Doença associada à infecção pelo Clostridioides difficile. Atualização
Palavras-chave:
Clostridioides difficile, Diarreia associada aos antibióticos, Colite pseudomembranosaResumo
Os autores relatam o crescente aumento da diarreia pelo Clostridioides difficile (Clostridium difficile) como causa de diarreia relacionada aos cuidados de saúde e na comunidade, incluindo o grupo pediátrico. São revisados os principais dados da sua microbiologia, destacando a produção de toxinas e a descrição da cepa NAP1/B1/027. As principais informações sobre a sua epidemiologia são analisadas, ressaltando a pobreza de publicações sobre o tema no Brasil. São abordadas as suas formas de transmissão e os fatores de risco presentes nos pacientes que são por ela acometidos, com ênfase no uso de antibióticos. Os mecanismos patogênicos são apresentados, inclusive o papel das toxinas A, B e binária. O quadro clínico é apresentado englobando as formas assintomáticas, os portadores, os casos leves e os moderados, os graves, os graves complicados e as formas recorrentes. Os principais métodos para o seu diagnóstico laboratorial são revistos, destacando aqueles mais usados na prática clínica, entre eles a coprocultura, a cultura toxinogênica, o teste de neutralização da citotoxicidade, pesquisa da GDH, das toxinas A e B e o PCR. No tratamento os autores abordam as principais medidas gerais e as inespecíficas e os esquemas mais usados para tratar as formas leves e moderadas, as formas graves, as graves complicadas e as recorrentes, priorizando os medicamentos disponíveis no Brasil, particularmente a vancomicina e o metronidazol, mas também abordando os principais avanços no seu tratamento disponíveis na literatura. Terminam citando as principais medidas disponíveis para a sua prevenção.
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