SAVED
File name .JPG
File alt. text
Image should be px wide x px tall.
Select Image
home - Colon - Colonic Infection - Clostridium Difficile Written by Dr Sebastian Zeki
Knowledge

Recognises the range of important inflammatory conditions of the
intestine other than inflammatory bowel disease
Knows the range of potential aetiologies including infection and
ischaemia
Understands how diverticular disease can give rise to complications mini-CEX, SCE 1
Knows how diseases can affect the peritoneum and how such
conditions can present both in the acute and chronic situation
Knows the range of both acute and chronic intestinal infections and
their various presentations
Knows the means of investigations of infectious diseases and
understands the principles and use of antimicrobial therapy

Skills
Makes a full clinical assessment of patients presenting with infective
and inflammatory conditions
Recognises the potential urgency of the clinical situation. Selects
appropriate investigations and treatments

Behaviours
Manages patients with inflammatory and infective conditions carefully,
competently and sympathetically.

Clostridium Difficile

Colitis -Clostridium difficile ( Clostridium difficile is an anaerobic gram-positive, spore-forming, toxin-producing bacillus ) InfantHigh carriageNo symptoms Atypical presentations:A long latency.Megacolon with ileus minimal diarrhoea.Acute surgical abdomen.Relapsing diarrhoea/post infectious.Hypoalbuminaemia and ascites.Associated with IBD.Toxin negative. AdultHealthy1-2% carriage Fulminant Colitis Death 1/3 asymptomatic. 1-2 weeks post antibiotics 1.3% 10% Histological features:Epithelial necrosis with exudate of neutrophils.Volcano lesion.Pseudomembraneous colitis. tcdD-tcdB-tcdE-tcdA tcdCExpressed in late log and stationery stage HOLINEnzyme translocation receptorDomain domain binding domain - + Ga1Beta1-4 G1cNacDisaccharide receptor ph 5.2-6 NH4Cl - Low pH alternatemolecule therefore can attack membrane Disruption of normal flora: Especially clindamycin/ other antibiotics Klean-Prep PEG feeding GI surgery Acquisition Of Organism Virulent Strain Host Susceptibility Environment c diff= Spore forming organism TcdA (enterotoxin) TcdB (cytotoxin) Inhibit glycosylation ofrho ra Cdc4L(ras super family of gpases) DISEASE Heat, acid, antibiotic resistant sporesIntra-colonic spores then produce toxin Criteria for Severe Disease Risk factors:Same as risks for c. diff acquisition Simple ADAD no PMC PMC Diarrhoea Toxin A Toxin B Pathology Rho family proteins are involved in cytoskeleton structure and signal transduction via (GTP). Leads to cell retraction and apoptosisDisrupts intercellular tight junctions Toxin A Causes inflammation leading to intestinal fluid secretion, mucosal injury and inflammation Toxin B 10x more than toxin A in mediat-ing colonic mucosal damage Advanced age(inc risk x10)Severe illnessGastric acid suppressionCancer chemotherapy Hematopoietic stem cell transplantation Hospitalization Severity associations:Advanced age.The presence of cancer.Lung disease.Chronic renal failure.Immunosuppression.Increased haematocrit.Hypoalbuminaemia.Tube feeding. Unhealthy - 15-20% carriage a) Definition 1:WBC >20,000 cells/microL Increased serum [creat]b) Definition 2:Age >60 years;T>38.3ºC;Albumin <25 g/L;WBC >15,000 cells/uL within 48hrs;Pseudomembranesc) Definition 3:≥10 BO/dayWBC ≥20,000 cells/microL or severe abdominal pain 20% relapse (50% reinfection)- occur 1-2 wks to months after recovery.65% chance of further relapse after 1st relapse Written by Dr Sebastian Zeki

Related Stories

Laparoscopic management of advanced epithelial ovarian cancer after neoadjuvant chemotherapy: a phase II prospective multicenter non-randomized trial (the CILOVE study)

Overexpression of CD47 inhibits apoptosis of SW480 human colon cancer cells by blocking Fas/FasL pathway

Short-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution

Bile acid-independent protection against Clostridioides difficile infection

Outcome of adult patients receiving parenteral support at home: 36 years' experience at a tertiary referral centre