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Clostridium difficile infection (CDI or C-dif) is a symptomatic infection due to the spore-forming bacterium, Clostridium difficile. Symptoms include watery diarrhea, fever, nausea, and abdominal pain. It makes up about 20% of cases of antibiotic-associated diarrhea. Complications may include pseudomembranous colitis, toxic megacolon, perforation of the colon, and sepsis.
Clostridium difficile infection is spread by bacterial spores found within feces. Surfaces may become contaminated with the spores with further spread occurring via the hands of healthcare workers. Risk factors for infection include antibiotic or proton pump inhibitors use, hospitalization, other health problems, and older age. Diagnosis is by stool culture or testing for the bacteria's DNA or toxins. If a person tests positive but has no symptoms, the condition is known as C. difficile colonization rather than an infection.
Prevention is by hand washing, terminal room cleaning in hospital, and limiting antibiotic use. Discontinuation of antibiotics may result in resolution of symptoms within three days in about 20% of those infected. Often the antibiotics metronidazole, vancomycin or fidaxomicin will cure the infection. Retesting after treatment, as long as the symptoms have resolved, is not recommended, as the person may remain colonized. Recurrences have been reported in up to 25% of people. Some tentative evidence indicates fecal microbiota transplantation and probiotics may decrease the risk of recurrence.
Signs and symptoms of CDI range from mild diarrhea to severe life-threatening inflammation of the colon.
In adults, a clinical prediction rule found the best signs to be significant diarrhea ("new onset of more than three partially formed or watery stools per 24-hour period"), recent antibiotic exposure, abdominal pain, fever (up to 40.5 °C or 105 °F), and a distinctive foul odor to the stool resembling horse manure. In a population of hospitalized patients, prior antibiotic treatment plus diarrhea or abdominal pain had a sensitivity of 86% and a specificity of 45%. In this study with a prevalence of positive cytotoxin assays of 14%, the positive predictive value was 18% and the negative predictive value was 94%.
In children, the most prevalent symptom of a CDI is watery diarrhea with at least three bowel movements a day for two or more days, which may be accompanied by fever, loss of appetite, nausea, and/or abdominal pain. Those with a severe infection also may develop serious inflammation of the colon and have little or no diarrhea. Metronidazole typically is the initial drug of choice for mild to moderate disease, because of lower price. Typically, it is taken three times a day for 10 days. Vancomycin by mouth is preferred for severe disease. Additionally, vancomycin may be used to treat mild-to-moderate disease if diarrhea persists after a course of metronidazole. Since metronidazole has the potential to cause birth defects, pregnant women with Clostridium difficile infection may be treated with vancomycin regardless of disease severity. Vancomycin may be more effective than metronidazole. Typical vancomycin dosage is taken four times daily for 10 days. It may be given rectally if the person develops an ileus and cannot take medications by mouth. Fidaxomicin has been found to be as effective as vancomycin in those with mild to moderate disease, and may be better in those with severe disease. It is tolerated as well as vancomycin, and may have a lower risk of recurrence. It may be used in those who have recurrent infections and have not responded to other antibiotics.
Medications used to slow or stop diarrhea, such as loperamide, may worsen C. difficile disease, so are not recommended. Cholestyramine, an ion exchange resin, is effective in binding both toxin A and B, slowing bowel motility, and helping prevent dehydration. Cholestyramine is recommended with vancomycin. A last-resort treatment in those who are immunosuppressed is intravenous immunoglobulin.
https://en.wikipedia.org/wiki/Clostri...
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