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Encyclopedia > Clostridium difficile
Clostridium difficile
C. difficile colonies on a blood agar plate.
C. difficile colonies on a blood agar plate.
Scientific classification
Kingdom: Bacteria
Division: Firmicutes
Class: Clostridia
Order: Clostridiales
Family: Clostridiaceae
Genus: Clostridium
Species: C. difficile
Binomial name
Clostridium difficile
Hall & O'Toole, 1935

Clostridium difficile or CDF/cdf' (commonly mistaken pronunciation , alternatively and correctly pronounced [klɒsˈtrɪdiəm dɪˈfɪsɪli]) (also referred to as C. diff or C-diff) is a species of bacteria of the genus Clostridium which are gram-positive, anaerobic, spore-forming rods (bacillus).[1] C. difficile is the most significant cause of pseudomembranous colitis,[2] a severe infection of the colon, often after normal gut flora is eradicated by the use of antibiotics. Treatment is by stopping any antibiotics and commencing specific anticlostridial antibiotics, e.g. metronidazole. Image File history File links Clostridium_difficile_01. ... An agar plate streaked with microorganisms isolated from a deep-water sponge. ... Scientific classification or biological classification is a method by which biologists group and categorize species of organisms. ... Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ... Classes Bacilli Clostridia Mollicutes The Firmicutes are a division of bacteria, most of which have Gram-positive cell wall structure. ... Orders The Clostridia are a class of Firmicutes, including Clostridium and other similar genera. ... Families Acidaminococcaceae Clostridiaceae Eubacteriaceae Heliobacteriaceae Lachnospiraceae Peptococcaceae Peptostreptococcaceae Syntrophomonadaceae The Clostridiales are an order of Clostridia bacterium, containing eight families. ... Genera Acetanaerobacterium Acetivibrio Acidaminobacter Alkaliphilus Anaerobacter Anaerotruncus Anoxynatronum Bryantella Caldanaerocella Caloramator Caloranaerobacter Caminicella Candidatus Arthromitus Clostridium Coprobacillus Dorea Ethanologenbacterium Faecalibacterium Garciella Guggenheimella Hespellia Linmingia Natronincola Oxobacter Parasporobacterium Sarcina Soehngenia Sporobacter Subdoligranulum Tepidibacter Tepidimicrobium Thermobrachium Thermohalobacter Tindallia The Clostridiaceae are a family of the Clostridia, and contains the Clostridium genus. ... Species Clostridium acetobutylicum Clostridium aerotolerans Clostridium botulinum Clostridium colicanis Clostridium difficile Clostridium formicaceticum Clostridium novyi Clostridium perfringens Clostridium sordelli Clostridium tetani Clostridium piliforme Clostridium tyrobutyricum etc. ... This article does not cite any references or sources. ... Image File history File links Clostridium difficile. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Species Clostridium acetobutylicum Clostridium aerotolerans Clostridium botulinum Clostridium colicanis Clostridium difficile Clostridium formicaceticum Clostridium novyi Clostridium perfringens Clostridium sordelli Clostridium tetani Clostridium piliforme Clostridium tyrobutyricum etc. ... Gram-positive bacteria are those that are stained dark blue or violet by gram staining, in contrast to gram-negative bacteria, which are not affected by the stain. ... Aerobic and anaerobic bacteria can be identified by growning them in liquid culture: 1: Obligate aerobic bacteria gather at the top of the test tube in order to absorb maximal amount of oxygen. ... An endospore is a dormant, tough, non-reproductive structure produced by a small number of bacteria from the Firmicute family. ... Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. ... It has been suggested that this article or section be merged with Large intestine. ... Escherichia coli, one of the many species of bacteria present in the human gut. ... Staphylococcus aureus - Antibiotics test plate. ... Metronidazole (INN) (IPA: ) is a nitroimidazole anti-infective drug used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. ...

Contents

Bacteriology

Clostridia are motile bacteria that are ubiquitous in nature and are especially prevalent in soil. Under the microscope after Gram staining, they appear as long drumsticks with a bulge located at their terminal ends. Clostridium difficile cells are Gram positive. Clostridium shows optimum growth when plated on blood agar at human body temperatures. When the environment becomes stressed, however, the bacteria produce spores that tolerate the extreme conditions that the active bacteria cannot. First described by Hall and O'Toole in 1935, "the difficult clostridium" was resistant to early attempts at isolation and grew very slowly in culture.[3] Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ... Loess field in Germany Surface-water-gley developed in glacial till, Northern Ireland Technically, soil forms the pedosphere: the interface between the lithosphere (rocky part of the planet) and the biosphere, atmosphere, and hydrosphere. ... Gram staining is a method for staining samples of bacteria that differentiates between the two main types of bacterial cell wall. ... Gram-positive Bacillus anthracis bacteria (purple rods) in cerebrospinal fluid sample. ... An agar plate is a sterile Petri dish that contains agar plus nutrients, and is used to culture bacteria or fungi. ... 1935 (MCMXXXV) was a common year starting on Tuesday (link will display full calendar). ...


C. difficile is a commensal bacterium of the human intestine in a minority of the population. Patients who have been staying long-term in a hospital or a nursing home have a higher likelihood of being colonized by this bacterium. In small numbers it does not result in disease of any significance. Antibiotics, especially those with a broad spectrum of activity, cause disruption of normal intestinal flora, leading to an overgrowth of C. difficile. This leads to pseudomembranous colitis. In ecology, commensalism is an interaction between two living organisms, where one creature benefits and the other is neither harmed nor helped. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine (or colon). ... This is a biological article: For a territory administered by another territory see: Colony For a group attempting to affiliate with a Fraternity or Sorority see: Colony (fraternity) In biology, a colony (from Latin colonia) refers to several individual organisms of the same species living closely together, usually for mutual... numerous beneficial bacterial microorganisms found in the lower intestine ... Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. ...


C. difficile is resistant to most antibiotics. It flourishes under these conditions. It is transmitted from person to person by the fecal-oral route. Because the organism forms heat-resistant spores, it can remain in the hospital or nursing home environment for long periods of time. It can be cultured from almost any surface in the hospital. Once spores are ingested, they pass through the stomach unscathed because of their acid-resistance. They change to their active form in the colon and multiply. Staphylococcus aureus - Antibiotics test plate. ... Many diseases can be passed when fecal particles from one host are introduced into the mouth of another potential host. ... For the record label, see Hospital Records. ... Rest home for seniors in Český Těšín, Czech Republic SNF redirects here. ...


It has been observed that several disinfectants commonly used in hospitals may fail to kill the bacteria, and may actually promote spore formation. However, disinfectants containing bleach are effective in killing the organisms[4]. This is an article about antimicrobial agents. ... Commercial chlorine bleach To bleach something, is to remove or lighten its color, sometimes as a preliminary step in the process of dyeing; a bleach is a chemical that produces these effects, often via oxidation. ...


Pseudomembranous colitis caused by C. difficile is treated with antibiotics, for example, vancomycin, metronidazole, bacitracin or fusidic acid. Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. ... Crystal structure of a short peptide L-Lys-D-Ala-D-Ala (bacterial cell wall precursor, in green) bound to vancomycin (blue) through hydrogen bonds. ... Metronidazole (INN) (IPA: ) is a nitroimidazole anti-infective drug used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. ...


Toxins

Pathogenic C. difficile strains produce various toxins. The most well-characterized are enterotoxin (toxin A) and cytotoxin (toxin B).[1] These two toxins are both responsible for the diarrhea and inflammation seen in infected patients, although their relative contributions have been debated by researchers. Another toxin, binary toxin, has also been described, but its role in disease is not yet fully understood.[5] This article or section does not cite any references or sources. ... This page is a candidate to be moved to Wiktionary. ... As citotoxinas sao umas cenas que matam as células. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...


Role in disease

With the introduction of broad-spectrum antibiotics in the latter half of the twentieth century, antibiotic-associated diarrhea became more common. Pseudomembranous colitis was first described as a complication of C. difficile infection in 1978,[6] when a toxin was isolated from patients suffering from pseudomembranous colitis and Koch's postulates were met. A broad-spectrum antibiotic is an antibiotic that is affective against many forms of bacteria. ... Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Year 1978 (MCMLXXVIII) was a common year starting on Sunday (link displays the 1978 Gregorian calendar). ... Kochs postulates (or Henle-Koch postulates) are four criteria designed to establish a causal relationship between a causative microbe and a disease. ...


Clostridium Difficile Infection (CDI), can range in severity from asymptomatic to severe and life threatening, and many deaths have been reported, especially amongst the aged. People are most often infected in hospitals, nursing homes, or institutions, although C. difficile infection in the community, outpatient setting is increasing. Clostridium difficile associated diarrhea (aka CDAD) has been linked to use of broad-spectrum antibiotics such as cephalosporins and clindamycin, which are frequently used in hospital settings. Frequency and severity of C. difficile colitis remains high and seems to be associated with increased death rates. Immunocompromised status and delayed diagnosis appear to result in elevated risk of death. Early intervention and aggressive management are key factors to recovery. For the record label, see Hospital Records. ... Rest home for seniors in Český Těšín, Czech Republic SNF redirects here. ... The cephalosporins, are a class of β-lactam antibiotics. ... Clindamycin (rINN) (IPA: ) is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. ...


The rate of Clostridium difficile acquisition is estimated to be 13 percent in patients with hospital stays of up to two weeks and 50 percent in those with hospital stays longer than four weeks.


Increasing rates of community-acquired Clostridium difficile-associated infection/disease (CDAD) has also been linked to the use of medication to suppress gastric acid production: H2-receptor antagonists increased the risk twofold, and proton pump inhibitors threefold, mainly in the elderly. It is presumed that increased gastric pH, (alkalinity), leads to decreased destruction of spores.[7] Gastric acid is, together with several enzymes and the intrinsic factor, one of the main secretions of the stomach. ... An H2-receptor antagonist, often shortened to H2-antagonist, is a drug used to block the action of histamine on parietal cells in the stomach, decreasing acid production by these cells. ... Proton pump inhibitors (or PPIs) are a group of drugs whose main action is pronounced and long-lasting reduction of gastric acid production. ... The correct title of this article is . ...


Prevention

Treatment with various oral supplements containing live bacteria has been studied in efforts to prevent Clostridium difficile-associated infection/disease. A randomized, double- blind, placebo-controlled study using a probiotic drink containing Lactobacillus casei, L bulgaricus, and Streptococcus thermophilus was reported to have some efficacy[8].


Diagnosis and treatment

C. difficile toxin detection as cytopathic effect in cell culture, and neutralized with specific anti-sera is the practical gold standard for studies investigating new CDAD diagnostic techniques. Toxigenic culture , in which organisms are cultured on selective medium and tested for toxin production remains the gold standard and is the most sensitive and specific test, although it is slow and labour-intensive.[9] Assessment of the A and B toxins by enzyme-linked immunoabsorbant assay (ELISA) for toxin A or B (or both) has a sensitivity of 63-99% and a specificity of 93-100%. In adults, the absence of diarrhea, exposure of antibiotics or absence of abdominal pain has a negative predictive value of 94% in hospitalized patients. Experts recommend sending as many as three samples to rule-out disease if initial tests are negative. This strategy may not be necessary given the high sensitivity and specificity of the ELISA test. Stool leukocyte measurements and stool lactoferrin levels have also been proposed as diagnostic tests, but may have limited diagnostic accuracy.[10] C. difficile toxin should clear from the stool of previously infected patients if treatment is effective. Image File history File links Broom_icon. ... In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ... Elisa (born Elisa Toffoli on 19 December 1977) is an Italian singer and solo artist, writing and performing within several genres, notably rock, blues, soul and ambient. ... See: Sensitivity (electronics) Sensitivity (human) Sensitivity (tests) For sensitivity in finance, see beta coefficient This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... In binary testing, e. ... Binary classification is the task of classifying the members of a given set of objects into two groups on the basis of whether they have some property or not. ... White Blood Cells is also the name of a White Stripes album. ... Lactoferrin is a globular protein found in milk and many mucosal secretions such as tears. ...


There has been debate about the emergence of a resistant strain: certain strains that express only the B toxin are now present in many hospitals and caution as to ordering both toxins should occur, in that many laboratories only test for the more prevalent toxin A. This can contribute to a delay in obtaining laboratory results, which is often the cause of prolonged illness and poor outcomes. Often clinicians begin treatment before results have come back based on clinical presentation to prevent such occurrences. Knowledge of the local epidemiology of intestinal flora of a particular institution can guide therapy. Many persons will also be asymptomatic and colonized with Clostridium difficile. Treatment in asymptomatic patients is controversial, also leading into the debate of clinical surveillance and how it intersects with public health policy. Clinical surveillance (or Syndromic Surveillance) refers to the systematic collection, analysis, and interpretation of health data about a clinical syndrome that has a significant impact on public health, which is then used to drive decisions about health policy and health education. ...


Patients should be treated as soon as possible when the diagnosis of Clostridium difficile colitis (CDC) is made to avoid frank sepsis or bowel perforation. In a recent study, a patient who received a diagnosis of CDC on the basis of CT scan had an 88% probability of testing positive on stool assay. Wall thickening is the key CT finding in this disease. Once colon wall thickening is identified as being >4 mm, ancillary findings of pericolonic stranding, ascites, and colon wall nodularity increase the specificity of CDC with additive effects. Using criteria of >=10 mm or a wall thickness of >4 mm and any of the more-specific findings does not add significantly to the diagnosis but gives equally satisfactory results. Patients who have antibiotic-associated diarrhea who have CT findings diagnostic of CDC merit consideration for treatment on that basis. Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ...


In those patients that develop systemic symptoms of CDC, colectomy may improve the outcome if performed before the need for vasopressors. A vasoconstrictor, also vasopressor or simply pressor, is any substance that acts to cause vasoconstriction (narrowing of the lumena of blood vessels) and usually results in an increase of the blood pressure. ...


Fecal bacteriotherapy, a procedure related to probiotic research, has been suggested as a potential cure for the disease. It involves infusion of bacterial flora acquired from the feces of a healthy donor in an attempt to reverse bacterial imbalance responsible for the recurring nature of the infection. It has a success rate of nearly 95% according to some sources.[11][12][13] Fecal bacteriotherapy is a promising new treatment for patients suffering from pseudomembranous colitis, ulcerative colitis and Crohns disease. ...


Pharmacotherapy

Three antibiotics are effective against C. difficile. Metronidazole 500mg orally three times daily is the drug of choice, because of superior tolerability, lower price and comparable efficacy. Oral vancomycin 125 mg four times daily is second-line therapy, but is avoided due to theoretical concerns of converting intestinal flora into vancomycin resistant organisms. However, it is used in the following cases: no response to oral metronidazole; the organism is resistant to metronidazole; the patient is allergic to metronidazole; the patient is either pregnant or younger than 10 years of age; the patient is critically ill because of C. difficile diarrhea (the duration of diarrhea is reduced to 3 versus 4.6 days with metronidazole). Vancomycin must be administered orally because IV administration does not achieve gut lumen minimum therapeutic concentration. The use of linezolid may be considered too. Metronidazole (INN) (IPA: ) is a nitroimidazole anti-infective drug used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. ... Crystal structure of a short peptide L-Lys-D-Ala-D-Ala (bacterial cell wall precursor, in green) bound to vancomycin (blue) through hydrogen bonds. ... Linezolid is a synthetic systemic antibiotic drug. ...


It has been known that drugs traditionally used to stop diarrhea worsen the course of C. difficile-related pseudomembranous colitis. Loperamide, diphenoxylate and bismuth compounds are indeed contraindicated, because slowing of fecal transit time is thought to result in extended toxin-associated damage. Cholestyramine, a powder drink occasionally used to lower cholesterol, is effective in binding both Toxin A and B, and slows bowel motility and helps prevent dehydration.[14] The dosage can be 4 grams daily, to up to four doses a day: caution should be exercised to prevent constipation, or drug interactions, most notably the binding of drugs by cholestyramine, preventing their absorption. A last-resort treatment in immunosuppressed patients is intravenous immunoglobulin (IVIG).[14] Loperamide, usually as hydrochloride, is a drug effective against diarrhea resulting from gastroenteritis or inflammatory bowel disease. ... On opiod agonist used for the treatment of diarrhea. ... General Name, Symbol, Number bismuth, Bi, 83 Chemical series poor metals Group, Period, Block 15, 6, p Appearance lustrous reddish white Atomic mass 208. ... Cholestyramine (Questran®, Questran Light®, Cholybar®) is a bile acid sequestrant, which binds bile in the gastrointestinal tract to prevent its reabsorption. ... Immunosuppression is the medical suppression of the immune system. ... Intravenous immunoglobulin (IVIG) is a blood product administered intravenously. ...


Recurrence

The evolution of protocols for patients with recurrent C. difficile diarrhea also present a challenge: there is no known proper length of time or universally accepted alternative drugs with which one should be treated. However, re-treatment with metronidazole or vancomycin at the previous dose for 10 to 14 days is generally successful. The addition of rifampin to vancomycin also has been effective. Prophylaxis with competing, nonpathogenic organisms such as Lactobacillus spp. or Saccharomyces boulardii has been found to be helpful in preventing relapse in small numbers of patients (see, for example, Florastor, or Lactinex). It is thought that these organisms, also known as probiotics, help to restore the natural flora in the gut and make patients more resistant to colonization by C. difficile. Rifampicin (INN) or rifampin (USAN) is an antibiotic drug of the rifamycin group. ... Species L. acidophilus L. brevis L. delbrueckii subsp. ... Binomial name Saccharomyces boulardii Henri Boulard Saccharomyces boulardii is a tropical strain of yeast first isolated from lychee and mangosteen fruit in 1923 by French scientist Henri Boulard. ... Binomial name Henri Boulard Saccharomyces boulardii is a tropical strain of yeast first isolated from lychee and mangosteen fruit in 1923 by French scientist Henri Boulard. ... Lactinex is used to replace good bacteria in your intestines and colon. ...


Notable outbreaks

On June 4, 2004, two outbreaks of a highly virulent strain of this bacterium were reported in Montreal, Quebec and Calgary, Alberta, in Canada. Sources put the death count as low as 36 and as high as 89, with approximately 1,400 cases in 2003 and within the first few months of 2004. C. difficile infections continued to be a problem in the Quebec health care system in late 2004. As of March 2005, it had spread into the Toronto, Ontario area, hospitalizing 10 people. One died while the others were being discharged. This article needs cleanup. ... Calgary is a city in the province of Alberta, Canada. ... ← - 2005 : January - February - March - April - May - June - July - August - September - October - November - December- → Deaths in March • 31 – Terri Schiavo • 30 – Mitch Hedberg • 29 – Johnnie Cochran • 27 – Wilfred Bigelow • 26 – Paul Hester • 26 – James Callaghan • 21 – Jeff Weise • 21 – Bobby Short • 19 – John De Lorean • 18 – Gary Bertini • 17 – George F... Template:Hide = Motto: Template:Unhide = Diversity Our Strength Image:Toronto, Ontario Location. ...


A similar outbreak took place at Stoke Mandeville Hospital in the United Kingdom between 2003 and 2005. The local epidemiology of C. difficile may offer clues on how its spread may relate to the amount of time a patient spends in hospital and/or a rehabilitation center. It also samples institutions' ability to detect increased rates, and their capacity to respond with more aggressive hand washing campaigns, quarantine methods, and availability of yoghurt to patients at risk for infection. Stoke Mandeville Hospital is a large hospital in Aylesbury, Buckinghamshire, England. ... Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. ...


It has been suggested that both the Canadian and English outbreaks were related to the seemingly more virulent 027 strain of bacterium. This strain has also been implicated in an epidemic at two Dutch hospitals (Harderwijk and Amersfoort, both 2005). A theory for explaining the increased virulence of 027 is that it is a hyperproducer of both toxin A and B, and that certain antibiotics may actually stimulate the bacteria to hyperproduce. Harderwijk is a municipality and a city in the eastern Netherlands. ... Amersfoort is a municipality and the second largest city of the province of Utrecht in central Netherlands. ...


On December 2, 2005, The New England Journal of Medicine, in an article spearheaded by Drs. Vivian Loo, Louise Poirier, and Mark Miller, reported the emergence of a new, highly toxic strain of C. difficile, resistant to fluoroquinolone antibiotics, such as Cipro (ciprofloxacin) and Levaquin (levofloxacin), said to be causing geographically dispersed outbreaks in North America.[15] The Centers for Disease Control in Atlanta has also warned of the emergence of an epidemic strain with increased virulence, antibiotic resistance, or both.[16] is the 336th day of the year (337th in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... Quinolones and fluoroquinolones form a group of broad-spectrum antibiotics. ... Ciprofloxacin is the generic international name for the synthetic antibiotic manufactured and sold by Bayer Pharmaceutical under the brand name Cipro® (and other brand names in other markets, e. ... Levofloxacin is relatively new fluoroquinolone antibiotic, marketed by Ortho-McNeil under the brand name Levaquin. ... The Centers for Disease Control and Prevention (CDC) in Atlanta is recognized as the lead United States agency for protecting the public health and safety of people by providing credible information to enhance health decisions, and promoting health through strong partnerships with state health departments and other organizations. ... This article is about the state capital of Georgia. ...


As one analyzes the pool of patients with the spores, many who are asymptomatic will pass the organism to individuals who are immunocompromised and hence, susceptible to increasing rates of diarrhea and poor outcome. It seems notable that the clusters described above represent a challenge to epidemiologists trying to understand how the illness spreads via the convergence of information technology with clinical surveillance. Information and communication technology spending in 2005 Information technology (IT), as defined by the Information Technology Association of America (ITAA), is the study, design, development, implementation, support or management of computer-based information systems, particularly software applications and computer hardware. ... Clinical surveillance (or Syndromic Surveillance) refers to the systematic collection, analysis, and interpretation of health data about a clinical syndrome that has a significant impact on public health, which is then used to drive decisions about health policy and health education. ...


On October 1, 2006, the bacteria was said to have killed at least 49 people at hospitals in Leicester, England over eight months, according to a National Health Service investigation. Another 29 similar cases were investigated by coroners.[17] A UK Department of Health memo leaked shortly afterwards revealed significant concern in government about the bacterium, described as being "endemic throughout the health service"[18] is the 274th day of the year (275th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... Leicester city centre, looking towards the Clock Tower Leicester (pronounced ) is the largest city and unitary authority in the English East Midlands. ... Motto (French) God and my right Anthem No official anthem specific to England — the anthem of the United Kingdom is God Save the Queen. See also Proposed English National Anthems. ... , the information in this article describes the current English public health service. ... A coroner is either the presiding officer of a special court, a medical officer, or an officer of law responsible for investigating deaths, particularly those happening under unusual circumstances. ...


On October 27, 2006, the bacteria was attributed to 9 deaths in Quebec, Canada.[19] is the 300th day of the year (301st in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ...


On November 18th, 2006, the bacteria was reported to have been responsible for 12 deaths in Quebec, Canada. This 12th reported death was only two days after the St. Hyacinthe's Honoré Mercier announced that the outbreak was under control. 31 patients were diagnosed with Clostridium difficile and four (as of Sat. Nov 18th) were still under observation. Cleaning crews took measures in an attempt to clear the outbreak.[20]


On February 27, 2007, a new outbreak was identified at Trillium Health Centre in Mississauga Ontario, where 14 people were diagnosed with the bacteria. The bacteria was the same strain as the one in Quebec. Officials were not been able to determine if C. difficile was responsible for deaths of four patients over the prior two months.[21] is the 58th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ...


Cracking of the genetic code of the Quebec strain

On December 14, 2005, researchers at McGill University in Montreal, Quebec, led by Dr. Ken Dewar and Dr. Andre Dascal and in collaboration with province-organized NPO Genome Quebec's research facility, announced they had cracked the genetic code of the highly virulent Quebec strain of C. difficile. This was accomplished by using ultra high-throughput sequencing technology. The tests involved doing 400,000 DNA parallel sequencing reactions which took the bacterium's genome apart and reassembled it so it could be studied.[15][22] is the 348th day of the year (349th in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... McGill University is a publicly funded, co-educational research university located in the city of Montreal, Quebec, Canada. ... This article needs cleanup. ... NPO can refer to: NPO UK Ltd. ...


It is expected this will allow quicker detection of the disease and better treatment.


References

  1. ^ a b Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill, pp. 322-4. ISBN 0-8385-8529-9. 
  2. ^ Pseudomembranous Colitis. eMedicine. WebMD (1 July 2005). Retrieved on 2007-01-11.
  3. ^ Hall I, O'Toole E (1935). "Intestinal flora in newborn infants with a description of a new pathogenic anaerobe, Bacillus difficilis". Am J Dis Child 49: 390. 
  4. ^ "Cleaning agents 'make bug strong'", BBC News Online, 3 April 2006. Retrieved on 2007-01-11. 
  5. ^ Barth H, Aktories K, Popoff M, Stiles B (2004). "Binary bacterial toxins: biochemistry, biology, and applications of common Clostridium and Bacillus proteins". Microbiol Mol Biol Rev 68 (3): 373-402, table of contents. PMID 15353562. 
  6. ^ Larson H, Price A, Honour P, Borriello S (1978). "Clostridium difficile and the aetiology of pseudomembranous colitis". Lancet 1 (8073): 1063-6. PMID 77366. 
  7. ^ Dial S, Delaney J, Barkun A, Suissa S (2005). "Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease". JAMA 294 (23): 2989-95. PMID 16414946. 
  8. ^ Hickson M, D'Souza A, Muthu N, Rogers T, Want S, Rajkumar C, Bulpitt C, (29 June 2007 epub ahead of print). "Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial". BMJ. 
  9. ^ Murray PR, Baron EJ, Pfaller EA, Tenover F, Yolken RH (editors) (2003). Manual of Clinical Microbiology, 8th ed, Washington DC: ASM Press. ISBN 1-55581-255-3. 
  10. ^ Vaishnavi C, Bhasin D, Kochhar R, Singh K (2000). "Clostridium difficile toxin and faecal lactoferrin assays in adult patients". Microbes Infect 2 (15): 1827-30. PMID 11165926. 
  11. ^ Schwan A, Sjölin S, Trottestam U, Aronsson B (1983). "Relapsing clostridium difficile enterocolitis cured by rectal infusion of homologous faeces.". Lancet 2 (8354): 845. PMID 6137662. 
  12. ^ Paterson D, Iredell J, Whitby M (1994). "Putting back the bugs: bacterial treatment relieves chronic diarrhoea.". Med J Aust 160 (4): 232-3. PMID 8309401. 
  13. ^ Borody T (2000). ""Flora Power"-- fecal bacteria cure chronic C. difficile diarrhea.". Am J Gastroenterol 95 (11): 3028-9. PMID 11095314. 
  14. ^ a b Stroehlein J (2004). "Treatment of Clostridium difficile Infection". Curr Treat Options Gastroenterol 7 (3): 235-239. PMID 15149585. 
  15. ^ a b Loo V, Poirier L, Miller M, Oughton M, Libman M, Michaud S, Bourgault A, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson T, Horn R, René P, Monczak Y, Dascal A (2005). "A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality". N Engl J Med 353 (23): 2442-9. PMID 16322602. 
  16. ^ McDonald L (2005). "Clostridium difficile: responding to a new threat from an old enemy". Infect Control Hosp Epidemiol 26 (8): 672-5. PMID 16156321. 
  17. ^ Trust confirms 49 superbug deaths - BBC News
  18. ^ Nigel Hawkes (11th January 2007). Leaked memo reveals that targets to beat MRSA will not be met. The Times. Retrieved on 2007-01-11.
  19. ^ C. difficile blamed for 9 death in hospital near Montreal. cNews (11th January 200). Retrieved on 2007-01-11.
  20. ^ 12th person dies of C. difficile at Quebec hospital - CBC News
  21. ^ [1]
  22. ^ Scientists map C. difficile strain - Institute of Public Affairs, Montreal

Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 11th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 11th day of the year in the Gregorian calendar. ... JAMA, published continuously since in 1883, is an international peer-reviewed general medical journal published 48 times per year. ... The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ... BBC News is the department within the BBC responsible for the corporations news-gathering and production of news programmes on BBC television, radio and online. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 11th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 11th day of the year in the Gregorian calendar. ... CBC redirects here, as this is the most common use of the abbreviation. ...

Further reading

  • Dallal R, Harbrecht B, Boujoukas A, Sirio C, Farkas L, Lee K, Simmons R (2002). "Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications". Ann Surg 235 (3): 363-72. PMID 11882758. 
  • Martin S, Jung R (2005). Gastrointestinal infections and enterotoxigenic poisonings. In: Pharmacotherapy: A Pathophysiologic Approach (DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors)., 6th ed., McGraw-Hill, pp. 2042-2043. ISBN. 
  • McDonald L, Killgore G, Thompson A, Owens R, Kazakova S, Sambol S, Johnson S, Gerding D (2005). "An epidemic, toxin gene-variant strain of Clostridium difficile". N Engl J Med 353 (23): 2433-41. PMID 16322603. 
  • Yamada T; Alpers DH (editors) (2003). Textbook of Gastroenterology, 4th ed., Lippincott Williams & Wilkins, pp. 1870-1875. ISBN 0-7817-2861-4. 
  • van den Hof S, van der Kooi T, van den Berg R, Kuijper E, Notermans D (2006). "Clostridium difficile PCR ribotype 027 outbreaks in the Netherlands: recent surveillance data indicate that outbreaks are not easily controlled but interhospital transmission is limited". Euro Surveill 11 (1): E060126.2. PMID 16801713. 
  • Sunenshine R, McDonald L (2006). "Clostridium difficile-associated disease: New challenges from an established pathogen". Cleveland Clinic J. Med. 73: 187. 

See also

// Nosocomial infections are those which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patients original condition. ...

External links


  Results from FactBites:
 
Clostridium difficile - Wikipedia, the free encyclopedia (1899 words)
difficile is a commensal bacterium of the human intestine in a minority of the population.
Clostridium difficile overgrowth has been linked to use of broad-spectrum antibiotics such as cephalosporins and clindamycin, which are frequently used in hospital setting.
"Clostridium difficile and the aetiology of pseudomembranous colitis".
  More results at FactBites »

 
 

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