C. difficile can produce several toxins. The two best understood are enterotoxin (toxin A) and cytotoxin (toxin B). Both cause diarrhea and inflammation in infected patients. Which is the worst is the subject of diff some debate.
What are c diff toxins?
Toxin A – TcdA is one of the largest bacterial toxins known. It is an enterotoxin which attacks the mucosal secretions of the intestine. The integrity of cell walls is damaged and they die and increased chlorine activity takes place.
Toxin B – This toxin is a cytotoxin – with similar results to that noted for Toxin A. It is a major virulence factor. It provokes the opening of tight junctions of intestinal epithelial cells. This makes the cells more permeable and induces hemorrhaging. It is recent studies that suggest the role that it has to play with previous research more focused on Toxin A
How are they detected?
Testing is important in order to distinguish an ordinary diarrhea attack from one provoked by c.difficile. There are tests that look for either toxin a or b using the nucleic acid amplification test (NAATs) method. These are more sensitive than methods using toxigenic culture but because of this may detect c difficile that is still in its benign state – the patients symptoms may have another cause.
Are c diff toxins in all c.difficile bacteria?
Non toxigenic c difficile is not uncommon. Studies indicate however that the nontoxigenic varieties resolve better with conventional treatment causing shorter hospital stays and fewer patient deaths.
How do c diff toxins cause an active infection?
The toxins damage the intestinal mucosa and cause the symptoms of C. difficile infection. Animal models suggest that TcdA provokes diarrhea, neutrophil infiltration, inflammation of intestinal mucosa, and necrosis of internal epithelial cells. This toxin is considered the main cause of CDAC. It causes cell erosion and fluid leakage in damaged areas. This results in the diarrhea often seen with an active Clostridium difficile infection.
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