Clostridium Infection

Question 1

What are the different types of Clostridia bacteria?

Answer 1

C.perifringes
C.botulinum
c. difficile
C. Tetani

Question 2

Describe features of C perfringes infections

Answer 2

It produces a toxin which causes gas gangrene (myonecrosis) and haemolysis.
This presents with tender, odematous skin with haemorrhagic blebs and bullae.

Question 3

Describe features of C. botulinum toxins

Answer 3

Typically found in canned foods and honey. It prevents Ach release leading to flaccid paralysis

Question 4

Describe features of C.difficile

Answer 4

It causes psudomembranous colitis. Typically seen after the use of a broad spectrum antibiotics.
Produces an exotoxin and a cytotoxin

Question 5

Describe features of C.tetani

Answer 5

It produces an exotoxin that prevents the release of glycine from Renshaw cells in the spinal cord resulting in spastic paralysis

Question 6

What is the presentation of C. difficle infection

Answer 6

Watery diarrhoea, abdominal pain, leukocytosis (raised WCC but normal CRP) and a history of recent antibiotic use

Question 7

Who should be investigated for a C. difficle infection

Answer 7

Patients with unexplained new-onset diarrhoea (3 or more unformed stools in 24 hours)

Question 8

What are the investigations for a C. difficile infection?

Answer 8

• Stool sample PCR to detect C. difficile toxin

Question 9

Which antibiotics are common culprits for causing C. difficile infections?

Answer 9

• Clindamycin,
• Ciprofloxacin
• Ceftriaxone
• Tazocin
• Meropenam

Question 10

What are the risk factors for C. difficile infections?

Answer 10

• Recent abx treatment,
• Stays in healthcare settings,
• Age > 65,
• Underlying health conditions such as IBD,
• Immunosupression
• Taking a PPI

Question 11

What is the management for the first episode C. difficle infections?

Answer 11

First line therapy is oral vancomycin for 10 days.
Second line is oral fidaxomicin
Keep patient in a side room and ensure you wash hands with soap and water

Question 12

What is the treatment for recurrent C. difficile infections?

Answer 12

Oral Fidaxomicin

Question 13

What is the treatment of life threatening C. difficile

Answer 13

Oral vancomycin and IV metronidazole.

Question 14

What are some other therapies for C. difficile infections?

Answer 14

• Bezlotoxumab (monoclonal antibody which targets C. difficile)
• Fecael microbiota transplant (may be considered for patients who’ve had 2 or more previous episodes)

Question 15

What are the severe complications of C. difficile infections?

Answer 15

• Massive colonic inflammation characterized by psudomembrane of immune cells, mucus and necrotic tissue
• Colonic distention,
• Entracolonic manifestations eg, bacteraemia.
• Systemic toxicity/sepsis

Question 16

What is the presentation of botulism?

Answer 16

Clinical syndrome characterized by cranial nerve palsies, oculobulbar weakness and descending symmetrical flaccid paralysis in the absence of a fever

Question 17

What is the treatment of botulism?

Answer 17

Botulism antitoxin (only effective if given early) and supportive care.