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Clostridium difficile: past, present and future

Since its first identification 1935, C. difficile has been the focus of much research. Here Charlotte Duncan provides an overview and update on the methodologies available to detect and identify this infective agent.

Clostridium difficile was originally recovered from the faeces of newborn infants by Hall and O’Toole in 1935.1 A hamster model proved essential in the early work where the toxin of C. difficile was shown to be the ‘agent’ of disease. The main contributors to this work included Keighley et al.2and Larsson et al.3 in the UK, and Bartlett et al.4 and Lusk et al.5 in the USA. In 1977, Bartlett and his co-workers showed that a cell cytotoxicity assay used to detect toxin in the faeces of affected patients was a useful diagnostic laboratory tool to establish the presence of disease.

In 1996, Braun et al.6 determined the nucleotide sequence 3.8 kb upstream and 5.2 kb downstream of the toxin genes A and B of C. difficile. They found nine open reading frames (ORFs), two of which were attributed to the pathogenicity locus (PaLoc). Further sequencing confirmed high conservation of the PaLoc borders, allowing the locus to be defined as a distinct genetic element.

Clostridium difficile Infection
The most common clinical presentation of C. difficile infection (CDI) is diarrhoea associated with antibiotic use. Diarrhoea can occur within a few days of the start of therapy but can equally occur up to eight weeks after therapy has ended. Patients with mild to moderate disease usually experience diarrhoea as the only symptom, with up to 10 bowel movements a day. More severe disease includes abdominal pain or cramps, fever and leucocytosis. The faeces are watery with a foul odour. The presence of blood is rare. Severely diseased patients also demonstrate hypoalbuminaemia and altered creatinine and lactate levels.

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Upcoming Events

USCAP 113th Annual Meeting

Baltimore Convention Center, Baltimore, Maryland, USA
23-28 March, 2024

Pathology Horizons 2024

MacDonald Bath Spa Hotel, Bath
18-20 April, 2024

Diagnostics North East Conference 2024

The Catalyst, Newcastle upon Tyne
19 April, 2024

ECCMID 2024 - European Congress of Clinical Microbiology and Infectious Diseases

Fira Gran Via, 08038 Barcelona, Spain
27-30 April 2024

British Society for Microbial Technology Annual Microbiology Conference

UK Health Security Agency, Colindale, London
2 May 2024

EQA Reports: Interpreting Key Information & Troubleshooting Tips

ONLINE - Zoom
Thursday 16th May 2024

Access the latest issue of Pathology In Practice on your mobile device together with an archive of back issues.

Download the FREE Pathology In Practice app from your device's App store

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