Clostridial infections

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anaerobic, spore-forming gram positive bacilli that exist widely in nature in soil and vegetation and within the GI tracts of humans and animals; all produce exotoxins that cause injury

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Pathogenic agents:

  1. C. tetani (tetanus)( contamination through a skin break)
    1. Can be confused with meningitis but no abnormal CSF profile is observed in tetanus
    2. Clinical presentation: lockjaw, neck stiffness, dysphagia, generalized muscle spasm with tonic seizure-like activity, autonomic dysfunction
    3. Treatment: penicillin G
  2. C. botulinum (foodborne, wound, and infant botulism)
    1. May survive several hours at 100 degrees Celsius but moist heat at 120 degrees Celsius for 30 minutes will kill the spores
    2. Outbreak is 18-36 hours after ingestion
    3. Clinical presentation: double/blurred vision, droopy eyelids, slurred speech, dysphagia, dry mouth, muscle weakness- can lead to respiratory failure, constipation
    4. Treatment: trivalent antitoxin
  3. C. Perfringens A (food poisoning, wound contamination, gas gangrene)
    1. Wound infection may occur as a cellulitis, myositis, or progressive myonecrosis (gas gangrene)
    2. Treatment: wound debridement, penicillin G, antitoxin
  4. C. difficile (antibiotic associated colitis)
    1. Transferred from person to person
    2. Associated with use of broad spectrum antibiotics, ulcerative cholitis, Crohn's disease)
    3. Clinical presentation: fever, diarrhea (watery stools), abdominal cramps/tenderness
    4. Diagnosis: white blood cells and C. difficile toxin in the stool
    5. Treatment: enteral vancomycin or metronidizole
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