A 67-year-old man had surgery for a ruptured sigmoid colon
diverticulum with an abscess. A repair was done, and the
abscess was drained. He was treated with intravenous
gentamicin and ampicillin. Ten days later and 4 days after being
discharged from the hospital, the patient developed malaise,
fever, and cramping abdominal pain. He had multiple episodes
of diarrhea.. His stool was positive for occult blood and the
presence of polymorphonuclear cells. On sigmoidoscopy,
the mucosa was erythematous and appeared to be inflamed,
and there were many raised white to yellowish plaques 4-8 mm
What is the likely cause of the patient’s problem?
2. What in his history was a predisposing factor for his development of this infection? How did it predispose him?
3. Evaluate the laboratory methods for the diagnosis of Clostridium difficile infection.
4. Why culture is not useful to establish the etiology of this disease?
5. Why is this organism particularly problematic as a nosocomial pathogen?
6. Describe a disease spectrum seen with this organism. Why is it difficult to manage infections caused by this organism?
7. What virulence factors does this organism produce, and what roles do these factors play in the pathogenesis of disease?
8. Discuss three different types of therapeutic strategies that can be used to treat this disease?
9. Recurrence of this diseases occurs in 10 to 20% of patients. Give two possible explanations for why recurrences are common in this disease. What was the likely source of bacteria for the relapse that occurred in the C. difficile infection?
10Since 2000 various studies from USA, Europe and Canada revealed increased incidence of CDI and more severity of the disease than previously reported. What data support this observation? What are possible explanations for this increased virulence