Clostridium difficile

Clostridium difficile; Clostridium comes from the Greek word "kloster" which means she has a
spindle shape when in vegetative form. Difficile represents difficulty to catch bacteria in a culture
because it is too choosy and takes time to grow up with it.
C. difficile is a Gram + spore-forming bacteria which lives in an anaerobic condition, so it needs
an oxygen-free environment to live, like colon. Since its cause, an urgent situation, C. difficile in
practice is detected by the toxin that produces, in the patient's stool.
The Chamber of the secret has opened, C. difficile is the cause of the most intrahospital infection,
and it is also known as "Phantom from the hospital," and "Super Bug." It causes
pseudomembranous colitis or post-antibiotic colitis. There are several types of this bacteria, some
of them are part of our microflora, but only strains that are not pathogenic(friendly species), which
means that the genetic material of the bacteria is not predetermined to produce a toxin.
40000 people die in the USA from C. difficile infection. It is a synonym for hospital infection as
it is hard to exterminate (HCL only kills it)Who is at risk of becoming ill? It usually hits people
with a weakened immune system (older adults), people with (HIV/AIDS) or no immune system
(radiation for cancer). Which would destroy the bone marrow as a site where the cells of the
immune system get formed, and people on broad-spectrum antibiotics use like treating pneumonia
with Penicillin, or Cephalosporins.It especially hits hospitals with a low level of hygiene and
prevention, because of lack of material. Pinpointing the source of infection is hard, and
extermination is even harder, even in best-equipped hospitals. It sounds scary but every single
object in the hospital is a reservoir for this bacteria, even stethoscopes can be mechanical vectors
for transmission. With stationary people, the primary source of infection is healthcare providers.
Okay, but how we can get it?
Bacteria in aerobic conditions have a spore form that can get inhaled, but it only needs anaerobic
environment. So, the main route is the fecal-oral transmission. It is a dirty hands disease. We can
pick up the spores which will turn into vegetative form in our intestines when the conditions are
suitable for(anaerobic environment). Clostridia is also animal pathogen, so today we need to keep
in mind that possibility of transmission. Food and water in hospital canteens also represent the
pathway of transfer. The incubation period is unknown and when a person uses broad-spectrum
antibiotics can be up to 30 days after use. Using a proton pump inhibitors leads easier to infection.
Why it is because older population use it to protect the gastric mucosa from NSAIL medication
which blocks the protective action of prostaglandin.
What are its superpowers that lead to the development of the disease?
C. difficile produces toxin A and toxin B. New species produce binary toxin. Toxin A causes
watery diarrhea, and B is cytotoxic, which makes our mucosa cells less adherent to each other.
They lose connections between the inside of the colon and causes their death. The binary toxin
binds to receptors then get into the cell an endosomal vesicle and create with a lysosome forming
endolysosome. Activation of the binary toxin uses ATP/ADP activated proton pump in the
endolysosome forcing extraction of H+ ions in the cytoplasm from endolysosome, which makes
PH lower than 5.7 which lead to cell death.
Bacteria make a pseudomembranous structure, like yellow firm jelly from cell detritus, so the
vegetative form is practically not available to our immune cell. In that case Healthcare providers
use "Vancomycin" antibiotic like trojan's horse (Van-Vancomycin) so it comes into bacteria cell
wall and prevents its formation. Vancomycin cannot reach the lumen of the colon from blood
because of pseudomembranous structures, so it is administrated orally into a body as it fights the
infection in its very source. The downside of this is that other bacteria's (part of our natural colon
flora) are also affected. Relapses are also possible as C. difficile has increased resistance to almost
all antibiotics.
So, what should we do? How health professionals treat infections except for Vancomycin?
Fight fire with more fire, to provide more friendly species of Clostridia so they can compete for
nutrition and in that manner overload toxin subspecies of clostridia. Another way of treatment is
rePOOPularisaion of microbiota in the gut.
Medications like Metronidazole are also efficient, and Bafilomycin prevents activation of binary
toxin preventing the acidification of endolysosomes and the release of toxins outside it.
In this case, the most common complication is the hypotension because of diarrhea, dehydration
and because of that acute renal failure, hypotensive shock, colon perforation, or toxic megacolon
and hypokalemia which leads to irregular heart rhythm and bradycardia. So, what is the real cure
for this open Pandora's box Do not open it! Prevention is proven best medicine. Highly hygiene
conduct, using new gloves for every patient and washing hands between procedures. Using mask,
caps, control of hospital food cantinas. When an infection is declared in particular department is
to stop it from spreading to other units, especially neonatal care, intensive care and
immunocompromised persons like HIV and oncological units.
Okay, as a quick recap!
C. difficile is a Gram + spore-forming bacteria which lives in anaerobic condition. It causes
pseudomembranous colitis or post-antibiotic colitis. It usually hits people with a weakened
immune system. The main route is the fecal-oral transmission. Food and water in hospital canteens
also represent the pathway of transmission. It is a dirty hands disease. The incubation period is
unknown. C. difficile produces toxin A and toxin B. New species produce binary toxin. Toxin A
causes diarrhea, and B is a cytotoxic. The complication is the hypotension, acute renal failure,
hypotensive shock, colon perforation, or toxic megacolon and hypokalemia. Prevention is proven
best medicine!