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Questions and Answers
What is the primary mode of transmission for Clostridioides difficile?
What is the primary mode of transmission for Clostridioides difficile?
Which of the following describes the severity of C.difficile infection characterized by an increase in white cell count greater than 15 x 10^9/L and severe colitis?
Which of the following describes the severity of C.difficile infection characterized by an increase in white cell count greater than 15 x 10^9/L and severe colitis?
What is considered the first-line treatment for a first episode of C.difficile infection?
What is considered the first-line treatment for a first episode of C.difficile infection?
Which clinical feature is NOT typically associated with Clostridioides difficile infection?
Which clinical feature is NOT typically associated with Clostridioides difficile infection?
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In cases of recurrent C.difficile infection occurring within 12 weeks, what is the preferred treatment?
In cases of recurrent C.difficile infection occurring within 12 weeks, what is the preferred treatment?
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Study Notes
Clostridioides difficile Overview
- Clostridioides difficile is a Gram-positive, anaerobic, spore-forming bacillus linked to pseudomembranous colitis.
- Transmission occurs via the faecal-oral route through spores, which can survive in harsh environments.
- Pathogenicity is primarily due to exotoxins A and B, which cause colitis and subsequent inflammation.
- Commonly triggered by antibiotics that disrupt normal gut flora, with clindamycin and certain cephalosporins being significant culprits.
Key Risk Factors
- Increased risk associated with the use of broad-spectrum antibiotics.
- Use of proton pump inhibitors also predisposes individuals to infection.
Clinical Features
- Presents with symptoms such as diarrhoea and abdominal pain.
- Elevated white cell count (WCC) is a common feature; severe cases may exhibit toxic megacolon or ileus.
Public Health England Severity Scale
- Mild: Normal WCC with 3-5 loose stools per day.
- Moderate: Elevated WCC below 15 x 10^9/L.
- Severe: Elevated WCC over 15 x 10^9/L, increased creatinine (> 50% above baseline), fever (T > 38.5°C), and severe colitis.
- Life-threatening: Symptoms include hypotension, ileus, and toxic megacolon.
Diagnosis
- Confirmation of infection is achieved through stool testing for C.difficile toxin (CDT).
- Detection of C.difficile antigen indicates prior exposure but does not confirm active infection.
Management Summary
- Discontinuation of unnecessary antibiotics is crucial.
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First Episode:
- First line: Oral vancomycin for a duration of 10 days.
- Second line: Oral fidaxomicin.
- Third line: Oral vancomycin with or without IV metronidazole.
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Recurrent Episode:
- If recurred within 12 weeks, use oral fidaxomicin.
- If more than 12 weeks, treatment can include oral vancomycin or fidaxomicin.
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Life-Threatening Cases:
- Combination of oral vancomycin and IV metronidazole recommended.
- Consult with specialists as surgery might be necessary.
Additional Therapies
- Bezlotoxumab: Targets toxin B; however, not deemed cost-effective by NICE.
- Faecal microbiota transplant: Considered for patients with two or more recurrent episodes.
Prevention Strategies
- Emphasize patient isolation until they are diarrhoea-free for at least 48 hours.
- Use personal protective equipment (PPE), including gloves and aprons, during contact.
- Hand washing with soap and water is critical, as alcohol-based gels are ineffective against spores.
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Description
This quiz covers the essential aspects of Clostridioides difficile, including its clinical features, transmission, and major risk factors associated with infection. It highlights the role of antibiotics in exacerbating the condition and outlines the public health severity scale. Test your knowledge on this important pathogen and its impact on health.
