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Cholera 

Cholera
Chapter:
Cholera
DOI:
10.1093/med/9780198729228.003.0057
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date: 26 June 2019

Clostridium difficile is a spore-forming, obligate anaerobic, Gram-positive bacillus. It is the commonest cause of antimicrobial-associated diarrhoea and is a common health care-associated pathogen. Over the past decade, the incidence of C. difficile infection (CDI) has approximately doubled in adults and children. Pathogenic strains circulating in asymptomatic infants from the community may represent a potential reservoir for transmission to others. The main virulence factors of the enteropathogenic C. difficile are two toxins, although it is likely that multiple factors determine whether a strain is virulent and/or epidemic. Exposure to antibiotics remains the pre-eminent risk factor for CDI; other well-established risk factors are older age, gastric acid suppression, and some chronic underlying medical conditions. The clinical spectrum of CDI varies widely, ranging from asymptomatic carriage to severe and fulminant pseudomembranous colitis that can be fatal. The diagnosis of CDI requires clinical suspicion based on the presence of specific risk factors in a patient with clinical manifestations of intestinal disease. Discontinuation of antimicrobial agents is the first step in treating CDI and may suffice in mild CDI without systemic signs. Antimicrobial therapy is indicated in children with mild to severe CDI or underlying gastrointestinal tract disease or immune compromise; both metronidazole and vancomycin are effective. The first step in preventing CDI in the health-care setting is to implement the correct use of the antimicrobial therapy; hand hygiene, contact precautions, and environmental decontamination are key control measures.

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