{"id":1713,"date":"2016-07-15T14:27:11","date_gmt":"2016-07-15T18:27:11","guid":{"rendered":"https:\/\/www.bu.edu\/research\/?page_id=1713"},"modified":"2025-08-05T11:54:36","modified_gmt":"2025-08-05T15:54:36","slug":"clostridium-difficile-agent-information-sheet","status":"publish","type":"page","link":"https:\/\/www.bu.edu\/research\/ethics-compliance\/safety\/rohp\/agent-information-sheets\/clostridium-difficile-agent-information-sheet\/","title":{"rendered":"Clostridium difficile Agent Information Sheet"},"content":{"rendered":"<p><span>Boston University<br \/>\nResearch Occupational Health Program (ROHP)<br \/>\n617-358-7647<\/span><\/p>\n<h2>Agent<\/h2>\n<p>The <em>Clostridia <\/em>species are gram-positive, rod-shaped, spore-formers. They are generally obligate anaerobes and are ubiquitous saprophytes or part of the normal flora. <em>Clostridium difficile <\/em>is an opportunistic pathogen that produces large, oval, subterminal spores and two toxins. Toxin A is an enterotoxin that causes fluid accumulation in the intestine while toxin B is a cytopathic agent. <em>C. difficile <\/em>flourishes when antibiotics eliminate the normal intestinal flora.<\/p>\n<h3>Disease\/Infection<\/h3>\n<p>The following diseases are caused by strains of <em><span style=\"text-decoration: underline;\">C. difficile<\/span><\/em>:<\/p>\n<ul>\n<li><em> difficile <\/em>can cause a range of diseases from diarrhea, pseudomembranous colitis to life threatening surgical condition called toxic megacolon.<\/li>\n<li>Some individuals, with long term exposure to healthcare facilities or frequent hospitalizations, may be chronic carriers of <em>C difficile<\/em><\/li>\n<\/ul>\n<h3>Pathogenicity<\/h3>\n<p>Opportunistic pathogen, broad-spectrum antibiotic therapy eliminates competing gut flora, allowing the overgrowth of <em>C. difficile<\/em>; important cause of antibiotic-associated diarrhea and pseudomembranous colitis; diarrhea in cancer patients receiving chemotherapy; symptoms range from mild diarrhea to severe colitis (possibly fatal).<\/p>\n<h3>Biosafety Information<\/h3>\n<p><strong> <\/strong><strong>Risk<\/strong> <strong>Group\/BSL<br \/>\n<\/strong>RG 2\/BSL-2<br \/>\nBiosafety Level 2 Practices<\/p>\n<p><strong>Modes of Transmission<br \/>\n<\/strong>Fecal-oral contact; evidence for transmission via fomites and hands exists<\/p>\n<div class=\"responsive-table\"><table>\n<tbody>\n<tr>\n<td><\/td>\n<td>Transmission<\/td>\n<\/tr>\n<tr>\n<td>Skin Exposure (Needlestick, bite, or scratch):<\/td>\n<td>Direct contact with bacteria, spores or toxins<\/td>\n<\/tr>\n<tr>\n<td>Mucous Membrane Splash to Eye(s), Nose or Mouth:<\/td>\n<td>Yes<\/td>\n<\/tr>\n<tr>\n<td>Inhalation:<\/td>\n<td>Remote<\/td>\n<\/tr>\n<tr>\n<td>Ingestion:<\/td>\n<td>Yes<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<p><strong>Host Range\/Reservoir<br \/>\n<\/strong>Humans and other animals<\/p>\n<p><strong>Symptoms<br \/>\n<\/strong><em style=\"line-height: 1.5;\">C. difficile <\/em><span style=\"line-height: 1.5;\">can cause a spectrum of clinical manifestations including watery diarrhea and mild abdominal cramping and tenderness. More severe colitis can be marked by:<\/span><\/p>\n<ul>\n<li>Watery or bloody diarrhea 10 to 15 times a day<\/li>\n<li>Severe abdominal cramping<\/li>\n<li>Fever<\/li>\n<li>Hematuria or pyuria<\/li>\n<li>Nausea<\/li>\n<li>Dehydration<\/li>\n<\/ul>\n<p>Fulminant colitis can present with above symptoms and additionally, abdominal distension and severe pain with possible shock.<\/p>\n<p><strong>Incubation Period<br \/>\n<\/strong>Not known<\/p>\n<p><strong>Viability<br \/>\n<\/strong>Spores are fairly resistant; moderate susceptibility to 1% sodium hypochlorite; susceptible to high level disinfectants (&gt;2% glutaraldehyde) with prolonged contact time.<\/p>\n<p>Spores are resistant to heat (spores destroyed by moist heat &#8211; 121\u00b0C for at least 15 min).<\/p>\n<p><strong>Survival Outside Host<br \/>\n<\/strong>Spores can survive for long periods outside of host.<\/p>\n<h2>Information for Lab Workers<\/h2>\n<h3>Laboratory PPE<\/h3>\n<p>Laboratory coat; gloves and safety glasses or face shield are recommended when direct contact with infectious materials.<\/p>\n<h3>Containment<\/h3>\n<p>BSL-2 practices and containment equipment are recommended for activities involving work with known clinical specimens or cultures of <em>C. difficile.<\/em><\/p>\n<h3>In Case of Exposure\/Disease<\/h3>\n<ul>\n<li><strong> <\/strong>For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc\u2026):\n<ul>\n<li><strong>Medical Campus: call or have a coworker call the Control Center at 4\u20134144.<\/strong><\/li>\n<li><strong>Charles<span style=\"line-height: 1.5;\"> <\/span>River Campus: call or have a coworker call campus security at 617-353-2121.<br \/>\n<\/strong><span style=\"line-height: 1.5;\">You will be referred to or transported to the appropriate health care location by the emergency response team.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li>For lab exposures (needle sticks, bite, cut, scratch, splash, etc\u2026) involving animals or infectious agents, or for unexplained symptoms or illness <strong>call the ROHP 24\/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) <\/strong>to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.<\/li>\n<li><span style=\"line-height: 1.5;\">Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.<\/span><\/li>\n<li><span style=\"line-height: 1.5;\">Provide the wallet-size agent ID card to the physician.<\/span><\/li>\n<\/ul>\n<h3>Vaccination<\/h3>\n<p>None available<\/p>\n<h2>Information for First Responders\/Medical Personnel<\/h2>\n<h3>Public Health Issues<\/h3>\n<p>Person to person transmission can occur through touch or via fomites, or environmental reservoirs through spores. Standard precautions, including gown and gloves, should be used when carrying for someone with active C.\u00a0difficile disease, both as personal protection measure and to decrease spread.<\/p>\n<h3>Diagnosis\/Surveillance<\/h3>\n<p>Toxins produced by C. difficile bacteria can usually be detected in a sample of your stool. There are several main types of lab tests (enzyme immunoassay, polymerase chain reaction and tissue culture assay). Most labs use the enzyme immunoassay (EIA) test, which is faster but can produce a false-positive result. PCR based tests are also available and more accurate. The diagnosis of pseudomembranous colitis entails visualization of characteristic findings on sigmoidoscopy and should be suspected in those with severe disease.<\/p>\n<h3>First Aid\/Post Exposure Prophylaxis<\/h3>\n<p>Perform one of the following actions:<\/p>\n<div class=\"responsive-table\"><table>\n<tbody>\n<tr>\n<td>Skin Exposure (Needlestick or scratch):<\/td>\n<td>Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution.<\/td>\n<\/tr>\n<tr>\n<td>Mucous Membrane Splash to Eye(s), Nose or Mouth:<\/td>\n<td>Exposure should be irrigated vigorously.<\/td>\n<\/tr>\n<tr>\n<td>Splash Affecting Garments:<\/td>\n<td>Remove garments that may have become soiled or contaminated and place them in a double red plastic bag.<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<h3>Treatment<\/h3>\n<p>Antibiotic therapy with metronidazole or oral vancomycin. In refractory cases, Fidaxomicin is also used.<\/p>\n<h3>References<\/h3>\n<p>Public Health Agency of Canada; <a href=\"http:\/\/www.phac-aspc.gc.ca\/lab-bio\/res\/psds-ftss\/msds36e-eng.php\">http:\/\/www.phac-aspc.gc.ca\/lab-bio\/res\/psds-ftss\/msds36e-eng.php<\/a><\/p>\n<p>Mayo Clinic; <a href=\"http:\/\/www.mayoclinic.org\/diseases-conditions\/c-difficile\/home\/ovc-20202264\">http:\/\/www.mayoclinic.org\/diseases-conditions\/c-difficile\/home\/ovc-20202264<\/a><\/p>\n<p>Medical Microbiology, Southern Illinois University:<\/p>\n<p>Microbiology and Immunology, University of S. Carolina School of On-Line Medicine;<br \/>\n<span>Revised: 7\/20\/2012<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Boston University Research Occupational Health Program (ROHP) 617-358-7647 Agent The Clostridia species are gram-positive, rod-shaped, spore-formers. They are generally obligate anaerobes and are ubiquitous saprophytes or part of the normal flora. Clostridium difficile is an opportunistic pathogen that produces large, oval, subterminal spores and two toxins. Toxin A is an enterotoxin that causes fluid accumulation [&hellip;]<\/p>\n","protected":false},"author":11959,"featured_media":0,"parent":5281,"menu_order":9,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/pages\/1713"}],"collection":[{"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/users\/11959"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/comments?post=1713"}],"version-history":[{"count":9,"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/pages\/1713\/revisions"}],"predecessor-version":[{"id":58174,"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/pages\/1713\/revisions\/58174"}],"up":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/pages\/5281"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/research\/wp-json\/wp\/v2\/media?parent=1713"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}