Clostridium difficile infection (CDI) involves:
Bacterial Infection: Transmission occurs through spores of C. difficile, which can survive in the environment and resist disinfection.
Colonization and Toxin Production: In the colon, C. difficile spores germinate into vegetative cells that produce toxins (Toxin A and Toxin B).
Toxin Effects: Toxins cause inflammation and damage to the intestinal lining, leading to diarrhea and colitis.
Complications: Severe cases can lead to pseudomembranous colitis, toxic megacolon, sepsis, and death.
Clinical Evaluation
Symptoms: Assessment of symptoms such as watery diarrhea (often with a foul odor), abdominal pain, fever, and leukocytosis.
Physical Examination: Examination findings may include abdominal tenderness and signs of dehydration.
Diagnostic Tests: Stool tests for C. difficile toxins (GDH and toxin enzyme immunoassays, PCR), sigmoidoscopy or colonoscopy with biopsy if needed.
Watery diarrhea, often with a characteristic foul odor.
Abdominal cramping and pain.
Fever and systemic signs of infection.
Dehydration and electrolyte imbalances.
Treatment aims to eliminate the infection and manage symptoms:
Antibiotics: Oral vancomycin or fidaxomicin for mild to moderate cases; oral vancomycin or intravenous metronidazole for severe cases.
Supportive Care: Fluid and electrolyte replacement, discontinuation of other antibiotics if possible, and symptomatic relief.
Fecal Microbiota Transplant (FMT): Considered for recurrent or refractory cases to restore healthy gut microbiota.
Infection Control: Strict adherence to hand hygiene and contact precautions to prevent transmission in healthcare settings.