Question

case. Last week you were on a clinical rotation at the local hospital as part of your second-year nursing program. On this rotation, your instructor took a hands-off approach and left you on your own for hours at a time. You spent most of your time hanging around at the nursing station, following nurses as they went about their duties from bed to bed, and listening to conversations between doctors and nurses about patients.

Then, one day one of the nurses who had just emerged from his fourth trip to the bathroom collapsed behind his desk. He had been losing weight and today looked especially pale. You ran to get the attending physician who was just across the hall. He took one look at the prostrate nurse and said something like “see dif” to the nursing instructor who had arrived on the scene. She replied that he had been on multiple antibiotics for the past few months in an attempt to treat a particularly nasty sinus infection.

After the sick nurse is transferred to a bed, your instructor asks you for a written report on the condition. You didn’t want to admit that you weren’t really sure what condition was involved here, so you figured you could look it up in your books or on the internet at home.

1. Your internet search of all kinds of different spellings of “see dif” yields nothing. What section of your microbiology text would likely contain the help you need? What clues lead you in that direction? (2 pts)
2. Now that you’ve found the right category of infections, can you identify what “see dif” is? (4 pts)
3. Your book has only a small paragraph on this infection. But now you know what to search for on the internet to find more information. Your instructor wants you to report on the epidemiology of the infection. You find that it is referred to as an opportunist and this accounts for its epidemiological patterns. First of all, what is an opportunist? (2 pts)
4. Part of an epidemiological description of an infection involves knowing who is most often affected by it. Let’s consider opportunistic infections as a group. People in which age groups are most likely to suffer symptoms from an opportunistic infection? (2 pts)
5. In this case, the affected nurse is in his mid-30s. Is it his age or something else that predisposes him to the infection? Provide your rationale. (3 pts)
6. What is the major virulence factor for this microorganism? What does it do to contribute to his symptoms? (4 pts)

Answer 1

Infections with Clostridium difficile typically occur in people taking antibiotics or those who have recently taken them. Symptoms include watery diarrhea, cramping and abdominal pain, loss of appetite, and fever.

Diarrhea is typically frequent; you may have 3 or more bouts in a 24-hour period. If you develop diarrhea within a few days of being admitted to or released from a hospital or healthcare facility, or within two months of taking an antibiotic, see your doctor.

To diagnose a C. difficile infection, your NYU Langone doctor takes a medical history and asks about any medications you are taking. He or she may also order one or several tests, depending on your symptoms, medical history, and whether you are currently in a hospital or healthcare facility or have recently been released from one.

?Stool test

The simplest way to detect C. difficile is through a stool test, in which you provide a sample in a sterile container given to you at your doctor’s office or a lab. A pathologist, a doctor who studies diseases in a laboratory, determines whether the sample has signs of C. difficile.

?Gram-positive, anaerobic, spore-forming and toxin-producing bacillus, belonging to cluster XI the Clostridium genus and can be isolated from water, vegetables, hospital environment, and the intestines of humans and domesticated animals  

?is a type of bacteria that is associated with diarrhea resulting from antibiotic use. C. difficile testing and C. difficile toxin tests identify the presence of these bacteria, genes associated with toxin production, and/or detect the toxins produced by them.

?The simplest way to detect C. difficile is through a stool test, in which you provide a sample in a sterile container given to you at your doctor's office or a lab. A pathologist, a doctor who studies diseases in a laboratory, determines whether the sample has signs of C. difficile.

?Once the diarrhoea has settled for a minimum period of 48 hours, you will no longer be considered infectious.

?Foods that contain probiotics will help repopulate the gut with good bacteria and reduce the risk of regrowth of C diff. Probiotic bacteria are found in yogurt and other fermented foods.

?Worst-case scenario, an untreated C. diff infection can lead to uncontrolled inflammation and distention in the colon that may lead to creation of a hole in the intestines that can be fatal

?difficile transmission, the facility should consider using a bleach solution daily in all resident rooms until transmission has ceased. Use a clean cloth saturated with a properly diluted disinfecting solution for each residents' area of the room. Work from clean to dirty (e.g., bedside tables, bedrails to bathroom).

?Use chlorine bleach if the items can be safely washed with it. Wash your hands with soap and water after you handle the dirty laundry. It's OK to take clothes to a dry cleaner that were worn by a patient infected with C. diff.

?A wide variety of probiotics have been tested and used to prevent or treat CDI. The best studied probiotic agents in CDI are Saccharomyces boulardii, Lactobacillus GG (LGG) and other lactobacilli, and probiotic mixtures.

?C. diff spores can live outside the human body for a very long time and are found frequently in hospitals, nursing homes and on items such as toilet seats, linens, telephones, floors, bed rails, bathroom fixtures, and medical equipment.

?diff. infection is contagious. The bacteria can spread person to person. They also live a long time on surfaces, such as toilet seats, telephones, and doorknobs.

?The high transmissibility and widespread environmental contamination by Clostridium difficile suggests the possibility of airborne dissemination of spores. We measured airborne and environmental C. difficile adjacent to patients with symptomatic C. difficile infection (CDI).

?The primary mode of transmission for C. difficile within healthcare facilities is by person-to-person spread through the fecal-oral route. The hands of healthcare workers transiently contaminated with C. difficile spores, along with environmental contamination play an important role in the transmission of C.

?C-diff or Clostridium difficile is shed in feces. Any surface, device, or material (e.g., commodes, bathing tubs, and rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the C-diff spores. The infection is usually spread hand to mouth.