What’s All the Fuss About Clostridium difficile ? Peter C. Iwen, PhD, D(ABMM) Nebraska Public Health Laboratory [email protected] 402-559-7774 Objectives C. difficile ….the organism Host relationships and pathogenesis Diagnosis Prevention and control Patient management
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From McDonald LC, et al. Emerg Infect Dis. 2006;12(3):409-15
Disturbed colonic microflora
C. difficile exposure & colonize
Toxin A & B
Diarrhea & colitis
“Clostridium difficile is the most common cause of nosocomial infectious diarrhea.”
Clin. J. Med.,
…only toxigenic strains of C. difficile produce disease…
Yellow lesion against
H & E, OM 400x
…if stool samples are obtained after hospital day 3, the only enteric pathogen most labs will test for is…..Clostridium difficile…..
Cell cytotoxin >
Toxin A & B EIA >
Toxin A EIA >
Latex agglutination >
A. 70% alcohol
B. 10% bleach
C. Hot water and soap
D. Phenol solutions
E. Quaternary ammonium compounds
Duration of isolation controversial
…2 days after diarrhea resolves
Surgical consult…perforation, toxic megacolon,
colonic-wall thickening, ascites….
shown to be highly effective….
Collectively referred to as “NAP1/BI/027 strain”
S. Dial, 2005, J. Amer. Med Assoc., 293:2989-2995.
From Dial S, et al. JAMA. 2005;294:2989-2995.