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0:00
Hello, My name is
Vincent Young and
I'm at the University
of Michigan, Ann Arbor.
Today I will be discussing
the relationship between the
indigenous microbiota of
the gastrointestinal tract and
the development of colitis
due to infection with
Clostridium difficile.
0:17
When discussing
infectious diseases it is
important to reconsider
Koch's postulates
which were formulated over
100 years ago to prove
causality of a microorganism
with an infectious disease.
According to Koch,
a pathogen must be found
in all cases of disease.
This pathogen has to be isolated
from an infected host,
grown in pure culture,
and then recreate disease
when given experimentally
to a susceptible host.
The susceptible host will
then develop the disease
and the pathogen
can be re-isolated.
0:52
As an illustration of
an infectious disease
for which Koch's postulates
have been fulfilled,
it is important to consider
the following case.
This is the case of
an elderly gentleman
who has chronic obstructive
pulmonary disease.
He is admitted with an
acute exacerbation of
his chronic bronchitis and is
treated with a
broad-spectrum antibiotic.
In this case, piperacillin
and tazobactam.
The patient
who is admitted for a
pulmonary complication
improves from a
pulmonary standpoint.
However, by hospital day three,
the patient develops
abdominal pain, diarrhea,
and hypotension and is
transferred to the
intensive care unit.
1:34
This is an example
of a severe case of
what most clinicians would
recognize as colitis
caused by Clostridium
difficile infection.
As seen in the left-hand figure,
if patients they receive an
endoscopic examination of
their colon they will have
yellow pseudomembranes on
their mucosal surface.
In severe cases, this
can lead to perforation
as is seen on the gross
pathologic specimen on the right.
