1. Clostridium difficile
Presented by: Ebony Porter
School of Medical Technology
Carolinas College of Health Sciences

2. Objectives
Upon completion of this presentation and viewing the display board, the audience will be able to:
Understand the bacteriology behind C. difficile and analyze why it is a cause for concern in the hospital and nursing home environments
Contrast C. difficile’s toxin A and toxin B and the role they play in the development of diseases
Evaluate the tests and methods used to recover or detect C. difficile

3. Objectives
Differentiate the recommended treatments and assess their effectiveness
Summarize the preventative measures used to reduce the spread of the organism in the community and hospital setting
Recall the notable outbreaks of C. difficile

4. Bacteriology gram-positive rod anaerobic spore-forming large (2-17 μm)
produces heat-labile toxins (A & B)
grows on highly selective cefoxitin, cycloserine, egg yolk, and fructose agar

5. C. difficile toxins Toxin A Toxin B enterotoxin 308 kDa
produces acute inflammation, induces fluid secretion, and causes necrosis of the epithelium
Toxin B
cytotoxin
270 kDa
more potent than toxin A

6. More about Clostridium difficile
ubiquitous (soil, air, humans, animals)
termed the “difficult clostridium” by Hall and O’Toole in 1935
causes one of the most widespread and potentially serious illnesses in the hospital and nursing home communities

7. Cause and Transmission
Use of broad-spectrum antibiotics, antiviral, antifungal, and chemotherapy drugs eliminates the “helpful” bacteria
Transmitted via the fecal-oral route in the vegetative state or spores
Rapidly multiplies and produces toxins

8. Symptoms Watery diarrhea Abdominal pain Fever Nausea
Blood and pus in stool
Foul stool odor
Dehydration
Weight loss

9. Diseases and Complications
Clostridium difficile-associated diarrhea (CDAD)
Pseudomembranous colitis (PMC)
Dehydration
Kidney failure
Bowel perforation
Toxic megacolon
Death

10. Diagnosis Enzyme immunoassay kits (EIA) Endoscopy or colonoscopy
Computerized tomography scan

11. Colonoscopy
NORMAL COLON
PMC

12. Risk Factors Antibiotic therapy Elderly Immunocompromised
Abdominal surgery
Chronic colon disease
Extended hospital or nursing home stay

13. Prognosis Excellent for people with a mild case of CDAD
More severe cases of CDAD may need two rounds of treatment
If CDAD goes untreated may lead to complications

14. Treatments Anti-clostridial antibiotics – metronidazole or vancomycin
Probiotics – Saccharomyces boulardii
Colectomy – surgery to remove infected part of the colon

15. Prevention
Hospital staff should wear disposable gloves, gowns, wash hands
Isolate infected patients
Disinfect surfaces and instruments with chlorine bleach
Only use antibiotics when necessary

16. Outbreaks
Quebec strain NAP1/027 – virulent strain responsible for deaths in Quebec, Alberta, Ontario, United Kingdom, England, Ireland, and Finland
New strain BI/NAP1 – contains a different toxin called binary toxin that is quickly emerging in North America

17. Outbreaks

18. References
"Clostridium difficile". Wikipedia. <
Cunha, Burke A.. Infectious Diseases in Critical Care Medicine, 2nd edition. New York: Informa Healthcare USA, Inc., (AHEC)
"General Information about Clostridium difficile Infections". CDC. <
Gronczewski, Craig. "Clostridium Difficile Colitis". Web MD. <
Mayo Clinic Staff, "C. Difficile". Mayo Clinic. <
Scheld, W.M., Craig W.A., and Hughes J.M.. Emerging Infections. Washington, D.C.: ASM Press, (AHEC)
Schroeder, Michael S. "Clostridium Difficile-Associated Diarrhea." American Family Physician 71 (2005).