ABSTRACT
Clostridioides difficile is a gram-positive anaerobic spore-forming bacterium that causes bacterial colitis. Risk factors for disease are the use of various antibiotics such as macrolides, beta lactams and fluoroquinolones, the use of chemotherapeutic agents and the use of some agents that reduce gastric acidity. The organism is acquired from the environment as the resistant spore and may germinate within the colon if local environmental circumstance allows. The organism produces a toxin that causes the disease. The toxin has two components TcdA and TcdB. Both components bind to colonic epithelial cells and are internalized. The proteins are glucosyltransferases and inactivate the GTPase Rho and Rac, leading to necrosis and symptoms. The illness presents with diarrhea and can either be mild or severe, the latter with dehydration and a high temperature and a high white cell account, and severe colitis can develop. The patient is isolated and started on metronidazole, vancomycin or fidoxamicin. Monoclonal antibodies are available to inhibit the toxin, or a fecal transplant can be used to inhibit the disease. In severe cases, the colon has to be removed. Strict control of infection measures are used to prevent spread. Relapse rate of disease can be high.
