Clostridioides Difficile

Question 1

What does clostridium difficile do?

Answer 1

• Bowel infection

Question 2

What are the pathogens for c.difficile?

Answer 2

• Gram positive rods with spores
• Anaerobic bacillus
• Found in the bowel microflora

Question 3

Who is at risk of c.difficile?

Answer 3

• Elderly
• Hospitalisation
• Severe illness
• Immunocompromised
• Gastric acid suppression
• IBD
• Antibiotics - suppressing competing flora

Question 4

How is c.difficile spread?

Answer 4

• Direct contact

* Faecal-oral spread

Question 5

How does c.difficile cause damage?

Answer 5

• Damaged epithelial cells leads to - fluid secretion, neutrophil adhesion and local inflammation

Question 6

What are the mild symptoms of c.difficile?

Answer 6

• Diarrhoea
• Mucus / blood in the stool
• Fever
• Abdominal pain

Question 7

What are the severe symptoms of c.difficile?

Answer 7

• Leukocytosis
• Increased creatinine
• Colitis

Question 8

What are the tests for c.difficile?

Answer 8

• Stool assays
• Enzyme assay for glutamate dehydrogenase
• PCR
• Enzyme immunoassay for toxins

Question 9

What are the treatments for c.difficile?

Answer 9

• Stop antibiotics
• Metronidazole - can’t kill spores
• Vancomycin - inhibits cell wall synthesis
• Quarantine patient

Question 10

What are the complications with c.difficile?

Answer 10

• Hypotension
• Shock
• Sepsis
• Relapse - 20-27%

Question 11

What are the properties of c.difficile spores?

Answer 11

• Resistant to heat
• Resistant to antibiotics
• Germinate in bile acids