Disease associated with Clostridioides difficile infection. Update
Keywords:
Clostridioides difficile, Diarrhea associated with antibiotics, pseudomembranous colitisAbstract
The authors report a large increase in the number of cases of Clostridioides difficile infection, a major cause of healthcare associated diarrhea, and is increasingly present in the community, including the pediatric group. The main data on its microbiology are reviewed, emphasizing the importance of toxins and the description of the NAP1/B1/027 strain. Epidemiological data are analyzed, calling attention to the small number of publications about this issue in Brazil. Its forms of transmission and the risk factors present in patients who are affected by it are discussed, with emphasis on the use of antibiotics. Pathogenic mechanisms are presented including the role of toxins A, B and binary. The clinical picture is presented encompassing asymptomatic forms, carriers, mild and moderate cases, severe, severe complicated and recurrent forms. The main methods for its laboratory diagnosis are reviewed, highlighting those most used in clinical practice, including coproculture, toxinogenic culture, the cytotoxicity neutralization test, investigation of GDH, toxins A and B and PCR. In treatment, the authors address the main general and nonspecific measures and the most used regimens to treat mild and moderate forms, severe forms, severe complicated and recurrent forms, prioritizing the drugs available in Brazil, particularly vancomycin and metronidazole, but also addressing the main advances in its treatment available in the literature. They end by citing the main measures available for its prevention.
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