<P> Pathogenic C. difficile strains produce multiple toxins . The most well - characterized are enterotoxin (Clostridium difficile toxin A) and cytotoxin (Clostridium difficile toxin B), both of which may produce diarrhea and inflammation in infected patients, although their relative contributions have been debated . Toxins A and B are glucosyltransferases that target and inactivate the Rho family of GTPases . Toxin B (cytotoxin) induces actin depolymerization by a mechanism correlated with a decrease in the ADP - ribosylation of the low molecular mass GTP - binding Rho proteins . Another toxin, binary toxin, also has been described, but its role in disease is not fully understood . </P> <P> Antibiotic treatment of CDIs may be difficult, due both to antibiotic resistance and physiological factors of the bacteria (spore formation, protective effects of the pseudomembrane). The emergence of a new and highly toxic strain of C. difficile that is resistant to fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin, said to be causing geographically dispersed outbreaks in North America, was reported in 2005 . The U.S. Centers for Disease Control and Prevention in Atlanta warned of the emergence of an epidemic strain with increased virulence, antibiotic resistance, or both . </P> <P> C. difficile is transmitted from person to person by the fecal - oral route . The organism forms heat - resistant spores that are not killed by alcohol - based hand cleansers or routine surface cleaning . Thus, these spores survive in clinical environments for long periods . Because of this, the bacteria may be cultured from almost any surface . Once spores are ingested, their acid - resistance allows them to pass through the stomach unscathed . Upon exposure to bile acids, they germinate and multiply into vegetative cells in the colon . </P> <P> In 2005, molecular analysis led to the identification of the C. difficile strain type characterized as group BI by restriction endonuclease analysis, as North American pulse - field - type NAP1 by pulsed - field gel electrophoresis and as ribotype 027; the differing terminology reflects the predominant techniques used for epidemiological typing . This strain is referred to as C. difficile BI / NAP1 / 027 . </P>

Role of spores in the development of c. difficile disease
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