Clostridium difficile associated infections: an updated view

Abstract

Clostridium difficile is an emerging anaerobic, spore forming pathogen, recognized as the etiological agent of similar to 30% of antibiotic associated diarrheas. Clinical symptoms can fluctuate from mild to moderate diarrhea, pseudomembranous colitis and toxic megacolon. The incidence of C. difficile associated infections (CDAI) is similar to 1% of total hospitalized patients. CDAI has a mortality rate of similar to 1 to 5%, and a relapse rate of similar to 20%. The appearance of severe outbreaks of CDAI could be attributed to changes in the production of the two major virulence factors, the enterotoxins TcdA and TcdB, which produce massive epithelial damage. C. difficile spores play an essential role in transmission, initiation and persistence of CDAI. Recent advances in detection methods, development of novel therapies and prevention methods could allow a reduction on the frequency of CDAI. The objective of this review is to provide an updated view on the mechanisms of pathogenesis, epidemiology, risk factors, detection methods, treatment and prevention of CDAI.