Description

Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an infection in the colon, the longest part of the large intestine. The symptoms can range from diarrhea to life-threatening damage to the colon. The bacterium is often called C. difficile or C. diff.

The disease due to C. difficile often occurs after the use of antibiotics. It mainly affects older adults in hospitals or in long-term care settings. The people, not in the environments of care or hospitals can also get infected by C. difficile. Some strains of the bacteria that can cause serious infections are more likely to affect younger people.

The bacteria that used to be called Clostridium (klos-TRID-e-um) difficile.

Symptoms

Often, symptoms begin within 5 to 10 days after starting an antibiotic. But the symptoms can occur as soon as the first day or up to three months after.

Mild to moderate infection

The most common symptoms of mild to moderate C. difficile infection are:

  • Watery diarrhea three or more times a day for more than a day.
  • Soft belly, cramping, and tenderness.

Severe infection

People who have a severe C. difficile infection tend to lose too much body fluid, a condition called dehydration. It may need to be treated in a hospital for dehydration. C. difficile infection can cause the colon is inflamed. You can sometimes form patches of raw tissue that can bleed or make pus. The symptoms of severe infection include:

  • Watery diarrhea as often as 10 to 15 times a day.
  • Belly, cramping and pain, which may be severe.
  • Fast heart rate.
  • The loss of fluids, called dehydration.
  • Fever.
  • Nausea.
  • Increased white blood cell count.
  • The renal failure.
  • Loss of appetite.
  • The bloated belly.
  • The loss of weight.
  • Blood or pus in the stool.

C. difficile infection that is severe and sudden, can cause the colon becomes inflamed and it gets bigger, so-called toxic megacolon. And it can cause a condition called sepsis, where the body's response to an infection damages its own tissues. People who have toxic megacolon and sepsis are admitted to an intensive care unit in the hospital. But toxic megacolon and sepsis are not common with a C. difficile infection.

When to see a doctor

Some people have diarrhea during or shortly after antibiotic therapy. This can be caused by infection by C. difficile. Make an appointment with your doctor if you have:

  • Three or more watery stools in a day.
  • Symptoms that last more than two days.
  • A new fever.
  • Severe stomach pain or cramps.
  • Blood in the stool.

Causes

C. difficile bacteria enter the body through the mouth. They can begin to reproduce in the small intestine. When they get to the part of the large intestine, or colon, the bacteria can release toxins that damage the tissues. These toxins that destroy cells and cause watery diarrhea.

Out of the colon, the bacteria are not active. They can live for a long time in places such as:

  • Human or animal feces.
  • Surfaces of a room.
  • Unwashed hands.
  • Ground.
  • Water.
  • The food, including meat.

When the bacteria once again find its way into a person's digestive system, they become active again and cause an infection. Because C. difficile can live outside the body, the bacteria spread easily. Do not wash hands or clean facilitate the spread of bacteria.

Some people carry C. difficile bacteria in their intestines but never become sick. These people are carriers of the bacterium. You can spread infections without being sick.

Risk factors

People who do not have known risk factors have become sick from C. difficile. But certain factors increase the risk.

Taking antibiotics or other medications

The guts of the home of a wide range of bacteria. Many of them help to protect the body against infection. Antibiotics to treat an infection, they tend to destroy some useful bacteria in the body, as well as the bacteria that cause the infection.

Without sufficient amount of useful bacteria to keep it in check, C. difficile can grow out of control quickly. Any antibiotic can cause C. difficile infection. But the antibiotics that most often lead to C. difficile infection are:

  • Clindamycin.
  • The cephalosporins.
  • The penicillins.
  • The fluoroquinolones.

Taking a proton pump inhibitor, a type of medication that is used to cut the acidity of the stomach, may also increase the risk of C. difficile infection.

Stay in a health care environment

The majority of infections by C. difficile occur in persons who are or have recently been in health care environments. These include hospitals, nursing homes and long-term care services. These are the places where germs are easily spread, the use of antibiotics is common, and the health of the people, puts them at high risk of getting an infection. In hospitals and nursing homes, C. difficile spreads in:

  • Hands.
  • Cart handles.
  • Railings.
  • Bedside tables.
  • Toilets and sinks.
  • Stethoscopes, thermometers, or other medical instruments.
  • Phones.
  • Remote controls.

Have a serious illness or a medical procedure

Certain medical conditions or procedures may reach to the risk of developing a C. difficile infection, including:

  • The inflammatory bowel disease.
  • Weakened immune system of a medical condition or treatment, such as chemotherapy.
  • Chronic kidney disease.
  • Procedures in the digestive tract.
  • Another type of surgery of the stomach area.

Other risk factors

Advanced age is a risk factor. In one study, the risk of C. difficile infection was 10 times higher for people age 65 and older compared with younger people.

Having a C. difficile infection increases the likelihood of having another. The risk increases with each new infection.

Complications

Complications of C. difficile infection are:

  • The loss of fluids, called dehydration. Severe diarrhea can lead to a severe loss of fluids and minerals called electrolytes. This makes it difficult for the body to function as it should. Can cause blood pressure to drop so low as to be dangerous.
  • The renal failure. In some cases, dehydration can occur so quickly that the kidneys stop working, it is called kidney failure.
  • Toxic megacolon.In this rare disease, the colon can not get rid of gas and stool. This causes it to enlarge, called megacolon. This is not, your colon may explode. The bacteria can also enter the bloodstream. Toxic Megacolon, which can be fatal. Need an emergency surgery.
  • A hole in the large intestine, called the perforation of the bowel. This rare condition resulting from damage to the mucosa of the colon or occurs after toxic megacolon. The bacteria is shed from the two points in the hollow space in the center of the body, called the abdominal cavity, it can lead to a life-threatening infection called peritonitis.
  • Death. Severe C. difficile infection can be rapidly fatal if not treated quickly. Rarely, death may occur with mild to moderate infection.

Toxic megacolon. In this rare disease, the colon can not get rid of gas and stool. This causes it to enlarge, called megacolon. This is not, your colon may explode.

The bacteria can also enter the bloodstream. Toxic Megacolon, which can be fatal. Need an emergency surgery.

Prevention

To protect against C. difficile, do not take antibiotics unless you need it. Sometimes, you can get a prescription for antibiotics to treat diseases that are not caused by bacteria, such as viral diseases. Antibiotics do not help to infections caused by viruses.

If you need an antibiotic, ask if you can get a prescription for a drug you take for a short time or is a narrow spectrum antibiotic. Narrow spectrum antibiotics target a limited number of types of bacteria. They are less likely to affect the healthy bacteria.

To help prevent the spread of C. difficile, hospitals and other health care establishments are still strict rules for the control of infections. If you have a loved one in a hospital or nursing home, follow the rules. If you have any questions, please refer to the caregivers, or other people not following the rules.

Measures to prevent C. difficile are:

  • The washing of hands.Health care workers should ensure that their hands are clean before and after treating each person in your care. For C. difficile outbreak, using soap and lukewarm water is best for cleaning the hands. Alcohol-based hand sanitizers do not kill C. difficile spores. Visitors to health care facilities should also wash their hands with soap and warm water before and after you leave the room or use the bathroom.
  • Contact precautions. People who are hospitalized with infection by C. difficile, a private room or share a room with someone who has the same disease. Hospital staff and visitors wear disposable gloves and isolation gowns while in the room.
  • Thorough cleaning. In any health care environment, all surfaces must be thoroughly disinfected with a product chlorine bleach. C. difficile spores can survive the cleaning products that do not have chlorine.

The washing of hands. Health care workers should ensure that their hands are clean before and after treating each person in your care. For C. difficile outbreak, using soap and lukewarm water is best for cleaning the hands. Alcohol-based hand sanitizers do not kill C. difficile spores.

Visitors to health care facilities should also wash their hands with soap and warm water before and after you leave the room or use the bathroom.

Diagnosis

A diagnosis of C. difficile infection is based on the fact that they have:

  • The diarrhea.
  • Other symptoms of C. difficile infection.
  • C. difficile in stool specimens.

People who have regular, formed stool should not be tested for C. difficile infection. Some people are infected with C. difficile infection without taking antibiotics. So the recent use of antibiotics is not necessary to make the diagnosis of C. difficile infection.

The analysis of feces

If infection with C. difficile is suspected, one or more tests of a stool sample may show any of the toxins or strains of bacteria that produce toxins.

Examination of the Colon

Rarely, to help confirm a diagnosis of C. difficile infection, a health care provider can see the inside of the colon. The tests used are the flexible sigmoidoscopy or colonoscopy. The tests involve placing a flexible tube with a tiny camera on the end into the colon to look for problem areas. These tests can also find other causes of the symptoms.

Imaging tests

An x-ray of the stomach area or a ct scan may find the possible complications of C. difficile infection. These imaging tests can detect:

  • Thickening of the wall of the colon.
  • Enlargement of the intestine.
  • A hole, called a perforation in the lining of the colon.

Treatment

The treatments are used only for the symptoms of the infection. The people who carry the bacteria, but they are not sick do not receive treatment.

Antibiotics

If the C. difficile infection is associated with an antibiotic, a health care provider will probably stop its use. Often, however, an antibiotic needed to treat other infectious disease. A switch to another antibiotic may be less likely to cause diarrhea associated with C. difficile infection.

Antibiotics are the main treatment for C. difficile infection. Commonly used antibiotics include:

  • Vancomycin (Firvanq Kit).
  • Fidaxomicin (Dificid).

Metronidazole (Flagyl) can be used with vancomycin for the treatment of severe C. difficile infection.

Surgery

The surgery to remove the diseased part of the colon may be required if there is:

  • The severe pain.
  • Organ failure.
  • Toxic megacolon.
  • The swelling and irritation, the so-called inflammation of the mucosa of the wall around the stomach area.

The treatment for the recurrence of the infection

Approximately 25% of people treated for infection with C. difficile is sick again. The reason might be that the first infection never went away or that the bacteria that cause the infection. The risk increases with each new infection by C. difficile. After three or more infections, the risk of another infection is greater than 50%.

The risk of recurrence of the infection is higher for people who:

  • Are older than 65 years.
  • You are taking other antibiotics for another condition, while on the antibiotics for C. difficile infection.
  • You have a serious medical condition, such as chronic renal failure, inflammatory bowel disease or chronic liver disease.

The treatment for C. difficile infection that comes back, include the following:

  • Antibiotics. Treatment for repeated infections, which may involve one or more courses of antibiotic. The antibiotic is often different from that used in the first. Antibiotic therapy works so well, every time that the infection becomes.
  • Antibody-based therapy. A therapy known as bezlotoxumab (Zinplava) is a human antibody against C. difficile toxin B. It has been shown to reduce the risk of recurrence of C. difficile infection in those at high risk of recurrence of the episodes.
  • Fecal microbiota transplantation (FMT).FMTis a novel treatment for C. difficile infection that keeps coming back.FMThas has been studied in clinical trials. The Food and Drug Administration has not approvedFMTbut allows the use ofFMTfor C. difficile infection as a test. FMTrestores of healthy intestinal bacteria by the placement of another person (the donor) of feces in the colon specialized in tubes inserted through your rectum. Donors are screened for health conditions, your blood is tested for infections, and the stools are carefully screened for parasites, viruses, and other infectious bacteria before being used forFMT. Someone anFMTmight must sign the consent form about the benefits and risks of treatment.FMTalso is called a transplantation of stool or a transplant of gut microbiota. FMTrestores of healthy intestinal bacteria by the placement of another person, called a donor, the fecal matter in the colon with special tubes in the rectum. Donors are screened for health conditions, your blood is tested for infections, and the stools are carefully screened for parasites, viruses, and other infectious bacteria before being used forFMT. Research has shown thatFMTdone one or more times, it has a success rate higher than 85% for the treatment of infections by C. difficile that keep coming back.
  • Probiotics.Probiotics are supplements or foods that have the micro-organisms in order to maintain or improve the "good" bacteria in the body. The role of these products in the C. difficile infection is not clear. Not all the research has shown that probiotics are useful in the prevention or treatment of infection by C. difficile. Researchers are studying advanced probiotics for the treatment or prevention of infection with C. difficile. These products are not offered outside of research studies.

Fecal microbiota transplantation (FMT). The FMT is a novel treatment for C. difficile infection that keeps coming back. FMT has been studied in clinical trials. The Food and Drug Administration has not approved FMT but allows the use of FMT for C. difficile infection as a test.

FMT restores healthy intestinal bacteria by the placement of another person (the donor) of feces in the colon specialized in tubes inserted through your rectum. Donors are screened for health conditions, your blood is tested for infections, and the stools are carefully screened for parasites, viruses, and other infectious bacteria before being used for the FMT .

Someone FMT might need to sign the consent form about the benefits and risks of treatment. FMT is also called a transplantation of stool or a transplant of gut microbiota.

FMT restores healthy intestinal bacteria by the placement of another person, called a donor, the fecal matter in the colon with special tubes in the rectum. Donors are screened for health conditions, your blood is tested for infections, and the stools are carefully screened for parasites, viruses, and other infectious bacteria before being used for the FMT .

Research has shown that FMT does one or more times has a success rate higher than 85% for the treatment of infections by C. difficile that keep coming back.

Probiotics. Probiotics are supplements or foods that have the micro-organisms in order to maintain or improve the "good" bacteria in the body. The role of these products in the C. difficile infection is not clear. Not all the research has shown that probiotics are useful in the prevention or treatment of infection by C. difficile.

Researchers are studying advanced probiotics for the treatment or prevention of infection with C. difficile. These products are not offered outside of research studies.

Lifestyle and home remedies

Auxiliary in the treatment for diarrhea includes:

  • Plenty of fluids. Choose fluids that are water, salt and sugar, such as diluted fruit juice, soft drinks and broths.
  • A good nutrition. For the watery diarrhea, eat starchy foods, such as potatoes, noodles, rice, wheat, and oats. Other good choices are saltine crackers, bananas, soup and boiled vegetables. If you are not hungry, you may need a liquid diet at first. After the diarrhea stops, you may have trouble digesting milk and milk-based products for a period of time.
Symptoms and treatment of C. difficile infection