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CLOSTIRIDIUM DIFFICILE (Difficulty in isolation) (PATHOGENESIS…
CLOSTIRIDIUM DIFFICILE
(Difficulty in isolation)
obligate anaerobic, gram +ve, spore forming bacillus, unique colonic disease-
pseudomembranous colitis
association with prolonged antimicrobial use
PATHOGENESIS
Prolonged hospital stay
Prolonged antimicrobial use
:- Cephalosporin, Clindamycin, Ampicilllin, Fluroquinolones
Antibiotic:- vancomycin, metronidazole
Toxin production
:- A & B secreted in intestine -> glycosylate GTP binding protein that regulate cellular acting cytoskeleton -> disrupt cytoskeleton result in loss of cell shape, adherence and disrupt epithelial cell Barrier -> diarrhoea and pseudomembrane formation
Host immune response may determine outcome of infection
:- Person developing strong IgG response to Toxin A- become asymptotic carrier
person with inadequate IgG response to Toxin A- develop disease
older age, underlying illness, intestinal surgery, use of electronic rectal thermometers and antacid treatment
Clinical manifestation
Diarrhea
(most common), fever, abdominal pain, leukocytosis, Blood in stool (uncommon)
Pseudomembrane
:- composed of necrotic leukocytosis, fibrin, mucus, and cellular debris
:star: appears as whites-yellow plaque of size ranging from 1-2 mm size to large enough to speed over entire colonic mucosa
relapse after treatment is common and seen in 15-30% cases
Laboratory Diagnosis
Stool culture
:- anaerobic condition , 37°C for 24-48 hours, selective media CCFA & CCYA
Toxin demonstration
:- cell culture cytotoxin test on stool ( highly specific but time consuming)
enzyme immunoassay for toxin A or A&B in stool-rapid but not sensitive
enzyme immunoassay detecting common glutamate dehydrogenase antigen in stool found in toxigenic strain of C. difficile - more sensitive
PCR detecting C. difficile toxin B gene in stool - highly specific & sensitive
Colonoscopy
: highly specific if pseudomembrane are seen , sensitivity low
Histopathology
:- done by hematoxylin and eosin stain
Prevention
:checkered_flag:
improve hospital hygiene
Avoid using contaminated electronic thermometers
Use of hypochlorite solution for decontamination of patient's room
reducing risk of infection if organism is already transmitted