CLOSTRIDIUM DIFFICILE
BACTERIOLOGY
C. dif cile is a
Gram-positive rod that readily forms spores. Its early reputation for
fastid-ious growth is responsible for its species epithet. Like the other
clostridia described in this section, C.
dif cile has a most important medical feature: its ability to produce
toxins. In this species, two distinct large polypeptide toxins, A and B, with
similar structure (45% homology) are released during late growth phases of the
vegetative organism, perhaps at the time of cell lysis. Both toxins act in the
cytoplasm by disrupting proteins involved in signal transduction, particularly
those involving the actin cytoskeleton. The A toxin causes cell rounding and
the disruption of intercellular tight junctions followed by altered membrane
permeability and fluid secretion. The net effect is that of an enterotoxin,
al-though inflammation and cytoxic activity are also present. The B toxin lacks
the entero-toxic properties of the A toxin but has cytotoxic potency at least
10 times higher. The two toxins appear to act synergistically by a mechanism
yet to be determined.
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