Description of Clostridium Difficile
Clostridium difficile, otherwise known as C. diff, is a species of spore-forming, anaerobic, gram-positive bacteria that is known to cause watery diarrhea. 1 The genus name, Clostridium refers to the spindle shape of the organism while Difficile means difficult in Latin due to the fact that this organism thrives in unfavorable conditions and is very difficult to isolate.4 The incidence of getting CDI has increased over the years due to new strains of increased toxin production of the bacteria and increased resistance to antibiotics.2 It is a gastrointestinal infection, and the most common cause of infectious diarrhea.1 C. difficile was first identified in the feces of healthy newborns back in the 1930’s and by 1935, it was considered normal flora. 2 During 1974, researchers conducted that about 21% of patients that were treated with an antibiotic called clindamyacin reported diarrhea and about 10% of them reported to have conducted pseudomembranous colitis as a side effect of this treatment. 2 It was in 1978 where C. diff had been known to cause anti-biotic associated diarrhea and pseudomembranous colitis. 2 It is known to form spores that resist many disinfectants; it also survives for several months on different surfaces.1 It is a common form of a nosocomial infection and the prevalence of becoming infected with C. diff is about 0-15% in a health care setting. 3 The spores survive well in environments such as soil, water and animals and is distributed worldwide. 4 CDI produces two toxins (Toxin A and B), which are cytotoxic and cause tissue necrosis.4
C. difficile is highly contagious and is transmitted through the fecal-oral route. 2 It also known to develop right after antibiotic use. Using antibiotics beforehand disrupts the normal flora contained in the intestines, which therefore promotes the proliferation of the C. diff bacteria. 2 The most common antibiotics associated with CDI include fluoroquinolones, penicillins and cephalosporins. Other factors that may increase the risk of getting an infection include increasing age; the use of a nasogastric tube and other related GI procedures and surgeries. 2 Since C. diff infections are a common nosocomial infection, constant exposure to healthcare workers increase the risk of transmitting this bacteria. 2 The most common places to find C. diff spores are toilets, commodes and 33% of hospital rooms that are occupied by someone who is asymptomatic of the infection. 2 Therefore, C. diff is most likely found in the stools of an asymptomatic hospital patient. 3 Spores survive from weeks to months on the surface of toilets, sinks and bed rails of hospital settings. 2
Virulence Factors and Mechanism of Pathogenicity
The spectrum of the severity of CDI starts off as benign diarrhea, which eventually progresses to colitis and pseudomembranous colitis. 3 It can also lead to complicated cases such as fever, shock, leukocytosis and ICU admission 3...