The bacterium Clostridium difficile lives in the body of every person. It has a tendency to intensive reproduction, which makes it dangerous, as it acquires pathogenic properties and causes certain diseases. It belongs to obligate anaerobes and can exist without oxygen. It is involved in the work of the most important processes, such as the breakdown of proteins, stimulation and toning of the intestinal walls.
What is Clostridium difficile?
The word "clostridia" in translation into Russian means "spindle". Microbes received a similar name for the peculiarity of swelling in the middle during sporulation. Bacteria can also take the form of a spindle. They are divided into four types, these are:
- Clostridium botulinum, is the causative agent of botulism;
- Clostridium tetanum, promotes tetanus;
- Clostridium perfringens, affects the occurrence of anaerobic infection;
- Clostridium difficile, causes pseudomembranous colitis.
Clostridia has a rod-shaped form. Can be arranged in chains and in pairs. Fairly mobile. In conditions of complete absence of oxygen, intensemultiply. Microbes create spores, which makes them resistant to antibiotics, heat, and various disinfectants. The central spore is shaped like a spindle, and the one located terminally is shaped like drumsticks.
Clostridium difficile causes diarrhea from antibiotics. Usually lives in the intestinal environment. In good he alth, beneficial microorganisms inhibit the growth of this bacterium. After using antibiotics, there are fewer beneficial bacteria, and the number of Clostridium increases, which can provoke the appearance of colitis, cause the development of serious pathology and even death of a person. This is especially true for elderly and debilitated patients. All varieties of Clostridium form toxins that provoke the appearance of a certain pathology. As a result of its reproduction, it produces toxin A and B Clostridium difficile. The former is called enterotoxin and the latter is called cytotoxin. They cause diarrhea and colitis in many people.
Infection
Clostridium difficile is most commonly found in hospitals and nursing homes. It can be placed anywhere: on the floor, window sills, bedside tables, in bed and toilets. The spores of the microorganism freely fall on the hands upon contact with an infected surface. Predominantly spread by the fecal-oral route.
After the spores have entered the body, they easily pass through the environment of the stomach and remain in the intestines. In the environment of the small intestine, they are converted into a vegetative form and activelyare starting to multiply. In the large intestine, the bacterium settles in the intestinal folds and begins to secrete toxins A and B, resulting in severe inflammation of the intestinal environment, which causes the expulsion of waste products and mucus. Pseudo-membranes are formed. Toxin A begins to attract leukocytes, while toxin B is involved in the destructive actions of epithelial cells. These processes provoke the appearance of colitis, watery stools and the appearance of pseudomembranes.
Basically, all pathologies involving Clostridium difficile occur after antibiotic treatment, as well as after surgery. Elderly people over 60 years of age and those on long-term hospital treatment, as well as patients taking immunosuppressive medications, are especially susceptible to microorganism exposure.
Clostridium difficile causes mild to moderate diarrhea and mild stomach cramps. But in exceptional cases, the disease progresses to a more severe form of colitis. What causes symptoms like:
- watery stool;
- pain in the abdomen;
- bloating;
- increased body temperature;
- dehydration;
- nausea.
In 3% of cases, patients develop a severe form of the disease. Of these, 30-85% die. In 20-25% of patients, the disease may recur. Relapses of pathology occur due to those bacteria that remained in the large intestine after therapy or due to a new infection with Clostridium difficile. Children, especially those who are weak, can suffer from the disease.
Diseases caused bybacteria
Clostridium difficile in one third of cases provokes diarrhea associated with taking antibiotics. In other situations, other bacteria influence the appearance of the disease. Most often, the disease occurs in hospitals. Children practically do not suffer from this
Antibiotic-associated diarrhea (AAD) can develop in various stages, from mild intestinal upset to severe enterocolitis, which is called pseudomembranous colitis. The cause of this pathology is an infection caused by Clostridium difficile, which appears in some cases due to the use of antibiotic therapy.
Even a single dose of a broad-spectrum antibiotic can cause diarrhea or pseudomembranous colitis. Moreover, the appearance of the disease does not depend on the dosage and method of administration of the drug.
Clostridium difficile: symptoms of infection
Clostridia caused by Clostridium difficile can take the following forms:
- asymptomatic infection;
- mild diarrhea;
- a severe form of the development of the disease, which turned into pseudomembranous colitis.
AAD occurs in patients who have undergone a course of long-term therapy - more than four weeks in a hospital setting. Clostridia in the intestinal environment acquire a certain resistance to drugs. When this pathology occurs, there is pain in the umbilical zone, which in the futureaffects the entire abdomen. Patients' stool becomes more frequent, but overall he alth remains satisfactory.
Pseudomembranous colitis caused by Clostridium difficile has more severe symptoms. Patients develop dysbacteriosis, and the activity of Clostridium difficile prevails. The bacterium colonizes the intestinal mucosa and produces cytotoxin and enterotoxin. The inflammatory process of the mucous membrane begins with the formation of pseudomembranes. In the absence of timely treatment, the disease progresses and gives more severe complications. There is a perforation of the intestinal wall, which causes peritonitis. In some cases, the disease is fatal.
Cancer patients, the elderly and patients who have undergone surgery are most susceptible to this disease. The development of pathology is accompanied by fever, pain in the abdomen and head, flatulence, belching, vomiting. There are other symptoms of intoxication of the body. Patients lose weight, some develop anorexia, moral depression, and depression occurs. There is also cachexia, attempts, tenesmus, diarrhea with a putrid odor and fibrin overlay up to 20 times a day.
When poisoned with toxins, necrotic enteritis can develop. In this case, erosions and ulcers, foci of necrosis are formed on the intestinal walls. The body temperature rises. Chills occur. Dyspepsia is observed, the stool becomes liquid, with an admixture of blood. Diagnosed with hepatosplenomegaly, intestinal paresis, accompanied by bloating. Possible intestinal bleeding, perforation of ulcers, as well as thrombosis of venules and arterioles.
Clostridia often cause foodborne illness, including Clostridium difficile. The clinical symptoms of this disease are manifested in the form of poisoning. As a rule, it is fever, pain in the abdomen, diarrhea, loss of appetite, dyspepsia. With this disease, all forms of dyspeptic and intoxication symptoms are manifested. Patients become irritable, lethargic and restless. Negative symptoms last about 4 days and gradually subside.
The main feature of the infection are relapses, which occur in 25% of cases. The cause of their occurrence is the spores in the intestinal environment. Re-infection cannot be ruled out. As a rule, recovery occurs immediately after the therapy, but a relapse may develop on days 2-28, similar in its symptoms to the initial manifestation of the disease.
Causes of occurrence
When Clostridium difficile is detected in the body, treatment should be started immediately. The causes of this infection are the following factors:
- bad environment;
- stress, depression, neurosis;
- long-term therapy with hormones and antibiotics;
- immunodeficiency;
- impaired functioning of the central nervous system;
- prematurity in children;
- Insomnia that has turned into a chronic form of development;
- respiratory disease;
- infectious agents living within hospital walls;
- surgical operations.
The above causes weaken the body and promote the reproduction of Clostridiumdifficile. Treatment of the disease should take place only after a thorough diagnosis of the patient.
Diagnosis
Diagnosis of the disease is based on identifying the symptoms of pathology and the causes of its occurrence. The anamnesis is taken into account, as well as epidemiological factors. Pay attention to the clinical manifestations of the disease. To establish the diagnosis, instrumental and laboratory methods are used.
The stool is analyzed for Clostridium difficile. Gram-positive rods and their spores are determined in the laboratory. During microscopic examination, the biomaterial is seeded in a special way, and on the basis of this, colonies of pathogenic microorganisms are determined. No special preparation is needed for such an analysis. The number of Clostridia is determined by the Gram smear. After that, the type of bacteria is identified. Feces for Clostridium difficile are examined in a bacteriological laboratory.
When diagnosing a disease, a biological test is carried out on white mice, which determines the stage of intoxication of the body, detects the toxin and helps determine the methods of treating the disease. When diagnosing a disease, an antigen test is done in special immunological laboratories.
In special cases, express diagnostics are prescribed to help determine the presence of enterotoxin in feces. A biopsy of the intestinal organ is performed, which allows you to find out the location of the foci of inflammation.
Serodiagnosis reveals the presence of a toxin in RNHA. It is determined together with the antibody diagnosticum. Watching overa reaction that occurs as a result of a counter immunoelectrophoresis.
Instrumental diagnostics is nothing more than an x-ray of the intestinal organ, which allows you to determine where gas has accumulated in the tissues of the human body.
The most accurate is considered tomographic and endoscopic examination. It shows the inflammatory process as well as the formation of pseudomembranes.
Increased activity of Clostridium in infants indicates the presence of dysbacteriosis. An infant with this pathology may experience bloating, a decrease in appetite, and regurgitation. Sometimes worried about sleep disturbance and irregular stools. The number of bacteria in infants should not be more than 103-104 CFU / g. Exceeding the indicator is considered a pathology that needs to be treated.
If the content of clostridia is normal when testing for dysbacteriosis, this means that the intestines are working stably. With an increase in the number of pathogenic bacteria, intestinal treatment should be carried out.
You can conduct a study on Clostridium difficile in "Invitro". The analysis costs about 1200 rubles. On its basis, most often, the necessary medical procedures are prescribed.
How does the disease manifest itself in children?
The bacterium Clostridium difficile rarely affects newborns and babies in the first year of life. This is because mother's milk contains specific antibodies that are effective against Clostridium.
When antibiotic-associated diarrhea occurs in childhood, all the same symptoms occur,as in adults. Enterocolitis and non-severe colitis in children proceed without intonation and fever. Patients may be disturbed by pain in the abdomen, which occurs during the method of palpation in this area.
Sometimes there is an increase in stool, which provokes diarrhea, which leads to water-electrolyte failures in the body.
The bacterium can cause recurring forms of clostridial infections accompanied by colitis. It occurs when the disease is not completely cured. In this case, clostridiosis occurs 7-14 days after stopping treatment.
Pseudomembranous colitis in childhood develops in an acute form. In the initial stage of the development of the disease, there is no appetite. There is fever, belching and abdominal cramps. There is intoxication of the body, diarrhea and bloating. Pain is observed on palpation of the abdomen. The chair becomes more frequent. It contains blood and mucus. Fragments of fibrinous overlays may be observed. If diarrhea is frequent, then exsicosis occurs, accompanied by circulatory failures. In isolated cases, collapse was noted.
The development of pseudomembranous colitis is sometimes exacerbated by perforation, bleeding and peritonitis. In such cases, not only a pediatrician, but also a surgeon should supervise the children.
Clostridium difficile disease: treatments
Clostridia is treated only in a hospital. In the event of intoxication, as well as dyspeptic disorders, gastric lavage andcleanse the intestines with an enema. On the first day, a water-starved diet is recommended.
Among medicines, antibiotics-macrolytes are used. It is to them that clostridia are sensitive. Among these drugs, Clarithromycin and Azithromycin are most commonly used. Clostridium difficile toxin (the symptoms and treatment are set individually by the doctor, based on the patient's condition) medicine can remove cephalosporins, among which are Cefazolin and Ceftriaxone. Often, antibiotics of the penicillin series are used to combat pathogenic bacteria, these are Vancomycin, Amoxiclav. Metronidazole is also used.
To restore the microflora of the intestinal environment, doctors prescribe probiotics and prebiotics. The most popular are Hilak Forte, Acipol, Laktofiltrum, Bifiform, Enterol, Linex, Enterol.
To remove intoxication, "Reopoliglyukin" is administered intravenously. If necessary, antihistamines and corticosteroids are prescribed.
Symptomatic treatment is being carried out with enterosorbents, hepatoprotectors, vitamins, nootropics, cardiac glycosides, as well as antipyretic drugs.
Therapy is said to be effective if:
- reduced stool frequency;
- stool consistency becomes thicker;
- the general condition is improving;
- seeing positive changes in clinical and laboratory tests;
- does not develop disease.
If symptoms persist with antibiotic therapyClostridium difficile, treatment adjusted.
Colitis caused by Clostridium difficile is sometimes treated with surgery. This usually occurs with perforation of the colon and when an inflammatory process develops with the occurrence of toxic megacolon, and intestinal obstruction also occurs. The operation is done only if adequate conservative treatment has failed.
Can Clostridium difficile be cured?
Clostridium difficile infection manifests itself in varying degrees of severity. It has a certain course and degree of complications.
When the disease is not started and has a mild or moderate severity, the disease is cured by 100%. Fever disappears in 1-2 days, and diarrhea stops in 4-7 days. With bowel obstruction, renal failure and pseudomembranous colitis, the situation is aggravated.
Preventive measures
Analysis for Clostridium difficile allows you to prevent the development of the disease in time, and timely preventive measures that manifest themselves in:
- compliance with the rules of personal hygiene;
- washing products;
- cooked food;
- increase immunity;
- stabilization of intestinal microflora;
- timely detection of infected persons;
- use of antibiotic therapy.
Pathogenic microorganisms are resistant to ammonia, but killed by exposuresodium hypochlorite, ethylene oxide containing substances, as well as during treatment with alkaline glutaraldehyde. When infected with Clostridium difficile, it is necessary to thoroughly clean all surfaces with the indicated means in order to destroy bacterial spores of the microbe. Bacteria are not killed when treated with alcohol, but washing hands with soap can prevent the onset of pathology.
