Clostridium difficile

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Clostridium difficile:

Clostridium difficile Dr.sonny

Clostridium difficile:

Clostridium difficile Morphology & staining Rod shaped 4-8 x .5 µm Sub terminal or terminal non bulging oval spores Wet film from RCM- oscillating motility

Clostridium difficile:

Clostridium difficile

Clostridium difficile :

Clostridium difficile Component of normal flora of 50 % 0f neonates Disease Pseudo membraneous colitis Antibiotic induced colitis Exacerbation of inflammatory bowel disease Non antibiotic associated diarrhoea

Clostridium difficile:

Clostridium difficile Cultural characters Strict anaerobe Optimum temp 37 0 C BA: glossy greyish, low convex, roughly circular with irregular edge, non hemolytic

Clostridium difficile:

Clostridium difficile

Clostridium difficile:

Clostridium difficile CCFA Cycloserine cefoxitine fructose gar Selective medium Large flat to umbonate yellow with ground glass appearance and filamentous edge Filamentous on gram stain Spores are absent in artificial media Motility is reduced susceptible to oxygen Farmyard smell

Clostridium difficile:

Clostridium difficile CCFA/CCEYA A selective media for the isolation of Clostridium difficile from faecal specimens. D-cycloserine and cefoxitin are used as selective agents. These inhibit most Enterobacteriaceae , enterococci, staphylococci, Gram-negative non-sporing anaerobic bacilli and Clostridium species , except C. difficile . This medium incorporates cholic acid (sodium salt) to enhance spore germination

Clostridium difficile:

Clostridium difficile Biochemical reactions Non hemolytic Sachharolytic Weakly proteolytic Indole negative Lecithinase negative Aesculin is hydrolysed

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C. dificile Virulence Factors

Clostridium difficile:

Clostridium difficile Toxins Entero toxin A & cytotoxin B Cytotoxin B Cytopathic effect on tissue cell monolayers Neutralised by Cl.sordelli anti toxin & Cl.difficile anti toxin

Clostridium difficile:

Clostridium difficile Entero toxin A Weakly cytotoxic Major virulence factor Provokes haemorrhagic dilatation when injected into ligated rabbit ileal loop

Clostridium difficile:

Clostridium difficile Pathogenesis Toxin A - neutrophil chemoattractant Both toxins glucosylate proteins that regulate actin cell cytoskeleton Loss of cell shape, adherence, tight junctions , fluid leak Pseudo membranes contain necoritic leukocytes, fibrin , mucus & cellular debris

Clostridium difficile:

Clostridium difficile Predisposing factors Old age ‘ Severity of illness Electronic rectal thermometres Enteral tube feeding Antacid treatment Gastro intestinal surgery

Clostridium difficile:

Clostridium difficile Predisposing factors Old age ‘ Severity of illness Electronic rectal thermometres Enteral tube feeding Antacid treatment Gastro intestinal surgery

Clostridium difficile:

Clostridium difficile Clinical features Diarrhoea Abdominal pain Fever Leukocytosis Paralytic ileus Toxic mega colon Sepsis

Clostridium difficile:

Clostridium difficile Diagnosis Clinical criteria Diarrhoea with no other recognised cause Detection of toxin A or B Cl.difficile detected by stool culture Pseudo membranes detected by colonoscopy

Clostridium difficile:

Clostridium difficile

Clostridium difficile:

Clostridium difficile Treatment Primary CDAD Discontinue precipitating antibiotics Hydration Avoid anti peristaltic agents & opiates Oral metronidazole, vancomycin Duration 10 days Do not consider treatment failure unless the drug is given for 6 days

Clostridium difficile:

Clostridium difficile Recurrent CDAD vancomycin+lactobacillus/saccharomyces boulardii Vancomycin + synthetic bacterial faecal enema Vancomycin in tapering dose for 21 days & subsequent pulse dosing for several days for 21 days

Clostridium difficile:

Clostridium difficile Vancomycin + rifampicin for 10 days Vancomycin + anion exchange binding resin cholestyramine

Clostridium difficile:

Clostridium difficile Fulminant CDAD Present with toxic mega colon or ileus May not have diarrhoea & mimics acute abdomen Can lead to sepsis Antibiotic history, peripheral leukocytosis Sigmoidoscopy CT

Clostridium difficile:

Clostridium difficile Vancomycin by nasogastric tube or retention enema I.V mteronidazole Surgical intervention

Clostridium difficile:

Clostridium difficile Prevention Restrict the specific antibiotics Prevent person to person transmission by hand washing, gloving while examining infected persons Room should be throughly cleaned when an infected patient is discharged

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