C. Diff Infection: Symptoms, Causes, Diagnosis, Treatment and Prevention

Aug 2, 2019 | Colonoscopy, General Medical

Most people never think about the bacteria living in their colon. You may have heard about the health benefits of probiotics or heard about the research being done on the relationships between your gut biome and many seemingly unrelated health conditions. Few people realize among the good bacteria that aid digestion lies a potential killer.

What is Clostridium Difficile?

A naturally occurring bacterium found in the soil, water, and many people’s colons, Clostridium difficile, now known as Clostridioides difficile, is normally harmless. Called simply C. diff, this bacteria is normally kept in check by myriad other helpful bacteria in your colon, collectively known as your gut flora. Like many things in nature, it is only when levels of C. difficile are out of balance that complications can arise. 

C. diff bacteria is often found as an inactive spore. If you have spores in your digestive tract, you can thank your healthy gut flora for keeping things in balance. When there is a disturbance to the balance of bacteria in your intestines, C. diff can begin to multiply and the spores become activated. When this happens, a potentially dangerous condition called colitis can result. This infection of the colon can result in sepsis, a generalized infection, or in the failure of organs from septic shock. You can even end up with a condition called toxic megacolon. If that happens, your colon will become dilated and can no longer pass stool or gas. In extreme cases, your colon can even rupture and possibly give you an infection that could be life-threatening. When the colon ruptures, it is known as a bowel perforation. The resulting infection is known as peritonitis. 

Cases of C. difficile are usually quite serious because they typically occur in people over the age of 65. These older individuals are at greater risk for infectious diseases and can have a harder time with the side effects of a C. diff infection like severe diarrhea. 

Unlike many other infections, Clostridium difficile infections most often begin in care settings like nursing homes, hospitals, and other long-term care facilities. This is due to one of the major causes of C. diff in the United States—prescribed antibiotics. 

What Are the Symptoms and Signs of Clostridium Difficile (C. diff)?

The initial symptoms of a C. difficile infection are similar to many other gastrointestinal issues. You will almost certainly experience watery diarrhea that lasts for several days. It is common to experience some episodes of loose stool when you are being treated with antibiotics, but this severe diarrhea is far worse. Combined with a loss of appetite, you may have a hard time staying hydrated and getting enough nutrients. 

If you have recently been on antibiotics, have diarrhea that persists longer than a few days, and you are experiencing abdominal pain, elevated body temperature, or other common symptoms of bacterial infections, it may be time to talk to your healthcare provider. When a C. diff infection is not treated, the inflammation of the colon can get worse. This may result in extreme discomfort, bloating, nausea, and even vomiting and weight loss.

If your doctor suspects you may have a C. diff, you will probably have your blood tested to see if your white blood cell count is higher than normal. A high white blood cell count can come from your body’s attempt to fight the ongoing infection. They will also be looking for the toxins produced by activated C. difficile bacteria. A blood test is not usually enough for your medical care provider to make a conclusive diagnosis. 

A more dependable proof of infection comes from a stool sample. By identifying the actual bacteria in your feces, your doctor can definitely diagnose your infection. If there is still any doubt, your doctor may prescribe a colonoscopy. When examining your colon, your medical provider will be looking for a buildup of white blood cells. These blood cells can form whitish membrane-like structures in your intestine, which are called pseudomembranes. This condition, called pseudomembranous colitis, is a very good indication you have a C. difficile infection.

How Does a C. Diff Infection Start?

When you take antibiotics for an infection, the drugs can end up killing healthy bacteria in addition to the harmful ones they are designed to treat. This nasty side effect can end up killing off many of the bacteria living in your colon, allowing C. diff bacteria to multiply out of control. Antibiotics like levofloxacin, Cipro, cephalosporins, and fluoroquinolones, in particular, are known for killing off healthy gut bacteria along with bad ones. 

Since antibiotics are usually only prescribed to people who have an ongoing medical condition and may be undergoing treatment in a care facility, it is easier for new infections to form. This is particularly true of C. difficile infections, as they are highly contagious. 

Once you have developed an active infection, you will be shedding activated C. diff spores in your feces. These can contaminate surfaces like floors and walls, as well as sheets, bathroom fixtures, door handles, and more. Anyone with a compromised immune system that comes into contact with those spores is at risk for ingesting them. C. diff is spread through fecal-oral transmission, which makes proper handwashing very important, especially if you have other risk factors for infection. 

Over the last several years, there has been a rise in cases of C. diff. According to the Centers for Disease Control and Prevention, more and more younger Americans are being treated for C. difficile infections. Normally you will not develop an infection if you are in good overall health, but if you have risk factors for infectious diseases, it is possible for you to develop a serious C. diff infection if your gut bacteria have been disturbed by the use of antibiotics. 

What Are C. diff Treatments?

Ironically, though Clostridium difficile infections are caused by antibiotics, we use antibiotics to treat them. C. diff bacteria can survive most other antibiotic treatments, so you have to use different drugs to kill off the infection. The list of drugs that can stop a C. diff infection is quite short and includes vancomycin (Vancocin), fidaxomicin, and metronidazole (or Flagyl).

Even if you have completed a course of treatment using vancomycin or one of the other drugs used to treat a C. diff infection, it can take a long time for the microflora in your gut to re-establish themselves. Your chances of an infection occurring again are still high for the next two to eight weeks after initial infection. 

Some doctors recommend taking probiotics to promote the growth of healthy bacteria. These naturally occurring microbes exist in foods such as some kinds of yogurt. Other medical professionals discourage treatment with probiotics, as there is no set standard for the specific formations of microbes in a given food, and a positive effect cannot be assured. 

If you are having trouble rebuilding a healthy balance of gut microflora, there are other, more surprising options. A treatment known as fecal microbiota transplantation involves introducing a healthy sample of another person’s feces into your colon. By adding a sample of feces that contains healthy microflora, it is possible a healthy balance of gut bacteria can be achieved. 

Fecal microflora transplantation, sometimes called fecal microbiota transplant, is not without risk, though. The FDA recently issued a warning following the death of a transplant recipient who contracted a disease from the fecal sample. If you have a compromised immune system or other risk factors to certain diseases, it is best to talk to your doctor first before considering this form of treatment. 

In extreme cases, surgery is sometimes needed to help manage or treat a C. difficile infection. This is rare, and typically only happens in the case of a bowel perforation or a high risk of peritonitis. Surgery is normally seen as a treatment of last resort and is only considered if other forms of treatment and drugs such as metronidazole have not been effective in managing your infection. 

What to do to Prevent C. Diff Infections

Clostridium difficile is very contagious. When spores are shed into the environment, they can survive for long periods of time, meaning the infection can still be spread long after someone has stopped having symptoms. This is one of the reasons C. diff is commonly found in hospitals, nursing homes, and other healthcare facilities. It is also possible for C. diff to start at home, and taking care of cleaning a home environment after an infection is vital to prevent a return of the infection. 

Proper handwashing is the best method of infection control for conditions like C. diff. You should be particularly careful to wash your hands well before you eat, especially if you have been in contact with areas where C. difficile spores might be found. This can include sheets, clothing, and beds of people who may have an infection. Bathrooms, doorknobs, toilets faucets, and some medical equipment like stethoscopes are all places where C. diff bacteria may be hiding. 

The best way to prevent the spread of C. diff is to stop it before it starts. If you have to visit your healthcare provider for an infection, ask them about the potential consequences of the use of antibiotics. Some medications have a greater effect on your gut flora, and your doctor may be able to prescribe a different drug that could help maintain your digestive health. If one of the stronger drugs like a cephalosporin is the only answer, be on the lookout for common symptoms of C. diff like cramping, watery diarrhea, and vomiting. 

Talk to Your Doctor about C. Difficile

Clostridium difficile infections and the complications that arise from them can be debilitatingly painful and even life-threatening. Some infections do resolve themselves without treatment, but for older Americans, the threat of infection is serious. A few loose bowel movements are not a cause for concern, but if symptoms persist, a more serious infection could be taking hold. If a C. difficile infection is likely, your healthcare provider will perform the tests necessary to confirm it through stool samples or even a colonoscopy to look for pseudomembranous colitis.

If you or someone you know has recently started antibiotic therapy and is experiencing watery diarrhea, severe abdominal pain, and other symptoms, contact Gastroenterology Consultants of Savannah. We are here to help you get the treatment you need.