CLOSTRIDIUM DIFFICILE

CLOSTRIDIUM DIFFICILE

1. Definition:

   • Clostridium difficile (C. difficile)
   • Anaerobic, gram-positive, spore-forming bacterium
   • Commonly known as C. difficile or C. diff

2. Causes:

   • Overuse or misuse of antibiotics
   • Disruption of normal gut flora
   • Exposure to contaminated food, water, or surfaces
   • Poor hand hygiene

3. Types:

   • Strains: Toxin-producing (A/B) and non-toxin-producing
   • Subtypes: BI, BII, NAP1, and others

4. Pathogenesis:

   • → Spores ingested through food or water
   • → Germinate in the colon
   • → Produce toxins (A and B)
   • → Toxins disrupt normal gut function
   • → → Diarrhea, abdominal pain, and weight loss

5. Memory Trick: "Spores → Germinate → Toxins → Trouble"

6. Pathogenesis Steps:

   1. Adhesion: C. difficile adheres to the intestinal mucosa
   2. Colonization: C. difficile colonizes the gut
   3. Toxin production: C. difficile produces toxins A and B
   4. Toxin action: Toxins disrupt normal gut function
   5. Inflammation: Inflammation of the gut lining
   6. Symptoms: Diarrhea, abdominal pain, and weight loss

7. Morphology:

   • Spores: Resistant to heat, drying, and chemicals
   • Vegetative cells: Non-sporulating, gram-positive rods

8. Clinical Features:

   • Diarrhea
   • Abdominal pain
   • Weight loss
   • Fever
   • Blood in stool

9. Complications:

   • Pseudomembranous colitis
   • Toxic megacolon
   • Sepsis
   • Organ failure

10. Diagnosis:

    • Stool testing: PCR, toxin EIA, or culture
    • Endoscopy: Visualization of pseudomembranes
    • Colonoscopy: Biopsy for histopathology

11. Management:

    • Discontinuation of antibiotics
    • Supportive care: Fluids, electrolytes, and nutrition
    • Metronidazole: First-line treatment for mild cases
    • Vancomycin: First-line treatment for severe cases
    • Fecal microbiota transplantation (FMT): Experimental treatment