© 2013 Pearson Education, Inc. Bell Ringer  What is an endospore, and what special characteristics do endospore forming bacteria have?

© 2013 Pearson Education, Inc. Exam Review  100 points  A  B  C  D  <60 F

© 2013 Pearson Education, Inc. Objective  By the end of the lesson, students will be able to  1) Describe the characteristics of the human microbiome  2) Describe how Clostridium difficile can withstand antibiotic theory  3) Describe alternative treatments for patients with C. diff infections

© 2013 Pearson Education, Inc. Microbes and Human Disease  Human Microbiome (Microbiota)  Friendly microbes inhabiting our body  Most found in intestines  Outnumber own cells by 10x-100x  Prevent overgrowth of harmful microbes  Produce vitamin K and B  Influence obesity, anxiety, autoimmune disorders © 2012 Pearson Education Inc.

© 2013 Pearson Education, Inc. Objective  By the end of the lesson, students will be able to  1) Describe the characteristics of the human microbiome  2) Describe how Clostridium difficile can withstand antibiotic theory  3) Describe alternative treatments for patients with C. diff infections

© 2013 Pearson Education, Inc. Insert Fig 25.1 Figure 25.1 The human digestive system. Parotid (salivary) gland Pharynx Liver Gallbladder Duodenum Pancreas Rectum Oral Cavity Tongue Teeth Esophagus Stomach Small intestine Large intestine Anus

© 2013 Pearson Education, Inc. Digestive System Defense  Stomach: acidic  pH = 2  Large number of microbes in large intestine  Microbial antagonism  100 billion bacteria per gram of feces

© 2013 Pearson Education, Inc. Clostridium difficile  Gram-positive  Bacillus  Endospore former

© 2013 Pearson Education, Inc. Pathogenesis & Epidemiology  Normal flora in 5% of Americans  Antimicrobial associated diarrhea  Antibiotics alter normal intestinal bacteria  Overgrowth of C. diff  Why is C. diff hard to kill?  1) Resistance to antibiotics (Fluoroquinoles)  2) Endospores  Nosocomial infection  20% of patients carry the pathogen  Fecal-oral transmission

© 2013 Pearson Education, Inc. Objective  By the end of the lesson, students will be able to  1) Describe the characteristics of the human microbiome  2) Describe how Clostridium difficile can withstand antibiotic theory  3) Describe alternative treatments for patients with C. diff infections

© 2013 Pearson Education, Inc. Virulence Factors  Exotoxins  Enterotoxin (Toxin A)  Disrupts tight cell junctions  increased cell permeability  diarrhea  Cytotoxin (Toxin B)  Destroys cytoskeleton due to actin depolymerization  Cell death and pseudomembrane formation

© 2013 Pearson Education, Inc. Signs and Symptoms  Diarrhea  5-10 clear, watery, foul-smelling bowel movements a day  Pseudomembranous colitis  Inflammation of colon with intestinal lesions  10 bloody stools per day  Life-threatening

© 2013 Pearson Education, Inc. Colon  Normal ColonAbnormal Colon

© 2013 Pearson Education, Inc. Diagnosis & Treatment  Diagnosis  Detects toxins in stool  Colonoscopy  Treatment  Vancomycin or Flagyl (metronidazole)  60% success rate  Fecal transplantation  80-90% success rate

© 2013 Pearson Education, Inc. The New England Journal of Medicine Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile  Feces collected by donor on day of infusion  Feces were diluted with 500 ml of sterile saline  Within 6 hours after collection, solution infused through nasoduodenal tube  2 to 3 minutes per 50 ml  Tube removed 30 minutes after the infusion

© 2013 Pearson Education, Inc. Treatment  Vancomycin vs Fecal transplantation  4/13 (31%) cured with vancomycin alone  13/16 (81%) cured after fecal transplant The New England Journal of Medicine Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile

© 2013 Pearson Education, Inc. Treatment  Test done on patients with >3 recurrent infections  Feces obtained from donor on day of procedure  Centrifuged to collect bacteria  Bacteria placed into capsules  Patient ingested capsules over 5-15 minutes  27/27 patients cured IDWeek.org Fecal microbiome transplantation (FMT) via oral fecal microbial capsules for recurrent Clostridium difficile infection (rCDI)

© 2013 Pearson Education, Inc. Objective  By the end of the lesson, students will be able to  1) Describe the characteristics of the human microbiome  2) Describe how Clostridium difficile can withstand antibiotic theory  3) Describe alternative treatments for patients with C. diff infections

© 2013 Pearson Education, Inc. Exit Slip  1) Describe the characteristics of the human microbiome  2) Describe how Clostridium difficile can withstand antibiotic theory  3) Describe alternative treatments for patients with C. diff infections