Clostridium difficile

Clostridium difficile

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Changed on: 23.05.2018
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Clostridium difficile

Clostridium difficile is a member of the group of Gram-positive, anaerobic spore producers. They can be found in the digestive system of humans and animals and can also be isolated in the environment. The spores -- bacterial permanent forms of the pathogen -- are extremely resistant to adverse environmental conditions and keep the bacterium safe from temperatures of more than 100 °C and also from various disinfectants.

This pathogen has become a focus of interest, given the occurrence of the hypervirulent Clostridium difficile strains PCR Ribotype 027 (NAP Type 1) in North America and Europe. Clostridium difficile infections – which can be avoided in most cases –result in additional costs of 3 billion euros at European hospitals per year, according to current estimates.

More information
caption
Clostridium difficile

Clostridium difficile is a member of the group of Gram-positive, anaerobic spore producers. They can be found in the digestive system of humans and animals and can also be isolated in the environment. The spores -- bacterial permanent forms of the pathogen -- are extremely resistant to adverse environmental conditions and keep the bacterium safe from temperatures of more than 100 °C and also from various disinfectants.

This pathogen has become a focus of interest, given the occurrence of the hypervirulent Clostridium difficile strains PCR Ribotype 027 (NAP Type 1) in North America and Europe. Clostridium difficile infections – which can be avoided in most cases –result in additional costs of 3 billion euros at European hospitals per year, according to current estimates.

More information

Transmission

In many cases, the patient is already the carrier of the pathogen. Administering antibiotics results in a shift of the ecological balance of the intestinal flora, which is favourable to Clostridium difficile.  In other cases, the infection is caused by the transmission of Clostridium spores. Often, the transmission is the result of insufficient hygiene in hospitals, which can eventually even lead to epidemics.

Symptoms

Symptoms

Toxin producing Clostridium difficile is responsible for the majority of diarrhoea cases after the administration of antibiotics. Different progression forms are described, based on the severity of the symptoms:

The lightest progression is antibiotic-associated diarrhoea (AAD), which usually ceases following the end of the antibiotics therapy.

C. difficile colitis (CDC) is more problematic, as this infection could end fatally in the worst case, especially together with a toxic megacolon. C. difficile colitis is accompanied by fever, intestinal cramps and severe, partly bloody diarrhoea.

Not all Clostridium difficile isolates possess genes for toxin production. Generally, toxin A and toxin B are responsible for AAD and C. difficile colitis. Little is known about the effects of the binary toxin, which is produced by only 6-10 % of all isolates.

 

 

Therapy

Therapy

The preferred drug is Metronidazol. Vancomycin and Teicoplanin are usually only given if this treatment fails. In a very small number of cases, such as cases of a toxic megacolon, a surgical procedure to remove parts of the colon would be deemed appropriate.

At present, the pathogen is detected mainly using rapid toxin tests on the patient’s stool samples. An attempt to grow the culture from the sample should always be carried out, given the importance of identifying outbreaks.

 

 


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