Clostridium Difficile

Question 1

Common Facts about Clostridium Difficile:

Answer 1

•Gram positive spore-forming rod

•Reservoir:

–Soil

–Colonizes GI tract of healthy individuals

–Hospitals: spores contaminate surfaces *

Question 2

Case Presentation of clostridium difficil

Answer 2

Case Presentation of clostridium difficil

• An 84-year-old man is hospitalized for a course on intravenous clindamycin to treat an abcess.
• One week later, he develops profuse heme-positive diarrhea, nausea, and malaise.
• He is febrile (38.8oC). Physical examination reveals abdominal tenderness and distension. The WBC count is elevated with a differential of 91% neutrophils.
• Sigmoidoscopy reveals 0.2-2cm raised, adherent, yellow plaques.

Question 3

How is Clostridium Difficile transmitted?

Answer 3

•Transmission: ingestion of spores

–Contaminated hands

Question 4

True or False.

Clostridium Difficile is an antibiotic-associated GI tract disease

Answer 4

True.

•Hospitalized pts on antibiotics

•Disease ranges from –

–Mild, self-limited diarrhea *

–Pseodomembranous colitis *

–Fulminant colitis

Question 5

Clostridium Dificile colitis results from:

Answer 5

•Clostridium difficile colitis results from:

–Disturbance of normal bacterial flora of colon

–Colonization by C.difficile

–Release of toxins→ mucosal inflammation, damage

•Antibiotic therapy key factor that alters colonic flora*

•Primarily in hospitalized patients*

–Received/ currently receiving antibiotic therapy*

Question 6

How does C. defficile set up infection in GI tract?

Answer 6

How does it set up infection in GI tract ?

Ingestion of spores→ organism colonizes colon→ antibiotics wipe out normal flora of GI tract→ C.difficile overgrowth → toxins→ mucosal inflammation and damage

Question 7

Cl. Difficile produces two toxins. What are they?

Answer 7

Produces 2 toxins:

•Enterotoxin

•Cytotoxin

Question 8

What conditions does Cl. Difficile cause?

Answer 8

Diseases caused:

•Mild, self-limiting diarrhea *

•Pseudomembranous colitis *

–Bloody diarrhea, abdominal pain, fever

Question 9

Antibiotic-associated Pseudomembranous colitis:

Answer 9

•Symptoms:

–Fever, abdominal cramps, bloody stools

•Colonoscopy/sigmoidoscopy shows:

–Yellowish patches on the mucosa

•Follows prolonged use of broad spectrum antibiotics

–Associated with these antibiotics:

• Clindamycin
• Cephalosporins
• Penicillins
• Fluoroquinolones

•# 1 inducer of Antibiotic-asscoiated colitis = Clindamycin

•#2 inducer = cephalosporins

Question 10

What does Pseudomembranous colitis- C. Difficile look like?

Answer 10

Question 11

Cl. Difficile- Diagnosis

Answer 11

Stool culture + toxin detection

•Stool exam for toxin production *

–Enyme-immuno assay (EIA) *

–Cytotoxin assay *

Question 12

Cl. Difficile- Treatment

Answer 12

Treatment: * *

• Mild disease – discontinue antibiotic treatment patient is receiving
• Mild to moderate colitis

–Metronidazole or

–Oral vancomycin

•Severe disease – combined therapy

–Metronidazole + vancomycin