Clostridium Difficile Infection is currently the most commonly found cause of diarrhoea in relation to antibiotic treatments in hospitals. Although C. difficile infections are common, there are only a limited methods of diagnosing accurately if a patient has been affected. I will be discussing methods of diagnosis, pros and cons and statistical facts regarding C. difficile infection.
METHODS OF LABORATORY DIAGNOSIS There are several methods of diagnosing if a patient is infected by C.difficile Although there are 5 different methods of detection which could in theory lead to a positive diagnosis; but only three out of the five, faecal-cytotoxin detection (Mollby R et al 1985), toxigenic culture detection and direct gas liquid chromatography (GLC), are considered to be procedures providing firm positive result for standard diagnosis to be made (BRAZIER 1998).
The other two, Latex agglutination and computed tomography scan are also tests carried out to diagnose the presence of C.difficile, but they are insufficiently sensitive nor specific on their own thus these tests are commonly used in conjunction with other methods of testing. In order for a precise bacteriological diagnosis, stool samples provided must be in the form of a liquid, freshly obtained and kept at 4°C or less.
The test sample must be fresh and kept at low temperatures due to the fact that the cytotoxin activity drastically decreases over time, 20% of samples sent by post were completely inactivated according to results reported by Brazier, therefore increasing the probability of a false result being obtained.
(BRAZIER 1998) DEPENDANCE ON PRIMARY SYMPTOMS IN DIAGNOSIS OF A PATIENT Patients maybe diagnosed with C. difficile infection if they produce diarrhoea or liquid-stools of more than 300ml in a period of 24 hours (JOHN STARR BMJ).
Even though main symptoms of C. difficile infection includes chronic diarrhoea, it is not enough to diagnose a patient positive of the infection due to dependancies on other primary or secondary symptoms. Other primary symptoms include frequent bowel movement, pyrexia, dehydration and delirium; although these symptoms are not unique for patients suffering C.difficile infection, a positive diagnosis can be made if several primary symptoms relevant are identified on a patient in conjunction to each other. (GEORGE W. L et al 1980).
In most cases, symptoms mentioned will appear at the start of their cycle of antibiotics or shortly after finishing. Antibiotics generally associated with C. difficile infection development are clindamycin and cephalosporins; (JOHN STARR BMJ) both are bactericidal thus they are commonly used for infections caused by bacterium. Amoxicillin may cause the same appearance of the symptoms, but is less common compared to the previous two antibiotics mentioned.
(SARAH A et al 2010) Antibiotics mentioned above lead to these symptoms being developed because they cause the original bacterial flora in the bowel to alter, which in turn leads to unbalance in competition between bacterial present in the bowel therefore allowing other bacterium such as C. difficile to thrive better. (PATIENT 2009) UNCERTAINTY AND SECONDARY SYMPTOMS OF C. DIFFICILE Pseudomembranous colitis is present in a prolonged exposure to the infection. The patient will show shedding of the colonic epithelium. Although this infection is commonly caused by C.difficile, Pseudomembranous colitis is not unique to patients suffering C. difficile infection.
(GEORGE W. L et al 1980) Despite the fact that C. difficile has various symptoms which allows for a diagnosis to be made by a doctor, a positive diagnosis may not be given until further laboratory testing is done; this is because the symptoms are not completely unique to C. difficile infection alone. Moreover, secondary symptoms such as pseudomembranous colitis may not be shown even if the patient is suffering from C. difficile infection. STATISTICS ON C. DIFFICILE INFECTION.
Anyone who are prescribed antibiotics has a probability of developing C. difficile infection. It is more likely for a person to develop this infection when they are undergoing a longer course of antibiotics treatment. Even though this is the case, most developments of C. difficile infections occur in hospital, or in people who have just come out of a hospital. (GIANNELLA R. A 1993) C. difficile infections are known to develop more commonly in elderly people due to the fact that older people are generally in hospitals more often than younger people. 8 out of 10 patients are over the age of 65 (Delmee M et al 1986).
Its a known fact that if a person gets older, their immune systems weaken thus being more susceptible to infections. (PATIENT 2009) Also people who have suffered C. difficile infection once are more likely to develop the same infection again in the future. Statistics show that there is 1 in 4. 5 chance that a person will be reinfected. (PATIENT 2009) We have to consider that not all patients showing symptoms of diarrhoea after or during antibiotic treatments are in fact infected by C. difficile; according to statistics, only 1 out of 5 people who have symptoms of diarrhoea are actually diagnosed and tested positive for C.difficile infection.
(PATIENT 2009) CONCLUSION Its can be deduced that C. difficile infection is undoubtably serious due to the fact that it has a very high risk level of developing in anyone on a course of antibiotics and affecting people with weaker immune systems. As it can be concluded from my essay that C. difficile infections are common throughout the population nowadays but are not always considered severe. Although severity is not an issue, diagnosis of C. difficile infection is; due to the fact that there is no concrete method of diagnosis that yields a conclusive basis for positive identification if a patient is infected.
Diagnosis, prevention and treatments are all vitally required in order to lower the probability of C. difficile infection amongst the population. Education of C. difficile infection should be more widely spread in order for people to be able pre-diagnose (self-diagnose) and visit the doctor as soon as symptoms occur. This will reduce the occurrence of C. difficile infection and may prevent this, so called “superbug” from uncontrollably spreading.
REFERENCE MOLLBY R et al, Pathogenesis and diagnosis of C. difficile enterocolitis, Scandanavian Journal of Infectious Diseases 46:47, 1985 Brazier J. S.1998, The diagnosis of Clostridium difficile – associated disease, Journal of Antimicrobial Chemotherapy, vol. 41, Suppl. C, pp. 29-40 DELMEE M et al, Application of a technique for serogrouping of C. difficile in an outbreak of antibiotic-associated diarrhoea. Journal of Infections 13:5, 1986 GEORGE W.
L et al, Treatment and prevention of antimicrobial agent induced colitis and diarrhoea. Gastroenterology 79:366, 1980 CHARALOBOS POTHOULAKIS et al, SEPTEMBER 1993, Clostridium Difficile Colitis and diarrhea, Gastroenterology Clinics Of North America, Acute Infectious Diarrhea, SAUNDERS 22:3, pp.623-634.
Clostridium Difficile, PATIENT UK, Version 38, 11 DEC 2009, (http://www. patient. co. uk/health/Clostridium-Difficile. htm ). JOHN STARR (Consultant physician and honorary professor of Health and Ageing at the UoE), 2010, Clostridium Difficile Infection: diagnosis and treatment, Viewed on 26 OCT 2010, (http://learning. bmj. com/learning/modules/module. html? execution=e1s15 ) Sarah A. Kuehne et al, 2010, The role of toxin A and toxin B in Clostridium difficile infection, Nature(International weekly journal of science), vol. 467, ISSUED 7 OCT 2010, pp. 711-713.