C diff - Revision history

Aesetholephews: /* TREATMENT */

2022-10-21T16:56:15Z

TREATMENT

Aesetholephews: /* TREATMENT */

2022-10-21T16:52:47Z

TREATMENT

Aesetholephews: /* DIAGNOSIS */

2022-10-21T16:51:33Z

DIAGNOSIS

Aesetholephews: /* Newer treatments */

2022-10-21T15:57:27Z

Newer treatments

Aesetholephews: /* Newer treatments */

2022-10-21T15:56:47Z

Newer treatments

Aesetholephews: /* TREATMENT */

2022-10-21T15:53:41Z

TREATMENT

Aesetholephews: /* TREATMENT */

2022-10-21T15:52:28Z

TREATMENT

Aesetholephews: /* TREATMENT */

2022-10-21T15:51:57Z

TREATMENT

Aesetholephews: /* DIAGNOSIS */

2022-10-21T15:49:39Z

DIAGNOSIS

Aesetholephews: /* Diagnostic approaches */

2022-09-12T15:14:44Z

Diagnostic approaches

@@ Line 53: / Line 53: @@
 **Clinical resolution occurred in 92% of patients (89% after a single treatment), without serious adverse effects.
 **A recent review of 536 patients reported a 27% clinical response rate.
-**A randomized trial of fecal microbiota transplantation demonstrated symptom resolution in 94% of patients who received vancomycin for s days followed by either one or two treatments with fecal microbiota transplantation, versus 31% in those receiving vancomycin alone for 14 days, and 23% for those receiving vanconycin for 14 days plus bowel lavage. This study was stopped early after interim analyses demonstrated superiority of fecal microbiota transplantation, Among 18 patients in the other treatment groups who received subsequent fecal microbiota transplantation 83% had symptom resolution
+**A randomized trial of fecal microbiota transplantation demonstrated symptom resolution in 94% of patients who received vancomycin for 5 days followed by either one or two treatments with fecal microbiota transplantation, versus 31% in those receiving vancomycin alone for 14 days, and 23% for those receiving vanconycin for 14 days plus bowel lavage. This study was stopped early after interim analyses demonstrated superiority of fecal microbiota transplantation, Among 18 patients in the other treatment groups who received subsequent fecal microbiota transplantation 83% had symptom resolution

@@ Line 53: / Line 53: @@
 **Clinical resolution occurred in 92% of patients (89% after a single treatment), without serious adverse effects.
 **A recent review of 536 patients reported a 27% clinical response rate.
-**A randomized trial of fecal microbiota transplantation demonstrated symptom
+**A randomized trial of fecal microbiota transplantation demonstrated symptom resolution in 94% of patients who received vancomycin for s days followed by either one or two treatments with fecal microbiota transplantation, versus 31% in those receiving vancomycin alone for 14 days, and 23% for those receiving vanconycin for 14 days plus bowel lavage. This study was stopped early after interim analyses demonstrated superiority of fecal microbiota transplantation, Among 18 patients in the other treatment groups who received subsequent fecal microbiota transplantation 83% had symptom resolution

@@ Line 6: / Line 6: @@
 =DIAGNOSIS=
-* Laboratory testing cannot distinguish between asymptomatic colonization and active infection.
+* Laboratory testing cannot always distinguish between asymptomatic colonization and active infection.
 ==Diagnostic criteria==
 * Diarrhea
 * Positive stool test for toxigenic C. diff or toxins or visualization of pseudomembranous colitis
 ==Diagnostic approaches==
-* Toxigenic Culture (TC) and/or Cell Cytotoxicity Assay (CCA)
+* Gold Standard: Toxigenic Culture (TC) and/or Cell Cytotoxicity Assay (CCA)
 ** Anaerobic culture for 24-48 hrs followed by colony selection and culture with human cells to test for cell cytotoxicity which takes an additional 24-48 hours.
 ** Time consuming and difficult, up to 5 days
 ** Detects a little as 3 picograms of toxin
@@ Line 21: / Line 20: @@
 * PCR / NAAT
 ** Detects tcdA/tcdB genes, mRNA for the toxins
-*** Detects presence of toxigenic strains of C. diff
+** Detects presence of toxigenic strains of C. diff
-* mRNA doesn't necessarily imply active infection
+** mRNA doesn't necessarily imply active infection
-** EIA / ELISA
+* EIA / ELISA
-*** Detects toxin in stool
+** Detects toxin in stool
-*** Low sensitivity (0.73-0.87)
+** Low sensitivity (0.73-0.87)
 * Multistep algorithms, there are dozens
 ** EIA for GDH / Toxin A/B
-* Both positive = C. diff
+*** Both positive = C. diff
-* Both negative = NO C. diff
+*** Both negative = NO C. diff
-* Mixed results, use PCR for tcdB as tiebreaker
+*** Mixed results, use PCR for tcdB as tiebreaker
 ** Toxin EIA 1 (Meridian), higher PPV, lower NPV
 ** Toxin EIA 2 (TechLab), lower PPV, higher NPV
-* Highest NPV (99.8%) GDH EIA + NAAT
+** Highest NPV (99.8%) GDH EIA + NAAT
-* Highest PPV (93.5%) Toxin EIA 1 + NAAT
+** Highest PPV (93.5%) Toxin EIA 1 + NAAT
 =TREATMENT=

@@ Line 49: / Line 49: @@
 **Expensive
 *Fecal microbiota transplant (83-94% success rate for recurrent COL).
-**Fecal microbiota transplantation restores gut microbiota diversity, with the
+**Fecal microbiota transplantation restores gut microbiota diversity, with the instillation of donor stool into the gastrointestinal tract of an infected patient.
 **This procedure has had good clinical response without reports of adverse events, for refractory or recurrent CDI.
-**The first systematic review was published in 2011 and
+**The first systematic review was published in 2011 and included 317 patients with recurrent CDI treated with fecal microbiota transplantation via enema, nasojejunal-tube/gastroscope or colonoscopy.
 **Clinical resolution occurred in 92% of patients (89% after a single treatment), without serious adverse effects.
 **A recent review of 536 patients reported a 27% clinical response rate.

@@ Line 48: / Line 48: @@
 *Fidazomicin (87.7% success rate vs. 86.8% for vanco, 15.4% recurrence rate)
 **Expensive
-*Fecal microbiota transplant (83-94% success rate for recurrent COL). Fecal microbiota transplantation restores gut microbiota diversity, with the
+*Fecal microbiota transplant (83-94% success rate for recurrent COL).
-instillation of donor stool into the gastrointestinal tract of an infected patient, This procedure has had good clinical response without reports of adverse events, for refractory or recurrent COI. The first systematic revien was published in 2911 and
+**Fecal microbiota transplantation restores gut microbiota diversity, with the
-included 317 patients with recurrent COI treated with fecal microbiota transplantation via enema, nasojejunal-tube/gastroscope or colonoscopy. Clinical resolution occurred in 92% of patients (89% after a single treatment), without serious adverse effects. A recent revien of 536 patients reported a 27% clinical response rate.
+instillation of donor stool into the gastrointestinal tract of an infected patient
-A randomized trial of fecal microbiota transplantation demonstrated symptom
+**This procedure has had good clinical response without reports of adverse events, for refractory or recurrent CDI.
 resolution in 94% of patients who received vancomycin for s days followed by either
 one or two treatments with fecal microbiota transplantation, versus 31% in those

@@ Line 37: / Line 37: @@
 =TREATMENT=
-*First line treatment
+==First line treatment==
 *PO Vancomycin (78.5% success rate, 25,3% recurrence rate)
 *PO Metronidazole (66,3% success rate, 47% recurrence rate), recent strains have higher MIC
-*Disease stratification
+==Disease stratification==
 *WBC (15), Cr (1.5% baseline), recurrence, hypotension, ileus, megacolon
 *Mild = Metronidazole, preferred for cost and non-inferiority in mild disease
 *Severe/Complicated = Vancomycin
 *Recurrent = Metro or Vanco for first recurrence, Vanco for subsequent
-*Newer treatments
+==Newer treatments==
-**Fidazomicin (87.7% success rate vs. 86.8% for vanco, 15.4% recurrence rate)
+*Fidazomicin (87.7% success rate vs. 86.8% for vanco, 15.4% recurrence rate)
-***Expensive
+**Expensive
-**Fecal microbiota transplant (83-94% success rate for recurrent COL). Fecal microbiota transplantation restores gut microbiota diversity, with the
+*Fecal microbiota transplant (83-94% success rate for recurrent COL). Fecal microbiota transplantation restores gut microbiota diversity, with the
 instillation of donor stool into the gastrointestinal tract of an infected patient, This procedure has had good clinical response without reports of adverse events, for refractory or recurrent COI. The first systematic revien was published in 2911 and
 included 317 patients with recurrent COI treated with fecal microbiota transplantation via enema, nasojejunal-tube/gastroscope or colonoscopy. Clinical resolution occurred in 92% of patients (89% after a single treatment), without serious adverse effects. A recent revien of 536 patients reported a 27% clinical response rate.

@@ Line 17: / Line 17: @@
 ** Time consuming and difficult, up to 5 days
 ** Detects a little as 3 picograms of toxin
-* Stool antigen looks for Glutamate dehydrogenase (COH) via ELISA (SIA)
+* Stool antigen looks for Glutamate dehydrogenase (GDH) via ELISA (EIA)
 ** Does not distinguish between toxigenic and non-toxigenic strains
 ** Half of C. diff isolates are non-toxigenic