DR Medhat MRCP

Clostridium difficile:
- Is a Gram positive rod often encountered in hospital practice.
- It produces an exotoxin which causes intestinal damage leading to a syndrome called
pseudomembranous colitis.
- Clostridium difficile develops when the normal gut flora are suppressed by broadspectrum
antibiotics.
- Clindamycin is historically associated with causing Clostridium difficile but the
aetiology has evolved significantly over the past 10 years.
- Second and third generation cephalosporins are now the leading cause.
• Features:
1) Diarrhea.
2) Abdominal pain.
3) If severe, toxic dilatation (toxic megacolon).
4) Sometimes seen in nosocomial outbreaks
• Diagnosis
- Is made by detecting Clostridium difficile TOXIN (CDT) in the stool.
• Management:
1) ORAL metronidazole for 10-14 days.
2) ORAL vancomycin may be used If severe or not responding to metronidazole
3) Oral vancomycin + I.V metronidazole combination should be used For lifethreatening
infections .
D. Listeria monocytogenes
- Is a Gram positive bacillus which has the unusual ability to multiply at low
temperatures.
- It is typically spread via contaminated food, typically unpasteurised dairy products.
- Infection is particularly dangerous to the unborn child where it can lead to miscarriage
- Features : can present in a variety of ways
1) Diarrhoea, flu-like illness.
2) Pneumonia , meningoencephalitis
3) Ataxia and seizures
- Diagnosis :
1) Blood cultures.
2) CSF may reveal :
o Pleocytosis, with 'tumbling motility' on wet mounts
- Management :
1) Amoxicillin/ampicillin (cephalosporins usually inadequate)
2) IV amoxicillin/ampicillin + Gentamicin : if Listeria meningitis .
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