Clostridium difficile is a gastrointestinal bacterial infection. Although the bacteria that cause it are normally held in check by the good bacteria in the stomach, sometimes—especially during or following a round of antibiotics—that good bacteria is decreased to such an extent that it can no longer prevent bad bacteria from multiplying.
Clostridium difficile is one of the worst of the bad ones. As they grow out of control, toxins are released from their cells that destroy the lining of the stomach and cause serious problems, specifically pseudomembranous colitis, an inflammatory bowel disease that causes ulcers in the intestines’ lining.
Symptoms
Hundreds of thousands of people are infected with Clostridium difficile each year, and tens of thousands die from it. Not every infection results in death, but all of them begin with diarrhea. In mild cases, the diarrhea may only be a few times a day, along with abdominal pain. As the infection becomes more severe, more symptoms begin. There may be a fever and loss of weight and appetite; the abdominal pain increases and the diarrhea may become several times as frequent.
Extremely severe cases may lead to dehydration, as well as kidney failure and abdominal swelling. Because of the inflammation of the colon and plaques (patches of tissue that become raw) caused by colitis, stool may have blood or pus in it. Colitis alone can cause diarrhea and is often irreversible, although the ulcers may go into remission and not cause constant problems.
Risk Factors
Since its spores can survive without a host for so long, Clostridium difficile can be picked up by coming in contact with almost any infected surfaces or object—whether that object is a doorknob, bed rail, feces, surgeon’s hand, or processed meat. Anyone with an improperly functioning immune system is at an increased risk of contracting it; this is especially true for those in the hospital, as more people in this environment tend to be carrying the bacteria. The elderly are also more likely to develop a dangerous amount of Clostridium difficile. Health care staff that fail to wash their hands are serious contributors to spreading it, and the risk increases during any sort of gastrointestinal surgery.
Normal healthy adults may carry an minute amount that does not cause sickness. However, as mentioned, any use (but especially extended or multiples use) of antibiotics also increases the chances that the bacteria will prosper and take over. If diarrhea begins within a few days of taking antibiotics, contact a doctor immediately before symptoms get worse. Medication to reduce stomach acid can also cause an upsurge of clostridium difficile, even proton pump inhibitors, which are used to treat ulcers.
Diagnosis
Diagnosing Clostridium difficile requires a stool sample, from which the particular toxins it produces are detected. Enzyme immunoassays (EIA), polymerase chain reactions, and cell cytotoxicity assays are all tests used to check for these toxins. EIA is the most common test because of its rapidity, but it is not as sensitive as the other two, and tends inaccurately diagnose those who are infected as normal. The Polymerase chain reaction is become more widely available, as it is also a fast test and more accurate than the EIA.
Cell cytotoxicity assays are slower and more difficult to perform, as they require taking the toxins and seeing how they affect human cells. It can take up to two days for the final results, but it is highly accurate and used mostly in hospitals in tandem with one of the other two to ensure accuracy. Occassionaly, it may be necessary to perform a colonoscopy to look for signs of inflammation and damage caused by the infection to confirm the diagnosis.
Treatment
Although use of antibiotics is one of the causes of Clostridium difficile, antibiotics are, ironically, the cure, as well. Depending on the severity, metronidazole, vancomycin, or fidaxomicin may be used to prevent continued growth of the bacteria, thereby treating other symptoms simultaneously. Hospitalization may be necessary if symptoms become severe enough. For particularly tenacious infections or when the pain is severe, surgery may be required. Part of the colon is removed to manage inflammation. These measures may be necessary if organ failure sets in, as well.
Prevention
Although people often get Clostridium difficile only once, recurrence of a different strain is possible; the original infection also may not have been thoroughly cured. Once infected more than twice, people are 65% more likely to become sick again. This means it is extremely important to take precautions, especially for those with other risk factors. Washing your hands before eating, ensuring health care workers wash their hands before touching you, cleaning anything an infected person touches or uses, and only taking antibiotics when recommended by a doctor are good ways to stay healthy and uninfected.
