Patient presenting with abdominal pain, diarrhea taking clindamycin for 5 days. Treated with metronidazole symptoms subsided. What is the causative agent –
**Core Concept**
The patient's symptoms, such as abdominal pain and diarrhea, following antibiotic use, suggest an antibiotic-associated diarrhea (AAD) caused by a toxin-producing bacterium. This condition is a known complication of broad-spectrum antibiotic therapy, including clindamycin.
**Why the Correct Answer is Right**
Clindamycin is a lincosamide antibiotic that disrupts protein synthesis by binding to the 50S subunit of the bacterial ribosome. This broad-spectrum activity can lead to the overgrowth of toxin-producing bacteria, such as Clostridium difficile (C. difficile). C. difficile produces two main toxins, A and B, which cause the characteristic colitis and diarrhea associated with AAD. The patient's symptoms subsided with metronidazole treatment, which is effective against anaerobic bacteria, including C. difficile.
**Why Each Wrong Option is Incorrect**
* **Option B:** Clostridium perfringens is a Gram-positive, anaerobic bacterium that produces a toxin causing food poisoning, but it is not typically associated with AAD following antibiotic use.
* **Option C:** Clostridium welchii is an outdated synonym for Clostridium perfringens.
* **Option D:** Clostridium marneffei is not a recognized species of Clostridium and does not cause AAD.
**Clinical Pearl / High-Yield Fact**
C. difficile is a leading cause of AAD, and its incidence increases with the use of broad-spectrum antibiotics. Early recognition and treatment with metronidazole or vancomycin can help prevent complications, such as pseudomembranous colitis.
**✓ Correct Answer: A. Clostridium difficile**