An Overview Of Clostridium Difficile
Clostridium Difficile
Bacterial Information and Culture
Clostridium difficile, commonly known as C. diff, is a spore-forming, gram-positive, anaerobic bacillus (The Mayo Clinic). Although the active bacteria are gram-positive, the spores are gram-negative (Horridge, et al). Culture of c-diff is performed at normal human body temp, on a blood agar (Nadan). After 48 hours of incubation, isolates resembling C. diff are anaerobically subcultured on a fastidious anaerobe agar. After the final culture, colonies are checked for florescence, and gram stained. Once gram-staining is complete, colonies are placed in broth, and given a final 48 hours to produce toxins. The broth supernatant is tested for toxins (Horridge, et al).
Causes and Risk Factors
C-diff infection is commonly acquired in hospitals and group homes, by people who are on, or have recently been on, antibiotics (The Mayo Clinic). C-diff exists, at undetectable levels, in the normal gut flora, but is contained by “good bacteria”. When normal gut flora is disrupted during antibiotic use, the C-diff is given a chance to multiply, causing disease (The Mayo Clinic).
C-diff can also be contracted via the fecal-oral route when a person, be they a patient or caregiver, comes in contact with surfaces contaminated with C-diff, such as medical equipment, counter tops, toilet seats, etc. (The Mayo Clinic).
A recent study in the United Kingdom has also found that C. diff spores can be present in the air around a patient (OR Manager).
Mechanism of Disease
C-diff produces 2 endotoxins: Endotoxin A, and Enterotoxin B. While Enterotoxin B does not exhibit any overt enterotoxicity, Endotoxin A causes disease by causing hemorrhagic fluid secretion in the intestinal loop, mucosal inflammation, and necrosis of intestinal tissue (Just, et al).
Signs and Symptoms
Signs and symptoms of C. diff include diarrhea, abdominal cramping, and nausea. Severe cases can lead to fever, elevated white blood cell count, indicative of
Bacterial Information and Culture
Clostridium difficile, commonly known as C. diff, is a spore-forming, gram-positive, anaerobic bacillus (The Mayo Clinic). Although the active bacteria are gram-positive, the spores are gram-negative (Horridge, et al). Culture of c-diff is performed at normal human body temp, on a blood agar (Nadan). After 48 hours of incubation, isolates resembling C. diff are anaerobically subcultured on a fastidious anaerobe agar. After the final culture, colonies are checked for florescence, and gram stained. Once gram-staining is complete, colonies are placed in broth, and given a final 48 hours to produce toxins. The broth supernatant is tested for toxins (Horridge, et al).
Causes and Risk Factors
C-diff infection is commonly acquired in hospitals and group homes, by people who are on, or have recently been on, antibiotics (The Mayo Clinic). C-diff exists, at undetectable levels, in the normal gut flora, but is contained by “good bacteria”. When normal gut flora is disrupted during antibiotic use, the C-diff is given a chance to multiply, causing disease (The Mayo Clinic).
C-diff can also be contracted via the fecal-oral route when a person, be they a patient or caregiver, comes in contact with surfaces contaminated with C-diff, such as medical equipment, counter tops, toilet seats, etc. (The Mayo Clinic).
A recent study in the United Kingdom has also found that C. diff spores can be present in the air around a patient (OR Manager).
Mechanism of Disease
C-diff produces 2 endotoxins: Endotoxin A, and Enterotoxin B. While Enterotoxin B does not exhibit any overt enterotoxicity, Endotoxin A causes disease by causing hemorrhagic fluid secretion in the intestinal loop, mucosal inflammation, and necrosis of intestinal tissue (Just, et al).
Signs and Symptoms
Signs and symptoms of C. diff include diarrhea, abdominal cramping, and nausea. Severe cases can lead to fever, elevated white blood cell count, indicative of
Cited: -The Centers for Disease Control and Prevention. Clostidium difficile. 6 Mar 2012. 31 Mar 2014 http://www.cdc.gov/hai/organisms/cdiff/cdiff_faqs_hcp.html -Golan, MD, MSc, Yoav, Lauren Epstein, MD. “Safety and Efficacy of Fidaxomicin in the Treatment of Clostridium difficile Associated Diarrhea.” Therapeutic Advances in Gastroenterology. 2012.5(6): p 395-402: Ebscohost. 31 Mar 2014 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491684/ -Hickson, May. “Probiotics in The Prevention of Antibiotic-Associated Diarrhoea and Clostridium difficile Infection.” Therapeutic Advances in Gastroenterology. May 2011 v 4(3): p 185-197: Ebscohost. 1 Apr 2014 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105609/ -Horridge, Angela D., Mary F. Nulsen, Rosemary Ikram. “An Evaluation of Laboratory Methods for the Diagnosis of Toxigenic Clostridium difficile Infection.” New Zealand Journal of Medical Laboratory Science. P 55-59. 1 Aug 2011: 31 Mar 2014 http://www.thefreelibrary.com/An+evaluation+of+laboratory+methods+for+the+diagnosis+of+toxigenic...-a0266845407 -Just, I., J. Selzer, C. von Eichel-Streiber, K. Aktories. “The Low Molecular Mass GTP-Binding Protein Rho is affected by Toxin A From Clostridium difficile.” The Journal of Clinical Investigation. v 95(3): Ebscohost 31 Mar 2014 http://www.ncbi.nlm.nih.gov/pubmed/7883950 -Lofmark, Sonja, Charlotta Edlund, Carl Erik Nord. “Metronidazole is Still the Drug of Choice for Treatment of Anaerobic Infections.” Oxford Journals. V 50.1. p S16-S23: Ebscohost 10 Mar 2014 < http://www.ncbi.nlm.nih.gov/pubmed/20067388> -The Mayo Clinic. May Foundation for Medical Education and Research. Clostrium difficile Infection. 1998-2014. 31 Mar 2014 < http://www.mayoclinic.org/diseases-conditions/c-difficile/basics/definition/con-20029664> -Nadan, MBA, MS, RN, ACNP-BC, CCRN, CEN, R. “Clostridium difficile.” Northshore LIJ. 1 Apr 2014 < http://www.northshorelij.com/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1247153305123&ssbinary=true>