What is Clostridium Difficile (C-Diff)?

What Is C-Diff?

Called Clostridium Difficile, it is a bacterium that causes diarrhea to life-threatening inflammation of the colon.  While it mainly affects older adults in hospital and long-term facilities after the use of antibiotics, there has been a rise in younger adults who are not at risk due to exposure to health care facilities.  Every year, about a half million people get sick with C-Diff, and has become more frequent, severe, and more difficult to treat.

Symptoms

Some people can be carriers of C-Diff and never become sick, but can spread the infection through contact.  Symptoms can show up within 5 – 10 days after starting antibiotics to up to 2 months later.

Mild to Moderate Infection

Symptoms of the mild to moderate C-Diff infection are:

·         Watery diarrhea  3-4 times a day for 2 or more days.

·         Mild abdominal cramping or tenderness.

Severe Infection

In severe cases of C-Diff, people can become dehydrated and need hospitalization.  It causes the colon to become inflamed with patches of raw tissue that bleed or cause pus (pseudomembraneous colitis).  Signs and symptoms are:

·         Watery diarrhea 10-15 times a day.

·         Severe abdominal cramping.

·         Rapid heart rate.

·         Fever.

·         Blood or pus in stool.

·         Nausea.

·         Dehydration.

·         Loss of appetite.

·         Weight loss.

·         Swollen abdomen.

·         Kidney failure.

·         Increased white cell blood count.

When to See a Doctor

While it may be normal to have loose stools after an antibiotic therapy, see your doctor if you have more than 3-4  watery stools per day, you have severe abdominal cramping, have a fever, or have blood in your stool.

Causes

C-Diff is found naturally in the air from the environment like soil, water, air, human and animal feces, and food products like processed meats.  A small number of healthy people can carry C-Diff in their intestines and not get sick. 

First associated with health care and antibiotic use in hospital and long-term facilities, it is being widely spread through the community where there is no high risk like children and people who haven’t used antibiotics. 

The spores from C-Diff can be spread through food and feces by people who don’t use hand hygiene very well.  The spores can be present in a room for weeks to months.  And you can touch a surface with C-Diff and swallow the spores without even knowing it.

While your intestines contain nearly 100 trillion bacteria cells as well as 2,000 bacteria that help you build an immunity to infection.  When you are on an antibiotic, they not only destroy the bacteria causing the infection, but the healthy bacteria as well.  Without enough of the healthy bacteria, C-Diff can get out of control.  Such antibiotics that lead to C-Diff infections are fluoroquinolones, cephalosporins, penicillins and clindamycin.

Once C-Diff is established in the body, it can attack the lining of the intestine as it produces toxins that destroy cells by producing patches, or placques, of inflammatory cells.  These cells cause watery diarrhea.

Emergence of a New Strain

A new strain has emerged that is known to be aggressive and that has been known to produce more toxins than others and more resistant to certain medications.  It has shown up in people who haven’t been in hospital or taken antibiotics and caused several outbreaks since 2000.

Risk Factors

While people, as well as children, have gotten sick from C-Diff who aren’t risk have gotten sick, there are certain risks associated with C-Diff.

Taking Medications or Antibiotics

Medication-associated risk factors are:

·         Currently taking or have taken antibiotics

·         Taking broad spectrum of antibiotics targeting wide range of bacteria.

·         Using multiple antibiotics.

·         Taking antibiotics for a while.

·         Taking antibiotics to reduce stomach acid, especially proton pump inhibitors.

Staying in a Health Care Facility

Most C-Diff cases occur in health care settings like hospitals, nursing homes, and long-term facilities where germs are spread easily and people are the most vulnerable to infection.  While it is easily spread from person to person via hands, it can also be spread through cart handles, bed rails, bedside tables, toilets, sinks, stethoscopes, thermometers, and yes, even telephones and remote controls.

Having a Serious Illness or Medical Procedure

Serious illnesses like inflammatory bowel disease, colorectal cancer, or a weakened immune system from a medical treatment like chemotherapy can make you more susceptible to a C-Diff infection.  And you’re at an even greater risk if you’ve had an abdominal surgery or gastrointestinal procedure.

Being elderly is also a risk factor with those 65 and older more likely to get C-Diff than those who are younger.  And having a previous strain can put you at risk 20 percent and increasing as with each strain.

Complications

 Complications of C-Diff include:

·         Dehydration:  leads to significant loss of fluids and electrolytes which leads to diarrhea making your body harder to function properly and make your blood pressure drop significantly.

·         Kidney failure:  when dehydration occurring quickly, it can rapidly cause kidney failure. 

·         Toxic megacolon:  this rare condition makes your colon unable to expel gas and stool leaving your colon distended (megacolon).  Left untreated your colon may rupture allowing bacteria to enter the body cavity.  And an enlarged colon requires emergency surgery and may be fatal.

·         A hole in your large intestine (bowel perforation):  this rare condition is caused by extensive damage to the large intestine after a toxic megacolon.  This can allow bacteria to enter the body cavity which can lead to a life-threatening infection (peritonitis).

·         Death:  a mild infection of C-Diff can quickly lead to a fatal progression if left untreated.

Diagnosis

If you’ve had diarrhea after taking antibiotics within two months, health care professionals will often suspect C-Diff, especially if you’ve been hospitalized.  In which case, you’ll more likely be given one of the following tests:

Stool Tests

C-Diff toxins can usually be detected with a stool sample.  There are several types of lab tests:

·         Enzyme immunoassay (EIA):  while this test may be faster than others, it isn’t able to detect infections and may have a higher rate of false normal tests.

·         Polymerase chain reaction:  this is a more sensitive test that can detect C-Diff toxin B gene in a stool sample and highly accurate.

·         GDH/EIA:  some hospitals have used the glutamate dehydrogenase (GDH) in conjunction with the EIA.  GDH is very sensitive test and can rule out the presence of C-Diff in stool samples.

·         Cell cytotoxicity assay:  this test looks for the effects of C-Diff toxin on human cells grown in a culture.  While it is more sensitive, it is less widely available, more cumbersome to do and requires 24-48 hours for results.  Some hospitals use both the EIA and cell cytotoxicity assay for more accurate results.

C-Diff testing is not necessary if you’re not having watery stools or diarrhea and is not helpful for treatment.

Colon Examination

Doctors may confirm C-Diff diagnoses in rare cases by examining inside your colon with sigmoidoscopy or colonoscopy.  He will insert a small tube with a small camera inside your colon to look for areas of inflammation and pseudomembranes.

Imaging Tests

When your health care provider is concerned with possible complications of C-Diff infection he may want a abdominal X-ray or computerized tomography (CT) scan that will show images of your colon.  This scan can show thickening of the colon wall, expanding of the bowel, or a hole (perforation) in the lining of the colon.