Clostridium difficile is a bacteria species known to cause diarrhea and other intestinal diseases to humans. Often known as C. diff or C. difficile, this pathogen is categorized under the species of Gram-positive bacteria, known to be rod-shaped, and which produces spores (2. Children & Health, 2012 ) C. difficile microorganisms are also said to be anaerobic; meaning they can survive in the absence of oxygen gas. However, where oxygen is present, the vegetative form of the microorganism can survive for about a day within an inanimate surface. It should also be noted here that, C. diff spores can exist for two years on inanimate surfaces that have been exposed to oxygen. As the name suggests, this common microorganism is in the genus of Clostridium. Clostridium difficile microorganisms are generally said to be caused by strains and genotypes, which may show resistance to the precipitating antibiotic. In other terms, the occurrence of these pathogens is associated with the use of antibiotics, and it is commonly known to affect older adults in long term healthcare facilities. Apart from being the causative agent for C. diff infections, antibiotics will also play a significant role in facilitating recurrent cases of the bacteria in the body. More ironically, antibiotics are also applied in the treatment of the pathogens. In this regard, the entire life cycle of C. diff basically revolves around antibiotics.
Clostridium Difficile is special to the human population in that, it is associated with the continued use of antibiotics, commonly applied in the treatment of many bacterial diseases. The disease has clearly manifested both the better and the bad part of the many antibiotic medications taken by humans in the treatment of various diseases. Recently, infections of this microorganism among the global human population have become more intense, more hazardous, and even more complicated to treat and control (4. Jump, Pultz and Donskey, 2007). The bacteria species in the Clostridium group are commonly found everywhere in the world, since they are contained in soil and marine sediment. Other species such as the C. difficile are found in human intestines and the genital tract, among millions of other harmless bacteria that aid in significant body mechanisms. C. diff can also be found in the dung and feces of animals and birds. The most severe pathogenic effects of this bacterium are very common nowadays, and can be found in many regions of the world. However, among all the other regions, they are observed to be more prevalent in the United States, where tens of thousands of individuals are frequently reported to be affected by the bacteria (1. Aslam and Musher, 2006). In most cases, patients or clients exposed to antibiotics are at a very high risk of getting infected with this bacterium. However, in some cases, healthy people who have neither been hospitalized nor been exposed to any form of antibiotic treatment are also likely to contract C. Difficile pathogens.
The following diagram shows the micrograph of Clostridium Difficile microorganisms.
Mechanism of Pathogenesis
Clostridium difficile is linked to various gastrointestinal diseases and infections. C. difficile-associated diarrhea or CDAD, and Clostridium difficile colitis are some of the most common infections associated with this bacterium. C. difficile-associated diarrhea, which is also known as antibiotic-associated diarrhea, is a common type of diarrhea that develops in persons who have recently been exposed to antibiotics, either at their homes or in long-term health care facilities. Clostridium difficile colitis, on the other hand, is a type of infection which affects the colon, as a result of antibiotics used in the treatment of some diseases and infections. This type of C. diff-associated disease is arguably the most common type of infection that people are likely to develop while still under the care of care facilities. While over three million annual cases of C. diff in the U.S. are said to occur within hospitals and rehabilitations, 10 percent of these cases are likely to develop in patients after they have stayed 48 hours or even less in the care facilities. In both cases, the severity of the infection is likely to range from being asymptomatic to hazardous, especially among the children and the elderly. C. diff infections normally present with numerous symptoms, some of which may resemble those of other diseases. Watery diarrhea, normally accompanied by abdominal tenderness and pain is a common symptom of mild cases of C. diff infections. The more severe infections are associated with flu-like symptoms such as fever, abdominal pains and discomforts, loss of appetite, loss of weight, and pus or blood in the stool.
C. diff bacteria spores are usually spread and transmitted via the fecal route. In most cases, this process involves people laying their hands on contaminated surfaces and then touching their mouths unknowingly with the hands carrying the spores, thus leading to ingestion of the harmful bacteria. The ingested spores would then make their way safely through the stomach linings, where they eventually take the vegetative form. The part of the body which is colonized by these bacteria is the intestinal microflora. According to Zar and others (8. 2007), the pathogenic strains of these resistant bacteria usually cause infections by releasing toxins that are known to cause inflammation and diarrhea on humans. These toxins would then result to severe inflammation of the colon. In the course of this process, white blood cells would be attracted to the zone by the toxins, and in cases where the white blood cells fails to deliver enough immune against the reaction, mild symptoms of C. difficile-associated diarrhea or CDAD are observed on patients. Pseudomembranous colitis takes place when the normal microflora is suppressed by antibiotics, thus forcing C. difficile bacteria to multiply and produce the two types of toxins, which can result to the most severe manifestation of the infection inside the human body.
Methods for Growth in the Lab
C. difficile microorganisms normally enter the human body through ingestion of the spores produced by the bacteria. Spores can survive in very extreme conditions, and it is this special feature which makes them viable for extended periods of time, while outside the human body. This characteristic plays a key role in enhancing the transmission of the bacteria. C. difficile remains a major cause of numerous health-related issues, and its prevalence in the past several years has dramatically increased the human concern and attention towards the microorganism. As it would be observed, there are many pathogens which can cause diarrhea, among other mild and severe symptoms as well as diseases commonly associated with Clostridium difficile. In that case, there are various effective testing methods; both laboratory and non-laboratory, which can be applied for effective diagnosis and study of C. diff microorganisms. One outstanding beneficial feature with Clostridium difficile is that, it can grow in a defined culture medium. Through ways of toxigenic culture, C. diff organisms are easily cultured on a selective medium, where they can be tested for production of toxins (7. Voth and Ballard, 2005).
C-difficile laboratory tests are meant to confirm the presence of the bacteria. These tests are conducted in ways that include; detection of the bacteria through glutamate dehydrogenase and toxigenic culture, or detection of toxin through toxin enzyme immunoassay and cytotoxicity neutralization assay. Enzyme immunoassays are observed to be more convenient in that; they are fast and easy to apply. However, enzyme immunoassays are associated with lower sensitivity when compared to other tests. Cytotoxic assays, on the other hand, are known for their ability to guarantee high sensitivity and specificity, and for these reasons, they are applied as standard laboratory tests for C. diff bacteria. Non-laboratory tests, which include computed axial tomography and endoscopy are applied in evaluating the effects of the bacteria. Another common lab test which can be used to detect C. diff would be the use of enzyme-linked immunosorbent assay or ELISA, which is used to test toxins. There are also other common stool tests, apart from the ones highlighted above, and these are; stool lactoferrin levels and stool leukocyte measurements. With the many methods used to test and diagnose C-diff pathogen in labs, researchers have always faced the challenge of choosing the perfect assay to apply in their studies. However, the cost of many of these assays remains prohibitive to many people who are involved in the study of C-difficile for both clinical and educational purposes, and in that regard, effective research of the pathogen remains a big challenge to many people.
The diagram below illustrates the micrograph of a colonic pseudomembrane in C. diff colitis.
Disease Treatment and Prevention Options
Unlike other serious pathogens, Clostridium difficile is easy to control, since it has both treatment and prevention options (3. Health Information, 2012). This actually has been a big relief to the researchers and physicians involved in the complex task of dealing with these disturbing bacteria.
It should be observed that, C. diff and its associated infections are usually curable through a number of antibiotics, as it would be prescribed by doctors and physicians. This has been made easy through extensive study and research on the pathogen allover the world. However, effective treatment of the bacteria is highly recommended, especially in the earlier times of diagnosis, considering the viability of the bacteria spores (6. Vaccine Success Story, 2012). The first step in the treatment of C. diff usually involves ways that are targeted at stopping those antibiotics which had enhanced the infection. Typically, a ten-day course of one or two antibiotics taken orally has proved to be an effective approach in the treatment of Clostridium difficile. Some of these antibiotics include; Dificid, metronidazole or Flagyl, and Vancocin.
Improvement from C.diff infection can be expected to occur within three days after the first round of antibiotics. Mild C. difficile-associated is usually treated with oral metronidazole, while severe CDAD is treated by vancomycin. These antibiotics can be introduced intravenously, and are usually given for a period of ten days, under normal circumstances. According to Musher, Aslam and Logan (5. 2005), physicians are always instructed on the importance of introducing metronidazole as the first priority to patients, since oral vancomycin can result to resistance of vancomycin. Apart from the prescribed medication, C. diff can also be treated by the use of Fluids and probiotics. Taking excessive fluids such and water and energy-giving drinks play a key role in preventing dehydration which is likely to result from diarrhea. Probiotics, which can be accessed without prescriptions in food stores, can also help in ensuring full control of C. diff infection, if taken together with the prescribed antibiotics.
Transmission of the microorganisms from one person to another usually occurs from contact with infected surfaces. Fortunately, there are various prevention options which can be of help to persons having great exposure on the bacteria, especially those who’d regularly visit long-term health care facilities. Some of the ways that can help at keeping people safe from C. diff infections include; avoiding un-prescribed use of antibiotics, frequent washing of hands with soap and effective detergents, ensuring that health workers wear protective gowns when entering rooms where C. diff patients are put, ensuring limited movement of C. diff patients, thorough cleaning or treatment of reusable tools and equipment, using detergent and chlorine bleach to wash soiled clothing, and always ensuring clean surfaces in kitchens and bathrooms, where strong detergents are used. Of all the above measures, hand washing is observed to be the most effective approach of preventing the infection and transmission of C. diff bacteria.
Aslam, S. & Musher, D. (2006). An update on diagnosis, treatment, and prevention of Clostridium difficile-associated disease. Gastroenterology Clinics of North America, 35(2), 315. Web.
Children & Health: Centers for Disease Control and Prevention. (2012). Web.
Health Information: Mayo Clinic. (2012) Web.
Jump, R., Pultz, M., & Donskey, C. (2007). Vegetative Clostridium difficile survives in room air on moist surfaces and in gastric contents with reduced acidity: a potential mechanism to explain the association between proton pump inhibitors and C. difficile-associated diarrhea? Antimicrobial Agents and Chemotherapy, 51(8), 883-887.
Musher, D., Aslam, S., & Logan, N. (2005). Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clinical Infectious Diseases, 40(11), 158. Web.
Vaccine Success Story: World Health Organization. (2012). Web.
Voth, D. and Ballard, J. (2005). Clostridium difficile toxins: mechanism of action and role in disease. Clinical Microbiology Reviews, 18(2), 247-263.
Zar, F., Bakkanagari, S., Moorthi, K. & Davis, M. (2007). A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile–associated diarrhea, stratified by disease severity. Clinical Infectious Diseases, 45(3), 302.