Question 8

What kind of symptoms are present in a C.tetani infection?

Answer 8

***Tetanus: lockjaw, facial contractions (these progressive neuro symptoms are treatable and preventable)
-Symptoms will present usually 1 week after injury
-Death can occur from autonomic NS instability/respiratory failure

Question 9

How can C. tetani be treated?

Answer 9

-Prevention/Vaccination (tetanus shot every 10 years!)
-Administer Tetanus immune globulin (for antibodies)
-Metronidazole for soft tissue infection
-Debridement of wound if necessary

Question 10

How can C.botulinum infect a host?

Answer 10

-Improperly canned foods
-Spores in honey (infant ingestion)
-Entry through wounds
-Inhalation
-Iatrogenic (provider can transmit to patients if they don’t take precautions with other C. botulinum + patients)

Question 11

What do the bacilli of C.botulinum and C. difficile form?

Answer 11

Spores

Question 12

What is the pathogenesis of C. botulinum?

Answer 12

Toxin mediated
*uncommon in U.S. <200

Question 13

What is the presentation of C. botulinum?

Answer 13

***Botulism
4 D’s
Dysphagia (difficulty swallowing)
Dysarthria (difficulty speaking)
Diplopia (double vision)
Descending paralysis

-Hyproflexia (absent reflexes)
-Symmetrical paresis (partial paralysis)
-Afebrile (not feverish)
-Ptosis (eyelid drooping)

Question 14

How can you diagnose C.botulinum/Botulism?

Answer 14

Detect the Botulinum toxin in food, vomit, blood

Question 15

How can C. botulinum/Botulism be treated?

Answer 15

-Anti-toxin
-Respiratory support (if not treated quickly, can cause death)
-GI decontamination if food borne/necessary

Question 16

Will colonization of C. difficile always result in disease?

Answer 16

No, it can colonize without causing infection

Question 17

What is the pathogenesis of C. difficile?

Answer 17

-Toxin mediated

Risks for infection: Antibiotic use after an exposure (can wipe out normal gut flora and promote further colonization/infection of C.diff)
***Most common causes: Clindamycin, Quinolones
*Can be caused by PPI’s (proton pump inhibitors/essentially antacids) because they decrease stomach acid production preventing the killing of C. diff when it enters the GI tract

Question 18

Who is most susceptible to C.diff infection?

Answer 18

-People over 65
-Immunocompromised patients
*Most common cause of nosocomial (hospital acquired) diarrhea

Question 19

How does a C. diff infection present?

Answer 19

-Colitis (inflammation of inner colon)
-Toxic megacolon (swelling and inflammation spreading to deeper layers of the colon)
-Sepsis
-Death

Question 20

How can you diagnose a C. diff infection?

Answer 20

-PCR for organisms AND confirm toxin PCR

Question 21

How can you treat C. diff?

Answer 21

-Oral/rectal Vancomycin or Fidaxomicin ($$$)
-Oral Metronidazole (not first line)

For severe infection or if oral route not an option: IV metronidazole

Solid stool: No treatment!

Question 22

What can lead to Infection of C. perfringens, septicum, and sordelli?

Answer 22

-Trauma or septic abortions

Question 23

What kind of anaerobes are C. perfringens, septicum, and sordelli?

Answer 23

Obligate (survive only in the absence of O2)

Question 24

What is the pathogensis of C. perfringens, septicum, and sordelli?

Answer 24

Gas formation in tissues (Gas gangrene) which causes tissue damage

Question 25

How would a C. perfringens, septicum, and sordelli infection present?

Answer 25

Rapid progression of fever, pain, shock, may cause death
-Hemolytic anemia (red blood cells destroyed faster than they are made)
-Renal failure
-DIC (abnormal blood clotting)

Question 26

How can a C. perfringens, septicum, and sordelli infection be treated?

Answer 26

-Surgery
-Clindamycin and Penicillin