Clostridium Difficile Infection: in Human Diagnosis and Management

Clostridium Difficile (CD) is the most important cause of nosocomial diarrhea in adults. Illness may range from mild watery diarrhoea to life-threatening colitis. CD has now also emerged in the community in populations previously considered low risk. Emerging risk factors and disease recurrence represent continued challenges in the management of CDI. Diagnosis is based primarily on the detection of C. difficile toxin A or toxin B. These toxins primarily disrupt the cytoskeletal structure and the tight junctions of target cells causing cell rounding and ultimately cell death. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosisthe major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood the organism has evolved over the last 8 years to become more virulent and resistant to antimicrobials causing a more severe form of the disease that has increased mortality and healthcare costs. The guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratified depending on whether they have mild-to-moderate, severe or complicated disease. This chapter highlights the current knowledge on C. difficile how to produce infection in human, transmission, guidelines, Epidemiology, risk and diagnosis.