CLOSTRIDIUM DIFFICILE INFECTION

Ley Qualls
Microbiology Non-sci Majors
April 23, 2019
 CLOSTRIDIUM DIFFICILE INFECTION
 Gastrointestinal disease that causes acute diarrhea, bloating or blood in stool
 Inflammation of the colon (colitis) caused by the bacteria Clostridium difficile ( C. diff)
 Spread by contact

Credit: Guh, Ay; Kutty. PK (2October 2018). “Clostridioides difficile infection”. Annals of international medicine. 169 (7) : ITC49-ITC64
 C. DIFFICILE: ETIOLOGY
 Enteric, Nosocomial bacteria
 Gram-positive, spore-forming bacillus
 Obligate anaerobe
 Infective dose is < 10 spores
 Part of the GI flora in
1-3% of healthy adults
70% of children under 12 months
 Some strains produce toxins A (cytotoxin) and B (enterotoxin).
 Toxigenic strains cause C. difficile infection (CDI) when ingested by a susceptible person.
 CDI ranges from mild, moderate, to severe and even fatal illness .

Credit: Science photo library

 SYMPTOMS AND RISK FACTORS
 Symptoms
Varying levels of watery diarrhea severity
Loss of appetite, fever, abdominal pain and cramping
Pseudomembranous colitis, or toxic megacolon
Recurs in about 20% of patients
 Risk factors
Exposure to healthcare
Broad spectrum antibiotic use
Use of gastric acid suppression medications
Age > 64 years, and comorbidities
Tube feeds and GI surgery
 C. diff spores can survive up to 5 months on surfaces.

Credit: Fotosearch, LLC

 LIFE CYCLE
 Relies on disturbance of normal microbiota to expend in guts
 Spores, the vehicle for transmission
 Resists to a wide range of antibiotics
Erythromycin
Chloramphenicol
Tetracycline

Credit: Orla Geoghegan, Christopher Eades, Luke SP Moore, Mark Gilchrist (2017), “Clinical Pharmacist”
PATHOGENESIS
EXAMPLE
 TREATMENT: FECAL MICROBIOTA
TRANSPLANT
 Stool from healthy donor diluted, filtered, centrifuged
 Method of administration:
1- Nasogastric Tube (NGT)
Risks: vomiting, aspiration
Inexpensive
2- Esophagogastroduodenoscopy (EGD)
Risks: Small Intestine Bacterial Overgrowth
Especially helpful if colon inflamed
3- Rectal enema and colonoscopy
 90% successful in preventing recurrence

© 2018 American Museum of Natural History

 TREATMENT: PHAGE THERAPY
 Use of bacteriophages to treat pathogenic bacterial infections.
Virus infect and kill bacteria
Can be very effective in certain condition
Not harmful to the body
 Limitations
Difficult to accomplish
Narrow host range
Douzaines of phage strains needed for a given infection while 1 to 2 antibiotic would do
May trigger the immune system to overreact
No specific lytic phage has yet been discovered for C. diff
 Used in the food industry
 Not yet approved for people

Credit: Kuchment A (2011), The Forgotten Cure: The Past and Future of Phage Therapy, Springer, ISBN 978-1-4614-0250-3
 You may get C. difficile colitis if you
take antibiotics

A False B True

tekhnologic
 C. difficile are bacteria that can cause all
of the following except:

A Diarrhea B Hearing loss

Abdominal
C Fever D cramp

tekhnologic
 C. difficile is especially common in older
people in hospitals and nursing homes.

A True B False

tekhnologic
 C. difficile bacterium is a:

A Protozoa B Virus

C Prion D Prokaryote

tekhnologic
 C. difficile bacterium is NOT:

A A coccus B Anaerobic

C Spore forming D Gram positive

tekhnologic
QUESTIONS