Clostridium Difficile Infection

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Recommended: Chapter 20 pathogenic gram negative bacteria

The bacterium Clostridium difficile is a strictly anaerobic, spore forming, bacillus. It is present as normal flora in the intestines in 3% of healthy adults.1 It forms spores for protection in inhospitable environments. When the spore finds the right environmental factors it develops into the bacterium. The spores can survive on surfaces for months waiting for the right environment to grow and thrive. It is Gram positive so it appears blue or purple when Gram stained and has a thick peptidoglycan cell wall. It produces Toxin A an enterotoxin that causes fluid accumulation and Toxin B a cytotoxin that causes cells to lose their structure and die. Clostridium difficile has an incubation period of anywhere from a week to a month.1 Therefore it may take someone a long time to figure out that they have it and they may have already passed it to someone else. The rate of infection is highest in females and people 85 years of age and older.1
Clostridium difficile infection often causes a disease known as pseudomembranous colitis. It is an inflammation of the intestine caused by Toxin A and B. Cell death and fluid accumulation stimulate the release of histamine and this causes inflammation. It is characterized by foul smelling diarrhea, abdominal pain, and fever. Complications that may arise include dehydration due to loss of water and electrolytes caused by excessive diarrhea, toxic megacolon, and in extreme cases death.2
Clostridium difficile infection usually occurs in people who are being treated with broad-spectrum antibiotics. The antibiotics kill all of the normal flora in the intestines leaving no bacteria to compete with C. difficile. It is then able to colonize and proliferate. It releases Toxin A and Toxin B. Toxin A is an ent...

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...s of normal flora in the intestines causing more competition for space making it hard for C. difficile to flourish. The intestine is put back into homeostasis. The risk for problems associated with antimicrobial use like the development of antimicrobial resistant bacteria are decreased or completely eliminated with the use of stool transplantation making it an effective treatment for Clostridium difficile infection.2

References
1. Headley C. Deadly diarrhea: Clostridium difficile infection. Nephrology Nursing Journal: Journal Of The American Nephrology Nurses' Association [serial on the Internet]. (2012, Nov), [cited March 18, 2014]; 39(6): 459-468.
2. Lofland D, Josephat F, Partin S. Fecal Transplant for Recurrent Clostridium difficile Infection. Clinical Laboratory Science [serial on the Internet]. (2013, July), [cited March 18, 2014]; 26(3): 131-135.

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