Master Clostridium difficile with Picmonic for Medicine

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Clostridium difficile is a gram-positive bacilli of the genus Clostridium, which are anaerobic, spore forming bacteria. This bacteria is known to cause severe diarrhea and other intestinal disease when the normal gut flora is killed by antibiotics, allowing proliferation of Clostridium difficile in the gut. Clostridium difficile releases two toxins that can damage the intestine. Toxin A is an enterotoxin that damages the brush border of the gut, and toxin B is a cytotoxin that induces actin depolymerization, leading to damage of the cytoskeletal structure. Together, these toxins are responsible for the inflammation and diarrhea seen in infected patients. Clostridium difficile infections almost always occur after use of broad-spectrum antibiotics like clindamycin or ampicillin. The use of antibiotics destroy the normal gut flora, allowing the gut to become overrun with C. difficile with release of large amounts of toxin. C. difficile infections are the most common cause of pseudomembranous colitis and can also lead to toxic megacolon in extreme cases. Because this bacteria is part of the normal gut flora in many patients, Clostridium difficile infection should be diagnosed via detection of toxins in the stool as opposed to culture. Treatment includes metronidazole and vancomycin.

14 KEY FACTS

This bacteria stains gram-positive, which means that it retains large amounts of the Gram stain due to its high peptidoglycan content in the cell wall.

This bacteria is rod-shaped.

This bacteria prefers to grow in an anaerobic environment.

Clostridium difficile is known to cause severe diarrhea when the normal gut flora is killed by antibiotics like clindamycin and ampicillin.

Toxin A is an enterotoxin released by Clostridium difficile that damages the brush border of the gut.

Toxin B is a cytotoxin released by Clostridium difficile that induces actin depolymerization, leading to damage of the cytoskeletal structure.

Toxin B is a cytotoxin released by Clostriidum difficile that induces actin depolymerization, leading to damage of the cytoskeletal structure.

Watery diarrhea is a common symptom of C. difficile infection. Any patient in the hospital with new onset of severe watery diarrhea after antibiotic use should be evaluated for a C. difficile infection.

An infection of the colon characterized by foul smelling diarrhea, fever, and abdominal pain. Pseudomembranous colitis is often associated with Clostridium difficile.

In severe cases of pseudomembranous colitis, life-threatening complications like toxic megacolon can develop. Toxic megacolon is characterized by extreme dilation of the colon and can lead to perforation of the colon.

Because this bacteria is part of the normal gut flora in many patients, Clostridium difficile infection should be diagnosed via detection of toxins in the stool as opposed to culture.

Metronidazole can be used to kill anaerobic bacteria and is often used in the first line treatment against Clostridium difficile.

Vancomycin is second line treatment for mild to moderate cases of C. difficile but is recommended as first line treatment in severe disease. It is important to note vancomycin should be administered orally because intravenous administration does not achieve minimum therapeutic concentration in the gut lumen.

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