The reason Clostridium difficile is such a big deal is that it produces toxins. So there's

entrotoxin A and cytotoxin B. Actually, there is a third toxin called a binary toxin that's produced

by some strains that may contribute to pathogenesis, but mostly we talk about enterotoxin A and cytotoxin B.

And there are all kinds of host responses that can occur on an immune complex level. So

that decides really what happens to the patient, meaning you might just have some diarrhea,

or you may have diarrhea with inflammation,

or you may get tissue necrosis. And you will hear the term fulminant disease used with

clostridium difficile, and when we talk about fulminant disease, we're talking about people with

shock, or an iliasis or toxic megacolon

or developing hypotension or organ failure. And there's all kinds of factors that go into that

beyond just the host response. So there are different strains of Clostridium difficile. For example,

the ribotype O27 can cause substantial disease severity and mortality.

And that's why everybody that sees this disease often enough sees a range of problems from diarrhea that just lasts a day or two and then you start treatment and it

goes away pretty quickly to the other side of that pendulum which is death.

Now when we do diagnose a Clostridium difficile infection, the very first thing we want to

do is try and discontinue the causative antimicrobial

agents if antimicrobial agents are the cause. Again, there are other causes like chemotherapy

and other risk factors. Let's see you absolutely cannot get this patient off of antivox because

of the infection that they have, well, then you

really want to try and narrow the spectrum because, for example, a commonly related antibiotic

to developing Clostridium difficile would be third and fourth generation Sufflesporins. But if you

use a first generation Sufflesporin, you can cause Clostridium difficile, but it's less likely.

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