The bacterium Clostridium difficile lives in the body of every person. It has a tendency to intensive reproduction, which is why it becomes dangerous, as it acquires pathogenic properties and causes certain diseases. Refers to obligate anaerobes and can exist without oxygen. Involved in the work of the most important processes, such as protein breakdown, stimulation and toning of the intestinal wall.
What is clostridium difficile?
The word "clostridia" in translation into Russian means "spindle". Microbes got a similar name for the feature of bloating in the middle during spore formation. More bacteria are able to take the form of a spindle. They are divided into four types, these are:
- Clostridium botulinum, is the causative agent of botulism;
- Clostridium tetanum, contributes to the occurrence of tetanus;
- Clostridium perfection, affects the appearance of anaerobic infections;
- Clostridium difficile, causes pseudomembrane colitis.
Clostridia is rod-shaped. It can be arranged in chains and in pairs. It’s quite mobile. In the absence of oxygen, it begins to multiply intensively. Microbes create spores, which gives them resistance to antibiotics, heat and various disinfection drugs. The central spore has the shape of a spindle, and the one located terminally has the shape of drum sticks.
Clostridium difficile causes diarrhea from antibiotics. Usually lives in the intestinal environment. In good health, beneficial microorganisms inhibit the growth of this bacterium. After using antibiotics, the beneficial bacteria become smaller, 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 clostridia form toxins that provoke the appearance of a certain pathology. As a result of its reproduction, Clostridium difficile produces toxin A and B. The first is called enterotoxin, and the second is called cytotoxin. They become the cause of diarrhea and colitis in many people.
Infection
Clostridium difficile most often lives in hospitals and nursing homes. It can be anywhere: on the floor, window sills, bedside tables, in bed and toilets. The spores of the microorganism freely fall on hands in contact with an infected surface. Mostly distributed 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 actively begin 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 displacement of decay products and mucus. The formation of pseudomembranes. Toxin A begins to attract white blood cells, while toxin B is involved in the damaging effects 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 operations. Particularly exposed to microorganisms are elderly people after 60 years of age and those who are on long-term treatment in a hospital, as well as patients taking immunosuppressive drugs.
Clostridium difficile provokes mild or moderate diarrhea and minor stomach cramps. But in exceptional cases, the disease goes into a more severe form of colitis. What causes symptoms such as:
- watery stools;
- pain in the abdomen;
- bloating;
- increase in 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 can occur repeatedly. Relapses of the pathology occur due to those bacteria that remained in the colon after therapy or due to a new infection of Clostridium difficile. The disease can affect children, especially those who are weakened.
Diseases caused by bacteria
Clostridium difficile in one third of cases provokes diarrhea associated with taking antibiotics. In other situations, the appearance of the disease is affected by other bacteria. Most often, the disease occurs in hospitals. Children practically do not suffer at the same time.
Antibiotic-associated diarrhea (AAD) can have various stages of development, 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 antibiotic with a wide spectrum of action 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
Clostridiosis caused by Clostridium difficile can occur in the following forms:
- asymptomatic infection;
- mild diarrhea;
- a severe form 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. Clostridia in the intestinal environment acquire a certain resistance to drugs. When this pathology occurs, there is pain in the umbilical region, which subsequently affects the entire abdomen. Patient stool becomes more frequent, but overall health remains satisfactory.
Pseudomembranous colitis caused by clostridium difficile, the symptoms are more severe. Dysbacteriosis appears in patients, and the activity of Clostridium difficile predominates. 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 serious complications. Perforation of the intestinal wall occurs, which causes peritonitis. In some cases, the disease is fatal.
Oncological patients, elderly people and patients who underwent surgery are most susceptible to such a disease. The development of pathology is accompanied by fever, pain in the abdomen and head, flatulence, belching, and vomiting. Other symptoms of intoxication are observed. Patients lose weight, some have anorexia, moral depression, depression occurs. Cachexia, attempts, tenesmus, diarrhea with a putrid odor and the application of fibrin up to 20 times a day are also noted.
When poisoning with toxins, necrotic enteritis can develop . In this case, erosion and ulcers, foci of necrosis are formed on the walls of the intestine. Body temperature rises. There is a chill. 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 venous thrombosis and arterioles.
Often cause foodborne toxicoinfection of clostridia, including clostridium difficile. The clinical symptoms of this disease manifest in the form of poisoning. As a rule, this is a fever, pain in the abdomen, diarrhea, loss of appetite, dyspepsia. With this disease, all forms of dyspeptic and intoxication symptoms appear. Patients become irritable, lethargic and restless. Negative symptoms last about 4 days and gradually subside.
The main feature of the infection is relapse, which occurs in 25% of cases. The cause of their occurrence are spores located in the intestinal environment. Cases of reinfection cannot be ruled out. As a rule, immediately after the treatment, recovery occurs, but on 2-28 days a relapse may develop, similar in its symptoms to the initial manifestation of the disease.
Causes of occurrence
If Clostridium difficile is found in the body, treatment should be started immediately. The causes of this infection are the following factors:
- bad ecology;
- stress, depression, neurosis;
- long-term therapy with hormones and antibiotics;
- immunodeficiency;
- impaired functioning of the central nervous system;
- prematurity in children;
- insomnia, which turned into a chronic form of development;
- respiratory diseases;
- pathogens living in hospital walls;
- surgical operations.
These causes weaken the body and contribute to the propagation of Clostridium difficile. Treatment of the disease should only take place after a thorough diagnosis of the patient.
Diagnostics
Diagnosis of the disease is based on identifying the symptoms of the pathology and the causes of its occurrence. History and epidemiological factors are taken into account. Pay attention to the clinical manifestations of the disease. To establish a diagnosis, instrumental and laboratory methods are used.
An analysis of feces on Clostridium difficile is done. In laboratory conditions, gram-positive bacilli and their spores are determined. Microscopic examination of the biomaterial is seeded in a special way and on the basis of this, colonies of pathogenic microorganisms are determined. Special preparation for passing such an analysis is not needed. The number of clostridia is determined by a gram smear. After this, the type of bacteria is identified. Feces on Clostridium difficile are examined in a bacteriological laboratory.
When diagnosing the 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, rapid diagnostics are prescribed to help determine the presence of enterotoxin in feces. A biopsy of the intestinal organ is performed, allowing you to find out about the location of the foci of inflammation.
Serodiagnosis can detect the presence of toxin in RNGA. It is determined in conjunction with antibody diagnosticum. Observe the reaction that occurs as a result of 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.
The increased activity of clostridia in infants indicates the presence of dysbiosis. In this infant, with a given pathology, bloating, a decrease in appetite, and regurgitation can be observed. Sometimes disturbed by sleep disturbance and irregular stools. The number of bacteria in infants should not be more than 103-104 CFU / g. Exceeding the rate is considered a pathology that needs to be treated.
If the content of clostridia is normal when taking an analysis for dysbiosis, then this means that the intestines are working stably. With an increase in the number of pathogenic bacteria, bowel treatment should be performed.
You can do research on the Clostridium difficile in Invitro. There is an analysis of about 1200 rubles. Based on it, the necessary medical procedures are most often prescribed.
How is the disease manifested in children?
The bacterium Clostridium difficile rarely affects newborns and the crumbs of the first year of life. This is due to the fact that mother's milk contains special antibodies that are effective against clostridia.
When antibiotic-associated diarrhea occurs in childhood, the same symptoms occur as in adults. Enterocolitis and mild colitis in children occurs without intonation and fever. Patients may be disturbed by pain in the abdomen that occurs with a palpation method in the area.
Sometimes there is an increase in stool, which provokes diarrhea, which leads to water-electrolyte malfunctions in the body.
The bacterium can cause recurring, relapsing forms of clostridiosis, accompanied by colitis. This occurs when the disease is not completely cured. In this case, clostridiosis occurs after 7-14 days after cessation of treatment.
Pseudomembranous colitis in childhood develops in an acute form. In the initial stage of the development of the disease, there is no appetite. Fever, belching, and abdominal cramps occur. Intoxication of the body, diarrhea and bloating are observed. On palpation of the abdomen, pain is observed. The chair is becoming more frequent. Blood and mucus appear in it. Fragments of fibrinous overlay may be observed. If diarrhea is frequent, then exicosis occurs, accompanied by circulatory failure. In isolated cases, collapse was noted.
The development of pseudomembranous colitis is sometimes exacerbated by perforation, bleeding and the occurrence of peritonitis. In such cases, not only the pediatrician, but also the surgeon should watch the children.
Disease caused by Clostridium difficile: treatment methods
Clostridiosis is treated only in a hospital. If intoxication occurs, as well as dyspeptic disorders, gastric lavage is prescribed and the intestines are cleaned with an enema. On the first day, a water-hungry diet is recommended.
Among the medicines, macrolite antibiotics are used. It is to them that clostridia is sensitive. Among these drugs, Clarithromycin and Azithromycin are most commonly used. Toxin Clostridium difficile (symptoms and treatment is determined 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 intestinal microflora, doctors prescribe probiotics and prebiotics. The most popular are “Khilak forte”, “Acipol”, “Lactofiltrum”, “Bifiform”, “Enterol”, “Linex”, “Enterol”.
To remove intoxication, Reopoliglukin is administered intravenously. If necessary, antihistamines and corticosteroids are prescribed.
Symptomatic treatment with enterosorbents, hepatoprotectors, vitamins, nootropics, cardiac glycosides, as well as antipyretic drugs.
It is believed that the therapy is effective if:
- stool frequency decreases;
- the consistency of the stool becomes thicker;
- general condition improves;
- positive changes in clinical and laboratory tests are observed;
- the development of the disease does not occur.
If the symptoms of Clostridium difficile do not pass through the use of antibacterial therapy, the treatment is adjusted.
Sometimes colitis provoked by Clostridium difficile is treated surgically. Usually this occurs with perforation of the colon and when the development of the inflammatory process with the occurrence of toxic megacolon is observed, and intestinal obstruction also occurs. An 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. Has a certain nature of the course and the degree of complications.
When the disease is not started and has a mild or moderate severity, the disease is cured by 100%. Fever disappears on day 1-2, and diarrhea stops on day 4-7. With bowel obstruction, renal failure and pseudomembranous colitis, the situation is aggravated.
Preventative measures
Analysis on the Clostridium difficile allows you to prevent the development of the disease in time, and timely preventive measures, which are manifested in:
- compliance with personal hygiene;
- washing products;
- heat treatment of food;
- increase immunity;
- stabilization of intestinal microflora;
- timely detection of infected persons;
- the use of antibiotic therapy.
Pathogens are resistant to ammonia, but die from exposure to sodium hypochlorite, ethylene oxide-containing substances, as well as when treated with alkaline glutaraldehyde. When infected with Clostridium difficile, it is necessary to thoroughly clean all surfaces with the indicated means in order to destroy the bacterial spores of the microbe. Bacteria do not die when treated with alcohol, but washing hands with soap can prevent the occurrence of pathology.