Clostridium difficile

 

 

Epidemiology

Five-ten percent of population is colonized.

 

Classification and Characteristics

 

 

 

Virulence Factors

C. difficile produces A and B toxins, also known as enterotoxin and cytotoxin, respectively. Both are responsible for diarrhea and inflammation, altough their relative roles are currently unknown.

 

 

 

Transmission and Infection

Fecal-oral spread of spores; can survive for one month.

Hospitals are one of the most common

 

 

 

Clinical Manifesations

Causes diarrhea diagnosed by clinical history of antibiotic use (especially broad-spectrum clindamycin), coupled with toxin screening.

 

 

 

Diagnosis

C difficile toxin.

 

 

 

Treatment

Antibiotics for anaerobes. Metronidazole first-line for community-acquired C. diff.

Vancomycin orally or IV (125 mg QID) is often used for hospital-acquired C. diff., due to conserns of the NAP1 strain.

 

Relapse rates are high, especially after many infections.

 

There is some evidence that probiotics may be useful in preventing disease-associated symptoms, though ongoing treatment is likely required.