Clostridium Difficile: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

The bacteria Clostridium difficile is the source of infections in the colon, which is the longest segment of the large intestine. The symptoms could include anything from diarrhea to potentially fatal colon damage. The names C. difficile and C. diff are commonly used to refer to the bacteria.

C. difficile infections often follow the use of antibiotic drugs. Elderly individuals in hospitals or long-term care facilities comprise most of those affected. Infections with C. difficile can also occur in assisted living or non-hospital settings. Younger people are susceptible to serious infections caused by specific types of germs.

Formerly, the bacterium was known as Clostridium difficile.

Causes Of Clostridium Difficile

A sudden, severe C. difficile infection can cause an inflammatory colon that grows bigger and becomes poisonous (a condition known as a megacolon). Moreover, sepsis may result from it, a disease in which the body harms its tissues to combat an infection. Intensive care unit patients are admitted if they have sepsis or toxic megacolon. Conversely, poisonous megacolon

The body is exposed to C. difficile bacteria through the mouth. They can reproduce in the small intestine. The bacteria can invade the colon, and a portion of the large intestine, and cause tissue damage by releasing toxins. Watery diarrhea and cell death are the results of these toxins.

Outside the colon, bacteria are inactive. They can endure for an extended period in places like:

• Human or animal feces.
• Dirty hands.
• Soil
• Water
• Food

Bacteria can cause infection when they re-enter a person's digestive system and become active. Because it can survive outside of the body, the bacterium C. difficile spreads easily. Hands that are not properly washed facilitate the transmission of bacteria.

Some individuals carry intestinal C. difficile bacteria but never experience disease. These people are the carriers of the bacterium. They can spread infections without really being sick.

Also Read: Shigellosis: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

Symptoms Of Clostridium Difficile

Five to ten days after beginning an antibiotic, symptoms typically begin to show. On the other hand, symptoms could show up as late as three months or as early as the first day.

Mild to Moderate infection

The most common indications of a mild to moderate infection with C. difficile are as follows:

• Watery diarrhea at least three times a day, for a few days.
• Moderate abdominal pain and cramps.
• Severe sickness
• Patients with severe C. difficile infections frequently have dehydration, a condition in which an excessive amount of bodily fluid is wasted. They might need to be treated for dehydration in a hospital. Inflammation of the colon may be caused by a C. difficile infection. On rare occasions, it could lead to patches of raw tissue that bleed or secrete pus.
• Watery diarrhea for ten or fifteen times a day.
• Abdominal aches and cramps, sometimes quite severe.
• Rapid heart rate.
• Loss of liquid, sometimes called dehydration.
• Fever
• Anxiety
• Higher level of white blood cell content.
• kidney injury.
• Reduced appetite.
• Large stomach.
• Reduce weight.
• Pus or blood in the stool.

Also Read: Listeriosis : Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention

Risk Factors Of Clostridium Difficile

Individuals with C. difficile infections are not considered risk factors. Some factors, though, make things more dangerous.

Taking antibiotics or prescription medications

The intestines are home to a variety of bacteria species. Many of them support the body's defense mechanism against infection. Antibiotics used to treat illnesses often kill both the germs causing the infection and some helpful microorganisms in the body.

If there aren't enough good bacteria to keep C. difficile in control, it could spread quickly. Any medicine can cause an infection with C. difficile. Nonetheless, the drugs listed below are the ones that typically result in a C. difficile infection:

• Tetracyclines
• Naproxen.
• Penicillin
• Fluoroquinolones

A family of drugs known as proton pump inhibitors is intended to lower the production of stomach acid; however, it also increases the chance of contracting C. difficile infection.

Healthcare worker

Infections with C. difficile are most common in those who are or have recently been in healthcare settings. These include hospitals, nursing homes, and long-term care facilities. These are places where the population's health raises the risk of infection, germs can move easily, and antibiotic use is common. In hospitals and nursing homes, C. difficile spreads by:

• Hands
• wheels for carts.
• Bedside tables
• Bed Rails.
• Toilets and sinks.
• Stethoscopes, thermometers, and other medical instruments.
• Mobile phones.
• Receiving extensive medical care

Certain medical disorders or procedures may increase the risk of contracting a C. difficile infection. These include:

• Colon inflammation caused by diarrhea.
• Weakened immunity brought on by a medical condition or treatment such as chemotherapy.
• Chronic disease of the kidneys.
• Procedures related to the digestive system.
• Gastric surgery.

Also Read: Measles: Causes, Clinical Presentation, Risk Factors, Complications, Diagnosis, Treatment And Vaccination

Diagnosis Of Clostridium Difficile

The following factors are used to diagnose a C. difficile infection:

• Leprosy
• Other signs of a C. difficile infection.
• E. Coli in a sample of stool.

It is not recommended to test for C. difficile infection in people who have regular, well-formed stools. Infections with C. difficile can happen to individuals who have never used antibiotics. It is therefore not necessary to have used antibiotics recently to diagnose C. difficile infection.

Stool examination

Toxins or bacterial strains that produce toxins can be detected in a stool sample, which can be tested once or more if a C. difficile infection is suspected.

Colon analysis

In rare cases, a colonoscopy may be performed by a medical practitioner to support a diagnosis of C. difficile infection. Flexible sigmoidoscopy or colonoscopy are the tests used. The tests involve putting a flexible tube with a tiny camera on one end into the colon to identify problem areas. These tests can also look for other causes of the symptoms.

Radiological tests

To rule out any potential effects from a C. difficile infection, an X-ray or CT scan of the stomach region might be performed. Such imaging examinations can determine:

• A thicker colon wall.
• Larger colon.
• A hole or perforation in the colon's lining.

Also Read: Group A Streptococcal Infections : Types, Causes, Symptoms, Diagnosis, Treatment

Treatment Of Clostridium Difficile

Treatment is limited to the infection's symptoms. Medical care is not provided to carriers of the bacteria who are left untreated.

Antibiotic-containing medication

If an antibiotic is connected to a C. difficile infection, a doctor is likely to discontinue using it. However, using an antibiotic is frequently required while treating another infectious disease. The chance of diarrhea caused by a C. difficile infection may be decreased by switching to a different medication.

Antibiotics are the mainstay of treatment for C. difficile infections. Commonly used antibiotics include:

• Vancomycin
• Fidaxomicin
• Severe C. difficile infections can be treated with vancomycin plus metronidazole (Flagyl).

Surgery

The following circumstances may call for surgery to remove the damaged colonic segment:

• Severe pain.
• Organ failure.
• The megacolon was toxic.
• The term "inflammation" refers to the swelling and irritation of the lining of the stomach wall.

Treatment for recurrent infections

About 25% of patients have recurrence after receiving treatment for their C. difficile infection. One explanation could be that the first illness never completely healed or that bacteria could spread to cause new infections. The risk increases with each C. difficile infection. After three or more infections, there is a greater than 50% likelihood of getting another one.

Recurrent infections are more likely to occur in people who:

• Are older than 65 years.
• Are you taking any other meds for a different disease in addition to the antibiotics for your C. difficile infection
• Have a severe condition, such as renal failure
• Inflammatory bowel disease
• Chronic liver disease.

Options for treatment once a C. difficile infection recurs include:

• Antibiotics: Recurring diseases may be treated with one or more doses of antibiotics. Often, the antibiotic that is given subsequently is not the same as the one that was initially prescribed. The effectiveness of antibiotic treatment decreases with each recurrence of the infection.
• A human antibody called bezlotoxumab (Zinplava) is used as a therapy against C. difficile toxin B. It has been shown to lower the incidence of recurrent C. difficile infection in individuals who are at high risk of recurrent episodes.
• Fecal microbiota transplantation (FMT): A more modern therapy for recurrent C. difficile infections is called FMT. FMT has been the subject of clinical trials.
• With FMT, the beneficial bacteria from the donor are reintroduced into your colon through specialist tubes inserted into your rectum. Donors are subjected to medical screening, blood is screened for infections, and stools are carefully inspected for parasites, viruses, and other infectious agents prior to being used in FMT.

The patient undergoing an FMT may be required to sign a consent letter that details the risks and advantages of the procedure. FMT is frequently called a stool transplant or an intestinal microbiota transplant.

FMT restores healthy intestinal bacteria in the colon by introducing donor stool with the use of special tubes put into the rectum.

Donors are subjected to medical screening, blood is screened for infections, and stools are carefully inspected for parasites, viruses, and other infectious agents before being used in FMT.

Also Read: Cholera: Causes, Symptoms, Types of Carriers, Risk Factors, Diagnosis, Treatment

Prevention Of Clostridium Difficile

Prevent from using antibiotics on C. difficile unless required. In certain cases, viral infections and other non-bacterial illnesses are treated with antibiotics. 

If you're not sure if you need an antibiotic, ask your doctor if you can get a prescription for a drug that targets the infection specifically or has a shorter half-life. Narrow-spectrum antibiotics target particular species of bacteria. They are less prone to destroy helpful microbes.

Hospitals and other healthcare facilities adopt stringent infection control protocols to help halt the spread of C. difficile. If you have a loved one in a hospital or assisted living facility, follow the rules.

Make inquiries if you see carers or other people not following the rules.

Precautions against Clostridium difficile include:

• Hand washing: Healthcare personnel should wash their hands both before and after caring for each patient. It is best to wash your hands with warm water and soap when there is a C. difficile outbreak. Alcohol-containing hand sanitisers do not eradicate C. difficile spores.

Additionally, it is advised that guests of medical institutions wash their hands with soap and warm water before entering and exiting rooms.

• Take steps to avoid it: Patients who are hospitalized and have C. difficile infections have either a private room or a room with another patient. Both hospital staff and visitors enter the room wearing disposable gloves and isolation gowns.

• Thorough cleaning: In a medical setting, every surface needs to be thoroughly cleaned with a chemical that contains chlorine bleach. Candida difficile spores are resistant to cleaning solutions that don't contain bleach.

Complications Of Clostridium Difficile

A C. difficile infection can cause the following adverse effects:

• Loss of fluid is also referred to as dehydration: Severe diarrhea may cause a large loss of electrolytes, or fluids and minerals. As a result, the body finds it challenging to operate normally. It may cause blood pressure decreases that are dangerously low.
• Renal damage: When dehydration occurs so rapidly that the kidneys fail, the condition is known as renal failure.
• Megacolon was toxic: Gas and stool cannot be expelled from the colon in this rare disease. As a result, it expands and becomes a megacolon. If the colon is not treated, it may burst.
• Bacteria can also get into the bloodstream: Poisoning with a megacolon may be fatal. Surgery is needed immediately.
• Bowel perforation: A large opening in the gut called a bowel perforation. This rare disease arises following a toxic megacolon or from damage to the colon's lining. Bacteria from the colon may seep into the abdomen cavity, a hollow space in the middle of the body, causing a potentially fatal infection called peritonitis.
• Death: A significant C. difficile infection can quickly become fatal if treatment is postponed. Rarely, conditions ranging from mild to severe can be lethal.

Also Read: Herpes: Causes, Symptoms, Stages of Herpes, Transmission of Herpes, Diagnosis, Treatment

To scale up your NEET PG preparation with the best-in-class video lectures, QBank, Mock Tests and more, download the PrepLadder App!

Download PrepLadder's NEET PG preparation app for Android

Download PrepLadder's NEET PG preparation app for iOS