The Clostridium Difficile Infections Biology Essay

The clostridia Difficile Infections Biology EssayThe organism cognize as clostridia difficile is a gram-positive bacillus bacteria which has the ability to form spores, as wholesome as produce a number of toxins. The toxins produced by these bacteria be presently considered to be one of the forefront causes of antibiotic-associated diarrhea (AAD).In addition, transmitting of this bacteria and the subsequent damage which is instigated by the organisms invasive toxins can lead to several serious GI conditions including pseudomembranous colitis (PHAC, 2011). According to the Centre for distemper Control (2012), Clostridium difficile is proposed to be the causative of between 15 and 25% of all AAD cases in Canada. ascribable to its specific pathogenesis, this organism is easily spread throughout a given population, with increased risk attri thoed to various factors which contribute to a higher level of exposure. effrontery this, there are often outbreaks experienced within heal thcare facilities, as well as within community settings. In addition, the organism has well cognize epidemiology, with certain patient attributes, exposure to high-risk environment, medical conditions and various medications contributing to an increased risk of both the a characteristic Clostridium difficile village (CDC) or the symptomatic and sometimes deadly Clostridium difficile contagion (CDI). Infection by Clostridium difficile can also lead to various chronic and adverse effects afterwards the initial recovery such as recurrent infections, surgeries being required to rectify the damage which has been caused by the toxins effect on the patients bowels (3). As a subject of this persistent organisms observable damage and tendency to spread, any sort of CDI outbreak has definite implications on the healthcare system, both from a fiscal as well as a resource and time-allocation standpoint.CLOSTRIDIUM DIFFICILEPathogenesisClostridium difficile (C. difficile) are gram positive, spore-forming bacillus bacteria which, as an opportunistic pathogen, inhabit the anaerobic conditions of the human gastrointestinal system. It is also the leading cause of health care-associated diarrhea (Bourgault, 2011). As reported in the Canadian Medical Association Journal (CMAJ), Clostridium difficile can be isolated from the stool of 3% of healthy adults and up to 80% of healthy newborns and infants (Kujiper, 2008). The reason that it can be so detrimental in the case of an infection is that along with a number of other virulence factors, it produces two toxins, known as toxin A and toxin B (CDC, 2012). In patients who display either a colonization or infection, the normal gastrointestinal flora is depleted due to a number of extenuating risk factors. Provided with these circumstances, the C. difficile bacteria are able to flourish and infest the patients bowel. The major agressins (Borriello, 1998) of C. difficile are undoubtedly toxins A and B, however, there are a number of other virulence factors possessed by the organism which contribute to its effectiveness to cause harm. According to Borriello, C.difficile is influenced by its ability to adhere the intestinal wall, which whitethorn be caused by the organisms intrinsic slight positive net charge. This attracts to the negatively supercharged host cells and may contribute to gut colonization (Borriello, 1998). Both toxins A and B are cytotoxic to a very large number of divergent cell types, both cause increased vascular permeability, and both cause haemorrhage (Borriello, 1998). In addition, toxin A appears to cause fluid accumulation, whereas toxin B does not (Borriello, 1998).clinical FeaturesImmediate clinical symptoms of C. difficile can include fever, loss of appetite, nausea, abdominal pain and tenderness (PHAC, 2011) as well as watery diarrhea. The diarrhea is a by-product of the toxins produced by the multiplying bacteria as they invade the mucosa of the intestines. This causes profuse inflammatory diarrhea secondary to destruction of the lining of the colon (4). In to a greater extent horrific cases, it can cause pseudomembranous colitis, bowel perforation, sepsis, and even death (PHAC, 2011).Diagnostic MethodsThere are currently several reliable, widely-used laboratory tests which are used in the diagnosing of C. difficile colonization and infection. Microbiological stool culture is the most sensitive test available (CDC, 2012) and is considered the confirmatory test, but it also carries the highest incidence of false-positives. This occurs when the patient is infected with a non-toxigenic argumentation of C. difficile. PCR assays cede been developed for the gene which encodes for toxin B. In addition, antigen detection by either latex agglutination or immunochromographic assays (CDC, 2012) provides a fast way to detect the heading of Clostridium difficile. Again, it is non-specific for toxigenicity. Toxin testing tests for specificity to toxin B, while enz yme immunoassays can detect either toxin (CDC, 2012). As studied by Kinson in 2009, additional testing for various markers is also being investigated as a means of detecting infections. Examples of this include fecal lactoferrin, a marker for intestinal inflammation (Kinson, 2009) as well as glutamate dehydrogenase (GDH), which is C. difficile-specific however GDH lucrativeness is independent of toxigenicity in strains of C. difficile (Kinson, 2009). Although its presence does confirm Clostridium difficile is present in the patient, it does not confirm that the strain present in this patient is toxigenic.TherapeuticsAccording to the populace health Agency of Canada, mild cases of CDI can resolve with only supportive treatment such as intravenous fluids to combat dehydration (PHAC, 2011). Additionally, the Centre for Disease Control states that up to 20% of cases will resolve within two to three days of discontinuing the antibiotic to which the patient was previously exposed (CDC , 2012). In more severe cases, the infection can usually be treated with an appropriate course (about 10 days) of antibiotics, including metronidazole, vancomycin (administered orally), or recently approved fidaxomicin (Aylin, 2011). If the bacteria have severely damaged sections of the bowel, it may have to be removed surgically as well (Louie, 2004).EPIDEMIOLOGYRisk Factors for InfectionThe incidence of infection by Clostridium difficile is affected by a number of risk factors, which is depicted in Figure 1 (Owens, 2008). Being hospitalized greatly increases the chances of becoming infected with C. difficile. These bacteria are shed in the feces, and are usually transmitted between patients either by healthcare workers, or by surfaces or equipment not being to the full sanitized between patients (Louie, 2004). However, there has been an increasing trend of community-acquired infections as well. In a study performed at Harvard Medical School, it was found that community-acquired C lostridium difficile infection may account for more than a third of Clostridium difficile-associated diarrhea overall (Leffler, 2012). In addition, the use of medications such as antibiotics, particularly fluoroquinolones (Bourgault, 2011), as well as proton pump inhibitors (used to supress production of gastric acid in gastrointestinal conditions) have been shown to increase the risk of a Clostridium difficile infection. In a study by Haider et al, it was shown that while the use of proton pump inhibitors appears to lead to an elevated risk of developing severe CDI (Haider, 2012), another widely used type of gastric acid appetite suppressant medication known as histamine 2 receptor antagonist (H2RA) actually appears to decrease the risk of an infection (Haider, 2012). Gastrointestinal surgery is also a known risk factor for severe infection with Clostridium difficile (Louie, 2004). According to Public Health Ontario, infections are more likely to be considered severe in an time-wo rn or immunocompromised patient (OAHPP, 2011). However, it has been shown that the presence of multiple medical conditions, or co-morbidity, is actually a better predictor then age as to the return of the infection. Severe CDI occurs more frequently with advancing age. However, age, per se, has no effect on mortality (Dharmarajan, 2000).IMPLICATIONS IN PUBLIC HEALTHResource AllocationIt has been shown that both the pecuniary implications, as well as the allocation of resources within the health care system produced by Clostridium difficile-associated disease (CDAD) are quite significant. Public Health Ontario stated at the time of their study in 2010, that the embody of CDI readmissions alone is estimated to be a minimum of CAD $128,200 per year per hospital (OAHPP, 2011). A more extensive look in to the associative costs was completed in 2008 at Washington Universitys School of Medicine. Dubberke studied a population of CDAD patients and proposed that a cost of $2454 was attribu ted to each case of CDAD, with that cost increasing to $5042 per patient if their stay exceeded 180 days of hospitalization (Dubberke, 2008). According to the study conducted in by Dr. Forster et al (2011), an infection with C. difficile extends the patients hospital stay from an average of 8 days to an average of 34 days (Forster, 2011). This not only increases the burden on health care workers, but also utilizes time and supplies which are quite preventable.CONCLUSION