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Clostridioides difficile

icanis
Contributor(s):

Richard Walker

Synonym(s): C. difficile, Clostridium difficile


Introduction

Classification

Taxonomy

  • Family: Peptostreptococcaceae.
  • Genus: Clostridioides.
  • Species: difficile.

Etymology

  • Latin: difficile - difficult; refers to the unusual difficulty encountered in its isolation and study.

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Clinical Effects

Epidemiology

Habitat

  • Isolated from diverse habitats, including:
    • Soil, hay, sand.
    • Intestines of cows, donkeys, horses, dogs, cats, rodents and human beings.
  • Part of normal intestinal flora.
  • Found in feces from cows, horses, dogs, cats, rodents, and human beings.

Lifecycle

  • Reproduces and proliferates when intestinal conditions are favorable:
    • Following destruction of other normal flora by antibiotic therapy Therapeutics: antimicrobial drug.
    • Bowel stasis.
    • Following intestinal surgery.
    • Unrelated to known risk factors.
  • Vegetative cells produce endospores.
  • Endospores detected by heat or alcohol treatment → germinate anaerobically.

Transmission

  • Infection may be endogenous or exogenous.
  • Feco-oral transmission of spores or vegetative cells.

Pathological effects

  • Antibody production against toxins may occur.
  • In pseudomembranous colitis, overgrowth of the organism occurs following antibiotic therapy Therapeutics: antimicrobial drug.
  • Diarrhea may occur, unrelated to antibiotics in dogs, pigs and foals.
  • C. difficile produces at least 3 potential virulence factors:
    • An enterotoxin (toxin A) that induces fluid secretion into the intestines.
    • A cytotoxin (toxin B) that kills cells.
    • A substance that inhibits intestinal motility.

Other Host Effects

  • Part of the normal flora of the gastrointestinal tract.
  • Carried asymptomatically in the gastrotintestinal tract of human and equine neonates.
  • Carriage rates are much lower in adults.

Control

Control via animal

  • Supportive therapy and appropriate antimicrobial drugs.
  • Good hygiene practices to avoid fecal contamination.

Control via chemotherapies

  • Resistant to many common antimicrobials, including ampicillin Ampicillin , clindamycin Clindamycin and cephalosporins.
  • Cases of human pseudomembranous colitis have been successfully treated using vancomycin or metronidazole Metronidazole.
  • Resistance to other antibiotics is common, and use of antimicrobials may induce C. difficile-associated disease.

Control via environment

  • Many infections endogenous, therefore environmental control not usually appropriate.
  • Avoid accidental ingestion of antibiotics.
  • Use antibiotics judiciously.

Vaccination

  • No vaccine available.

Diagnosis

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Weese J S, Staempfli H R, Prescott J F et al (2001) The roles of Clostridium difficile and enterotoxigenic Clostridium perfringens in diarrhea in dogs. J Vet Intern Med 15 (4), 374-378 PubMed.
  • Struble A L, Tang Y J, Kass P H et al (1994) Fecal shedding of Clostridium difficile in dogs - a period prevalence survey in a veterinary medical teaching hospital. J Vet Diag Invest (3), 342-347 PubMed.
  • Riley T V, Adams J E, O'Neill G L et al (1991) Gastrointestinal carriage of Clostridium difficile in cats and dogs attending veterinary clinics. Epidemiol Infec 107 (3), 659-665 PubMed.
  • Berry A P & Levett P N (1986) Chronic diarrhea in dogs associated with Clostridium difficile infection. Vet Rec 118 (4), 102-103 PubMed.

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