C. diff (Clostridioides difficile) Infection

C. diff 

C. diff, or Clostridioides difficile, is a highly contagious bacterium that causes diarrhea and colitis. This infection often affects individuals who have recently taken antibiotics, which can disrupt the balance of bacteria in the gut, allowing C. diff to grow unchecked. Treating C. diff usually requires a different antibiotic.

What is Clostridioides difficile (C. diff)?

Clostridioides difficile (pronounced klos-TRID-e-OY-dees dif-uh-SEEL), commonly known as C. diff, is a bacterium that infects the large intestine (colon), leading to symptoms such as diarrhea. While many colon bacterial infections are mild, C. diff can be aggressive and harmful, often causing severe colitis known as pseudomembranous colitis.

How does C. diff infection occur?

Many people naturally carry the C. diff bacterium without infection because other intestinal bacteria keep it in check. However, when the balance of these bacteria is disrupted, typically by antibiotic use, C. diff can proliferate rapidly, often during recovery from another infection.

How does C. diff infection impact your health?

C. diff releases toxins in the gut that damage the intestinal lining, resulting in inflammation (colitis) and associated symptoms. The severity of symptoms depends on the extent of this toxin-induced damage, ranging from mild to life-threatening.

How common is C. diff infection?

C. diff infection (CDI) is a significant global health concern. In the United States alone, there are approximately half a million infections annually, leading to about 15,000 deaths.

Is Clostridioides difficile the same as Clostridium difficile?

Yes, Clostridioides difficile is the more recent name for Clostridium difficile. Clostridium is the genus, while Clostridioides difficile is the specific species responsible for the infection.

Symptoms and Causes

What are the symptoms of C. diff infection?

C. diff infection typically begins with watery diarrhea, occurring at least three times a day in mild cases, often accompanied by abdominal cramping or tenderness. In severe cases, diarrhea can occur up to 10 to 15 times a day and may include blood. Additional symptoms include persistent abdominal pain, nausea, vomiting, loss of appetite, fever, and a rapid heart rate.

What characterizes the appearance and smell of C. diff stool?

C. diff diarrhea is usually mushy or porridge-like, sometimes with a greenish tint. It may contain blood, mucus, or pus and has a distinctive and unusually strong, sweet odor due to increased bile acids in the stool.

How does one contract C. diff?

C. diff may already be present in the gut from birth, or it can be acquired through accidental ingestion. It spreads through feces, and approximately 5% of the population may carry it without showing signs of infection, thus potentially spreading it to others.

How is C. diff transmitted?

C. difficile reproduces by releasing spores that persist in the environment, especially where infected individuals or animals are present. These spores can enter the gastrointestinal tract through the mouth.

Why is C. diff highly contagious?

C. diff spores are exceptionally hardy, resistant to heat, acid, many antibiotics, and disinfectants, and can survive on surfaces for months.

What causes C. diff infection?

Antibiotic use is the primary cause, as antibiotics disrupt the balance of gut bacteria, allowing C. diff to proliferate. Other risk factors include certain medical conditions, age, hospitalization, and institutionalization.

What complications can arise from C. diff infection?

Severe C. diff infections can lead to complications such as recurrent infection, dehydration, electrolyte imbalances, pseudomembranous colitis, toxic megacolon, peritonitis, sepsis, and septic shock.

Diagnosis and Tests

How is C. diff infection diagnosed?

Healthcare providers typically collect a stool sample for laboratory testing to detect C. diff toxins. Further tests, including blood tests and imaging studies, may be performed to assess the infection's severity.

Management and Treatment

What is the treatment for C. diff infection?

Treatment depends on the infection's severity. If you developed the infection while taking antibiotics, your healthcare provider may discontinue them. Antibiotics effective against C. diff, such as metronidazole, vancomycin, and fidaxomicin, may be prescribed. Severe cases may require hospitalization and intensive care, and in rare instances, emergency surgery to remove the infection source.

What if the infection recurs?

For recurrent infections, options include repeat antibiotic therapy or fecal microbiota transplantation, which involves transferring stool from a healthy donor to restore a healthy gut microbiome.

Prevention

How can you prevent the spread of C. diff?

• Isolation: Infected individuals should stay isolated, with caregivers wearing disposable gloves.
• Handwashing: Frequent handwashing with soap and warm water is essential.
• Disinfection: Use chlorine-based products to disinfect surfaces.
• Limiting antibiotics: Avoid unnecessary antibiotic use to prevent antibiotic-resistant strains.

Outlook / Prognosis

What can one expect if they have C. diff?

Most C. diff infections are mild and resolve without complications. However, severe cases can occur, particularly for those with risk factors, and may require extensive treatment.

Can C. diff resolve on its own?

C. diff can resolve on its own if the intestinal flora reestablishes balance, particularly after discontinuing antibiotics. However, prompt medical attention is crucial if symptoms persist.

Are there long-term complications after C. diff infection?

The most common long-term issue is recurrent infection. In rare cases, severe infections can lead to chronic inflammation and long-term symptoms, such as post-infectious IBS and reactive arthritis.

Living With

What questions should individuals ask their healthcare provider about C. diff infection?

• How severe is my infection?
• What are the potential complications?
• How will I know when my infection is improving?
• When should I seek emergency care?
• Do I need a referral to a gastroenterologist?
• What are my treatment options for recurrent infections?

Understanding C. diff is essential for managing and preventing its spread. By staying informed and following proper precautions, individuals can protect themselves and others from this highly contagious bacterium.