Clostridium difficile (C. diff.) infection: Symptoms, causes, and treatment

By: Dr. Victor Marchione | Colon And Digestive | Thursday, April 27, 2017 - 02:00 PM

Clostridium difficile infectionClostridium difficile infection (C. diff infection) results from a bacterium that lives in the intestines. In fact, C. diff is part of the normal biological balance of bacteria currently living in your gut and is required for normal digestive health. The bacteria can also be found in the environment, as it is commonly seen in soil, water, and in animal feces.

During times of poor health or pharmacological intervention, this microorganism balance in the intestines may fluctuate, leading to what was a relatively harmless bacterium growing out of control and making you sick.

Symptoms of clostridium difficile infection

The symptoms of a C. diff infection may have a variable time of onset, with signs developing immediately or up to two months in the future, depending on the circumstances. The following encompass the various symptoms of a C. diff infection, with more severe cases requiring hospitalization and causing intestinal tissue to become inflamed, leading to bleeding and pus production—referred to as pseudomembranous colitis—which requires additional pseudomembranous colitis treatment.

Mild to moderate infection:

  • Watery diarrhea: Generally, three or more times a day for two or more days
  • Mild abdominal cramping and tenderness

Severe infection:

C. diff. infection causes

Ironically, medication meant to help us feel better is the most common cause of C. difficile infection. The use of antibiotics to help treat other bacterial infections a patient may currently be facing can disrupt the normal balance of bacteria in the intestine, which is referred to as intestinal flora, leading to C. difficile quickly growing out of control. Once overgrowth occurs, C. difficile can produce toxins that attack the lining of the intestine. The most common location for C. difficile infection occurrence happens to be in a hospital setting, where a much higher percentage of people carry the bacteria. However, recent studies show that C. difficile infections are seeing increased rates in communities not typically considered high-risk, such as children and people without a recent history of antibiotic use or hospitalization.

Other modes of infection occur due to C. difficile spores being passed in feces and spread to food, surfaces, and objects contaminated by infected individuals who do not thoroughly wash their hands. These spores can persist on various surfaces for weeks and sometimes months.

C. diff. infection: Risk factors and complications

C. difficile infections can occur in both the young and old, with certain risk factors predisposing them to increased risk of infection. These are:

  •  Currently taking or having recently taken antibiotics
  •  Taking antibiotics for a long period of time
  •  Taking medications like proton pump inhibitors to reduce stomach acid
  •  Have undergone recent gastrointestinal surgery
  •  Disease of the colon i.e. inflammatory bowel disease or colorectal cancer
  •  A weakened immune system
  •  Advanced age, typically over 65
  •  Kidney disease

Complications of C. difficile infection may include:

Dehydration: Primarily due to severe diarrhea and excessive fluid loss

Kidney failure: A result of severe dehydration

Toxic megacolon: A rare condition where the colon is unable to expel gas or stool. This results in the colon becoming massively distended. Left untreated the colon may rupture causing bacteria to enter the abdominal cavity, and requires emergency surgery.

Bowel perforation: Due to a small hole in the large intestine and is considered rare occurrence. It can result in the spillage of bacteria from the intestine into the abdominal cavity, requiring emergency surgery.

Death: If C. difficile infections are not properly managed and treated

When to see a doctor?

If you are on a current antibiotic regimen and begin to experience loose or watery stool, it may be due to a C. difficile infection. Going to the bathroom three or more times a day with watery stool and the symptoms of C. difficile previously described for a couple of days should prompt you to visit your doctor right away, and depending on their recommendation, they may admit you into a hospital for treatment if necessary.

How is C. diff. diagnosed?

If a diagnosis of a C. difficile infection is suspected, your doctor will first get a brief history from you to 0out the possibility of antibiotic-related causes. To confirm the diagnosis, a stool sample will be taken to check for C. difficile infection. If necessary, your doctor may request x-rays or CT scan of the colon if appropriate.

C. diff. infection treatment tips

Doctors currently use a different kind of antibiotic to help combat C. difficile infection. It is typically prescribed for a duration of 10 to 14 days and called metronidazole (Flagyl). Alternatives include fidaxomicin (Dificid) or vancomycin (Vancocin). Improvement is typically observed within 72 hours after starting antibiotic treatment, but diarrhea may return temporarily.

Occasionally, the first round of treatment is not effect, in which case another dose of treatment is required— this happens in 25 percent of cases. While receiving antibiotic therapy, patients may also be given bezlotoxumab (Zinplava) as a shot to reduce C. difficile recurrence. Other adjunct treatments may include the following:

Probiotics: Promote good bacteria within the intestine. They may help keep intestinal flora balanced, preventing future cases, but more research is needed in this regard.

Fluids: Obtaining adequate amounts of fluids, via IV or by mouth, is vital for treatment during a C. difficile infection causing severe diarrhea.

Preventing C. diff. infection

Much like other fecal-borne illnesses, keeping your hands clean will help reduce the spread of infection. It is important to keep this in mind at all times, as the C. difficile spore has the ability to remain on surfaces long after it has been contaminated. The following are additional methods for keeping yourself and those around you safe:

  • Use bleach when cleaning kitchen and bathroom surfaces, and clean them regularly
  • Wash dirty clothing with detergent and choline bleach
  • When visiting a hospital or health care facility, make sure you wash your hand after the visit
  • Don’t use antibiotics without doctor supervision.

Related: Lower abdominal pain in women: Causes and treatments


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Sources:

http://www.webmd.com/digestive-disorders/clostridium-difficile-colitis#1
http://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/dxc-20202389
https://familydoctor.org/condition/clostridium-difficile-c-diff-infection/

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