Clostridium infection

Question 1

Why was C difficile named the way it was?

Answer 1

Due to difficulties in culture

Question 2

Describe Clostridium difficile?

Answer 2

• Gram positive rod
• Produces exotoxin which causes intestinal damage
  
  • Can lead to pseudomembranous colitis

Question 3

Signs of C. difficile?

Answer 3

• Diarrhoea
• Abdominal pain
• Raised CRP, WCC
• Low albumin

Question 4

Predictors of fulminant C. diff colitis?

Answer 4

• >70 yrs old
• Past C. diff infections
• Use of anti-peristaltic drugs

Question 5

Treatment of C. difficile?

Answer 5

• 1st line:
  
  • Oral Metronidazole for 2 weeks
• Severe:
  
  • Oral Vancomycin / Fidaxomicin
• Life-threatening disease:
  
  • Oral vancomycin + IV metronidazole
• Urgent colectomy if toxic megacolon occurs

Question 6

What is a big complication of clostridium difficile?

Answer 6

• Pseudomembranous colitis
  
  • Swelling and inflammation of the colon due to overgrowth of clostridium difficile

Question 7

Treatment for reccurrent C. difficile?

Answer 7

• Fidoximicin
• Faecal transplantation

Question 8

Describe Faecal transplantation?

Answer 8

• Introduction of suspension prepared from faeces of a screened donor
• Via NG tube

Question 9

Describe the prevention of C. difficile spread?

Answer 9

• Meticulous cleaning
• Appropriate bed management policies
• Use of disposable gloves, aprons and stethoscopes
• Hand washing (soap and water not alcohol gel)

Question 10

Describe Clostridium perfringens (type A)?

Answer 10

• Gram positive anaerobe
• Produces enterotoxin
• Cause of gastroenteritis
• Spores survive cooking and germinate during unrefridgerated storage

Question 11

Describe the diagnosis of Clostriium perfringens (type A)?

Answer 11

• Stool toxin
• Quantification of faecal bacteria

Question 12

Describe the treatment of Clostridium perfringens?

Answer 12

Supporive

Question 13

Describe the use of testing for c. difficile antigen and toxin?

Answer 13

• Toxin positive
  
  • Bacteria is actively replication and is likely cause of the diarrhoea
• Antigen positive (in isolation)
  
  • Bowel is colonised with c. difficile
  • Not necessarility the cause of the diarrhoea

Question 14

Risk factors for developing C difficile?

Answer 14

• Clindamycin
• 2nd and 2rd generation cephalosporins
• Protein pump inhibitors

Question 15

Non-antibiotic risk factors for C difficile?

Answer 15

Protein pump inhibitors

Question 16

Describe the diagnosis of Clostridium difficile?

Answer 16

• Detecting C. diff toxin (CDT) in stool
• C. diff antigen only shows exposure to bacteria rather than current infection