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Section 3. Summaries of Infectious Diseases
Clostridial Infections
Clostridium difficile
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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CLINICAL MANIFESTATIONS
Syndromes associated with infections range from asymptomatic carriage to watery diarrhea to pseudomembranous colitis. Pseudomembranous colitis generally is characterized by diarrhea, abdominal cramps, fever, systemic toxicity, and abdominal tenderness. Occasionally, children have marked abdominal tenderness and distention with minimal diarrhea (toxic megacolon). The colonic mucosa often contains 2- to 5-mm, raised, yellowish plaques. Disease characteristically begins while the child is in a hospital receiving antimicrobial therapy but may occur weeks after hospital discharge or after cessation of therapy. Uncommonly, the illness is not associated with antimicrobial therapy or hospitalization. Complications may include toxic megacolon and intestinal perforation. Severe or fatal disease is more likely to occur in neutropenic children with leukemia, in infants with Hirschsprung disease, and in patients with inflammatory bowel disease. Colonization by toxin-producing strains without symptoms is common in newborn infants and in children younger than 1 year of age.
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ETIOLOGY
Clostridium difficile is a spore-forming, obligate anaerobic, gram-positive bacillus. Disease is related to the action of toxin(s) produced by these organisms. Although other toxins exist, toxins A and B have been associated most strongly with human disease.
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EPIDEMIOLOGY
C difficile can be isolated from soil and commonly is present in the hospital environment. C difficile is acquired
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