Clostridium difficile is a bacterium that affects the bowel in people on prolonged antibiotics course, resulting in diarrhea. Read the article to know more about its symptoms, risk factors, diagnosis, and treatment.
Clostridium difficile is also called C. difficile or C. diff, a bacterium capable of causing symptoms like diarrhea or some severe infections like inflammation of the colon. The most commonly affected people are with a compromised immune system, who are older hospitalized people or the ones that are taking medications for a long time.
The signs and symptoms may vary from mild to severe, depending on the stage or severity of the condition. Mild symptoms involve the following:
1. Diarrhea that is too watery and frequency accounting for three to four times in a day and the days being two to three days.
2. Cramps in the abdomen that is mild in nature and associated with tenderness.
Severe symptoms in people can lead to severe dehydration, and ultimately, they might require hospitalization. Clostridium difficile can affect the colon by causing its inflammation and forming raw tissue patches that can cause bleeding or pus exudation. The signs and symptoms of a severe type of infection include the following:
1. Diarrhea that is too watery, lasting 10 to 15 times a day.
2. Pain and cramps in the abdomen that is very severe.
3. Increased or fast heart rate.
4. High temperature or fever.
5. Presence of blood or pus in the stool of the patient.
7. Loose motions or diarrhea.
8. Appetite loss.
9. Loss of weight.
10. Swelling of the abdomen.
11. Kidney issues like kidney failure.
12. Presence of increased white blood cells.
As severe C.difficile can cause severe inflammation of the colon, it can also cause colon enlargement, which is also known as toxic megacolon, and in some cases, sepsis may be caused. People having severe symptoms are usually hospitalized.
It is common to get loose stools after taking a few antibiotics, but if you notice the following symptoms, consult your physician as it can be due to C.difficile infection:
1. Watery stools with a frequency more than three.
3. Symptoms that stay for more than two days.
4. Pain and cramps in the abdomen get severe.
5. Presence of blood in stools.
C.difficile is a common microorganism that is found everywhere in the environment like water, soil, air, processed meats, etc. It is interesting to know that they are also found commonly in intestines in human beings, and it stays as a common commensal there without causing any infection.
The spores of these organisms can pass through feces and spread to various surfaces, foods, etc., when those who are infected do not wash their hands properly. It is known that the spores of these microorganisms can survive up to weeks or months in a room or place. Finally, if the infected surface is touched by a person, they might swallow the pores while eating without washing their hands. When these spores reach the intestine, it starts to produce toxins that can
affect the intestinal lining, and also, the toxins can lead to cell destruction, production of patches, plaques of cells of inflammation, and finally, lead to loose stools.
The following can increase the risk of getting C.difficile:
1. Intake of certain antibiotics like Fluoroquinolones, Cephalosporins, Penicillins, Clindamycin, Proton pump inhibitors, etc.
2. Presence of any serious health issues or who have undergone any medical or surgical procedure.
3. Women have more chances to get than males.
4. Elderly people are more prone to get infected.
Following are the potential complications of the C.difficile infection:
2. Kidney problems, ultimately leading to kidney failure.
3. Toxic megacolon wherein it becomes difficult to pass stool and gas.
4. Perforation of the bowel (formation of a hole in the bowel).
Yes, it can be prevented by following the below-mentioned levels:
1. Usage of antibiotics unnecessarily should be avoided, as it can decrease the natural potential of the body to fight against even the common commensals of the body.
2. Wash your hands properly.
3. Precautions should be taken to isolate the people who are affected with C.difficile infection and those who are visiting them.
4. Complete cleaning of all the surfaces being touched or coming in contact with the affected person.
When you visit your physician, he or she will ask you detailed questions about your personal history, signs and symptoms and the complaint of loose stools makes the physician suspect c.difficile infection. Following this, the doctor will ask for the following details and tests to come to a conclusion or final diagnosis in order to provide the apt treatment accordingly.
1. Stool tests.
2. Polymerase chain reaction to detect C.difficile toxin B.gene.
3. Glutamate dehydrogenase (GDH) test, along with the enzyme immunoassay (EIA).
4. Only EIA (enzyme immunoassay).
5. Cell cytotoxicity assay.
Apart from these tests, certain examinations of the body will be done, like a colon examination (sigmoidoscopy or colonoscopy). A few imaging tests will also prove to be helpful, like X-ray of the abdomen, computerized tomography (CT).
The first line of management involves stopping the medication that actually initiated the condition. The next line of management is advised based on the stage and severity of the condition and may include any of the following:
1. Antibiotics like Vancomycin, Metronidazole.
2. Surgery in case of severe conditions like toxic megacolon.
Yes, it might recur in cases of elderly and has a 20% chance or recurrence. Others who may experience the recurrence are those who are taking antibiotics for other conditions while on antibiotic therapy for c.difficile infection. People with immunocompromised state or other severe medical conditions may face recurrence.
Treatment for recurred conditions includes antibiotics and/or a transplant (Fecal microbiota transplant).
C.difficile is a common condition, but if not treated in proper time can lead to severe complications, even death. It is important to have detailed information about the same. With the help of online medical platforms, it has become easy to consult a physician at the ease of home.
- Mild to moderate diarrhea.
- Abdominal pain.
- Severe dehydration.
- Low blood pressure.
- Toxic megacolon.
- Colon perforation.
- Pseudomembranous colitis.
In conditions like hospitalization, recent antibiotic therapy, and immune compromise, the gut microflora gets altered, resulting in colonization of Clostridium difficile species. It invades the colon and releases toxins resulting in inflammation of the colon’s lining, ultimately causing colitis.
The presence of clinical symptoms like three or more unformed stools within 24 hours, along with a positive stool test for bacterial toxin and a colonoscopy revealing pseudomembranous colitis, lead to the diagnosis of Clostridium difficile induced colitis.
Clostridium difficile can cause colitis. When the normal microflora is disturbed, these bacterial species outgrow other healthy bacteria and release toxins that cause inflammation of the colon lining and damage them leading to pseudomembranous colitis.
- Mild infection resolves on its own with cessation of the current antibiotic.
- Oral Vancomycin or Metronidazole (oral or intravenous) for 10 days.
- Fluid and electrolyte administration for hydration.
Vancomycin and Metronidazole are effective in managing Clostridium difficile infection. Recurrent C.diff infections can be managed by Rifaximin and Fidaxomicin.
Clostridium difficile toxin test uses the stool of an individual to detect the C.diff infection, by the presence of the toxins (toxin A and B) produced by the bacteria, and the genes associated with the toxin production.
Watery diarrhea in hospitalized patients or patients with a similar history and people with a recent history of antibiotic therapy (within the last 3 months) are indicative of Clostridium difficile infection.
It most commonly spreads from one person to another through the feco-oral route.
The Clostridium difficile infection infects the organs of the lower digestive tract, especially the colon and bowel.
When someone touches their mouth after touching a surface contaminated with fecal particles of a Clostridium difficile infected person, they contract the infection. Not all people are symptomatic. Hospitalized patients, people with low immunity, and those taking broad-spectrum antibiotics for extended periods are susceptible to develop C.diff infection.
A person whose Clostridium difficile infection symptoms have cleared up is still considered contagious until 48 hours from the time the symptoms had subsided.
Last reviewed at:
26 Aug 2020 - 4 min read
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