The bacterium named Clostridium difficile (or C. diff) causes mild illness such as diarrhea to life-threatening inflammation (swelling) of the intestine (colon). Infection usually occurs after use of antibiotics and are the most common ones that people get while they’re in hospitals. More than 3 million such infections occur yearly in the United States. Infection is more common in people age 65 and older and in people in hospitals and long-term care facilities, but even healthy people may get sick after prolonged antibiotic therapy.
C. diff is associated with illness after use of antibiotics such as clindamycin, penicillins, fluoroquinolones and cephalosporins but it can occur with any antibiotic. Bacteria and dormant spores are spread by contact with stool and contaminated surfaces or food. People touch the surfaces and then their mouths without washing their hands. Such surfaces include bedpans, furniture, linens, and toilet seats.
Symptoms include watery diarrhea 10 to 15 times a day and cramping and pain in the abdomen (belly) that can be severe. Others are fever, blood or pus in the stool, nausea, dehydration, loss of appetite, and weight loss. Severe illness can mean an inflamed colon (colitis) or patches of colon tissue that can bleed or make pus (pseudomembranous colitis). Some infected people never become sick but can still spread infection: they are called “carriers".
Diagnosis is suspected if there is a history of antibiotic use and the onset of typical symptoms. Diagnosis is confirmed by blood and stool tests. One test looks for bacterial toxins in the stool. Sometimes the colon is examined by flexible sigmoidoscopy and computed tomography (CT) if diagnosis is unclear or complications occur. A flexible sigmoidoscopy procedure involves putting a flexible tube with a small camera on one end into the colon.
Stopping use of the antibiotic that triggered the infection is critical and may be the only needed treatment. Others may need a treatment course with a new antibiotic (metronidazole or vancomycin). These antibiotics keep C. diff from growing, while allowing normal bacteria to grow in the intestine. Fever usually goes away in 2 or 3 days, and diarrhea, in 3 or 4 days. Fluids are given for dehydration. Good nutrition is important. Other possible treatments are probiotics or, in severe cases, surgery to remove diseased parts of the colon. Probiotics are beneficial bacteria and yeast that help restore a healthy balance of microorganisms in the intestine. Relapse is common and needs more treatment. In resistant cases, the transplantation of feces from healthy donors with the use of tubes inserted in rectum or through the stomach has been very effecting in curing C. diff.
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