A 70 year old male went to the emergency room complaining of fever, diarrhea, intestinal cramps and a sore throat. Blood cultures were negative for bacteria, but stool cultures isolated a gram positive rod-shaped bacterium. When asked about any new or unusual food he had consumed, the patient stated the he had consumed a ripened farm cheese his daughter had given him that she had brought back from a recent trip to Mexico. A sample of the cheese was sent to the laboratory. Further culturing revealed the same type of bacterium and that this microbe grew best at 4o C, rather than 37o C.
- What is the appropriate treatment(s) for the disease/disorder?
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Clostridium difficile is a Gram positive staining bacteria. There are certain antibacterial drugs that are effective against it. Metronidazole is a popular treatment for this disease because it is available orally and it has been around for several decades so it is generic (meaning inexpensive). Vancomycin is another drug for C. difficile. It is traditionally given intravenously but it can be given orally for this particular case since it is not taken up into the boodstream and will inhabit the intestine.
Interestingly, a stool transplant (more properly termed "fecal bacteriotherapy") has had very high success rates for curing the bacterial infection. A stool sample from a healthy individual is transplanted into the intestine of an individual with C. difficile infection. The presence of the healthy, normal gut flora in the transplanted stool from the healthy individual recharges the sick person's own gut flora so the C. difficile can be wiped out through bacterial competition for nutrients. This could become a more prevalent procedure in the future.
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