Clostridium Difficile Diarrhea

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Clostridium Difficile Diarrhea

• Hasan Askari, MD

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Clostridium Difficile Diarrhea

• Classification
• Spore forming gram positive rod
• Disease
• Antibiotic associated pseudomembranous colitis

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Clostridium Difficile Diarrhea

• Transmission
• Carried in GIT of 3 of general population
• Up to 30 of hospitalized patients become
  colonized
• Fecal-Oral Route
• Hands of hospital personnel are important
  intermediary

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Clostridium Difficile Diarrhea

• Pathogenesis
• Antibiotics suppress drug sensitive normal flora
• C. difficile multiplies in the GIT
• Produces Exotoxin A and Exotoxin B

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Clostridium Difficile Diarrhea

• Exotoxin A (enterotoxin)
• mechanism of action is unknown.
• causes outpouring of fluid and thus a watery
  diarrhea
• Exotoxin B (cytotoxin)
• damages colonic mucosa leading to pseudomembrane
  formation
• mechanism is via ADP-ribosylation of Rho (a
  GTP-BP)
• this causes depolymerization of actin in the
  cytoskeleton

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Clostridium Difficile Diarrhea

• Clinical S/Sx
• History of antibiotic use (especially PCN or
  Ceph)
• Acute onset of diarrhea, non bloody, 50 cases
  Neut.
• Pseudomembrane (yellow-white plaques) on colonic
  mucosa
• Toxic Megacolon may occur
• Death may occur

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Clostridium Difficile Diarrhea

• Diagnosis
• Pseudomembrane on sigmoidoscopy
• Presence of exotoxin B in cell cultures ? cell
  death and Inhibition of cytotoxicity by specific
  antibody (routinely used)
• ELISA for exotoxins A B
• Stool Culture

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Clostridium Difficile Diarrhea

• Treatment
• Metronidazole
• 500 mg t.i.d. PO else IV (1-2 weeks), or
• 250 mg. PO TID for 10 days (PO is better route)
• Vancomycin
• 125 mg PO q 6 hrs
• Restrict its use due to antibiotic resistance
  especially VRE (VR enterococci)

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Clostridium Difficile Diarrhea

• Relapse
• Recurrent C. difficile colitis occurs in up to
  20 of patients
• One relapse makes additional relapses more common
• Treatment of relapse
• Therapeutic approaches for recurrent disease
  include another (longer) course of metronidazole
  or pulsed or tapered administration of vancomycin
• Prevention
• Primary only
• No vaccines or medications