Clostridium difficile–Associated Diarrhea

Abstract

Clostridium difficile causes 300 000 to 3 000 000 cases of diarrhea and colitis in the United States every year. Antibiotics most frequently associated with the infection are clindamycin, ampicillin, amoxicillin, and cephalosporins, but all antibiotics may predispose patients to C difficile infection. The clinical presentation varies from asymptomatic colonization to mild diarrhea to severe debilitating disease, with high fever, severe abdominal pain, paralytic ileus, colonic dilation (or megacolon), or even perforation. The most sensitive and specific test available for diagnosis of C difficile infection is a tissue culture assay for the cytotoxicity of toxin B. However, this test takes 1 to 3 days to complete and requires tissue culture facilities. Detection of C difficile toxin by means of enzyme-linked immunoassay is more rapid and inexpensive. A minority of patients may require more than 1 stool assay to detect toxin. Oral metronidazole or oral vancomycin hydrochloride for 10 to 14 days are equally effective at resolving clinical symptoms; oral metronidazole is preferred in most cases because of lowered cost and less selective pressure for vancomycin-resistant organisms. Approximately 15% of patients experience relapse after initial therapy and require retreatment, sometimes with an extended, tapering regimen. Immunity appears to be incomplete and predominantly mediated by serum IgG to toxin A. Measures for preventing the spread of the pathogen, appropriate diagnostic testing, and treatment may avert morbidity and mortality due to C difficile-associated diarrhea.

Alternative Splicing in Class V Myosins Determines Association with Rab10

“…The corresponding residues in toxin A are at position 285 and 287, and their change to alanine also inhibited glucosyltransferase activity. 3 All three toxin variants induced the release of 86 Rb ϩ after an acidic pulse from HT-29 cells in a comparable manner (Fig. 3A).…”

Rarity of toxigenic Clostridium difficile infections after hematopoietic stem cell transplantation: implications for symptomatic management of diarrhea

“…Clostridium difficile is the cause of approximately one-quarter of all antibiotic-associated diarrheas, and is the most common cause of nosocomial diarrhea. 1 The development of C. difficile-associated diarrhea is related to the disruption of normal bowel flora and subsequent colonization with C. difficile. This occurs with the use of broad-spectrum antimicrobial agents, antineoplastic agents, and mucositis; risk factors which are prominent in patients undergoing HSCT.…”

“…1 For this reason, many patients are not treated symptomatically until multiple stool specimens have been found to be negative for C. difficile toxin (CDT). This results in significant, and potentially avoidable, morbidity in these patients.…”

Omnipresence of Probiotics in Diversified Clinical Practices

“…The normal gut flora possesses a quality called colonization resistance, which prevents the overgrowth of pathogens; some of these antibacterial effects may be caused by volatile fatty acids and a decrease in pH of the luminal contents [75]. The clinical presentation varies from asymptomatic colonization to mild diarrhea to severe debilitating disease, with high fever, severe abdominal pain, paralytic ileum, colonic dilation (or megacolon), or even perforation [76,77].…”

“…Antibiotics associated diarrhea Lactobacillus GG [119] Enterococcus [76] Saccharomyces boulardii [79] Clostridium difficile associated diarrhea Saccharomyces bouladii [83] Bacteriodes spp [84] Inflammatory bowel disease S. salivarius subsp [89] Bifidobacterium infantis [85] Irritable bowel syndrome Bifidobacterium infantis [85] Colon cancer Bifidobacterium Clostridium perfringers [102] Urinary tract infection Lactobacillus GR-1 [111] Lactobacillus B-54…”