GI infections

Question 2

What is Clostridioides difficile (C. difficile)?

Include type of bacteria

Answer 2

A gram-positive, spore-forming anaerobic bacterium causing antibiotic-associated colitis and diarrhoea.

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Question 3

What are common symptoms of C. difficile infection?

Answer 3

Common symptoms include watery diarrhea (>3 in 24 hrs), abdominal cramping, fever, nausea, and loss of appetite.

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Question 4

What are the risk factors for C. difficile infection? List 4

Answer 4

• Recent antibiotic use,
• PPI use due to suppression of gastric acid
• Prolonged hospitalization,
• older age, weakened immune system, previous C. difficile infections.

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Question 5

How is C. difficile infection diagnosed?

Answer 5

Stool PCR – toxins

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Question 6

What are the treatment options for C. difficile infection?

Answer 6

PO vancomycin 125mg QDS 10 d.
Fluids

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Question 7

What complications can arise from C. difficile infection?

Answer 7

Complications can include severe dehydration/shock/AKI, bowel perforation, pseudomembranous colitis, and toxic megacolon.

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Question 8

How is C. difficile transmitted?

Answer 8

C. difficile is transmitted via the faecal-oral route.

The bacteria form spores that can survive on surfaces for long periods. These spores can be ingested through contaminated hands, surfaces, or food.

Common in healthcare settings

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Question 9

What is the pathophysiology of C. difficile infection?

Answer 9

C. difficile produces toxins (Toxin A and Toxin B) that damage the intestinal lining, leading to inflammation and diarrhea.

Antibiotic use disrupts the normal gut flora, allowing C. difficile to proliferate and produce these toxins.

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Question 10

An elderly patient develops a profuse diarrhoeal illness after a stay to treat bacterial pneumonia. What are your next steps?

Answer 10

Probably C. Diff infection.

Investigate stool culture, and manage infection and symptoms e.g. IV fluid.

Question 11

Are alcohol-based hand sanitisers effective against C. diff?

Answer 11

No. Use water and soap.

Question 12

Where does C. difficile attack?

Answer 12

Colon.

Causes colitis and associated complications i.e. toxic megacolon, pseudomembranous colitis and perforation.

Question 13

General principles of managing and monitoring patients with diarrhoeal illnesses?

Answer 13

• Treat underlying cause
• Pain relief if needed
• Monitor fluid and stool chart
• Daily FBC, inflammatory markers and UnEs

Question 14

When is imaging indicated for patients with diarrhoeal illnesses?

Answer 14

Marked abdominal pain and distension.

X-ray for toxic megacolon
CT for colitis.

Question 15

A C. diff patient’s colon was found to have damaged mucosa developing thickened, scab-like plaques, which are composed of dead cells, white blood cells, and cellular debris.

What is this describing?

Answer 15

Pseudomembranous colitis