Measures of morbidity

CAPSTONE CASE CLOSTRIDIUM DIFFICILE OUTBREAK A Steven T. Fleming clostridium difficile ( C. difficile, also known as C. diff) has recently been Croman renamed Clostridioides difficile and is a " fastidiously anaerobic, gram-positive bacillis" that causes diarrhea and is one of the most prevalent healthcare-associated infections, particularly in the Western Hemisphere Viswanathan, Mallozzi, and Vedantam 2010). According to a 2011 study by the US Centers for Disease Control and Prevention, there were 453,000 incident cases of C. difficile infection (CDI) in the United States, with 29,300 deaths (Lessa et al. 2015). C. diff can exist in a spore form, which is highly stable and can survive for months in the healthcare setting, or a vegetative form, which is much less stable but can colonize in the colon, release exotoxins, and cause severe inflammation or colitis (Kwon and Dubberke 2018). Risk factors include age, comorbidities, immune suppression, cancer, gastrointestinal disorders, and previous antibiotic use or hospitalization (Viswanathan, Mallozzi, and Vedantam 2010). This case study, which relates to Chapter 3, focuses on a large outbreak of a particularly deadly strain of the bacteria (NAP1/027/BI) in Southern Quebec in the early part of the twenty-first century. Between April 1, 2003, and March 31, 2004, there were 7,004 cases and 1,270 deaths (an 18.1 percent mortality), which is about double the incidence and a 50 percent higher mortality rate compared with 2000-2001. Questions 1. Recalling the discussion in Chapter 3, would you call the increased incidence of C. diff in Quebec’s hospitals an epidemic or an outbreak? 2. C. diff is a bacterial pathogen. What are the broad categories of diseases that one must consider when investigating a gastrointestinal disease outbreak? 3. What characteristics can be used to describe infectious agents? 4. What measures of morbidity would you use to estimate infectivity, pathogenicity, and virulence? 5. What are the possible modes of transmission? Describe them. 6. How would you characterize C. diff