Clostridium difficile (known as ‘C. Diff’ for short) is a species of bacterium that can cause severe diarrhea requiring hospitalization. This bacterium normally lives in soil, water, deli meat, and human feces and we are exposed to it on a fairly regular basis. It may not cause symptoms until our normal intestinal bacterial colonies are disrupted by illness or antibiotics.

Our intestines have over 2000 different kinds of helper bacteria, all living in harmony when we are well. They assist in fermenting food and keeping out harmful bacteria. However, when we take antibiotics for an infection (such as pneumonia, skin, or urinary tract infections) the medicine kills the bad bacteria curing those infections, but at the cost of many “friendly fire” casualties in our intestines. This allows the C. Diff to reproduce rapidly, manufacturing toxins that trigger diarrhea by infecting the intestinal lining.

Many of the risks of a C. Diff infection are the same for any severe diarrhea: dehydration, kidney failure, ruptured colon wall, and in rare cases, death. It is more common to catch C. Diff after taking antibiotics (especially fluoroquinolones, cephalosporins, penicillins and clindamycin), or being in a hospital (because many patients take antibiotics there). It is 10 times more common in people over the age of 65.

Symptoms usually develop 5-10 days after starting a course of antibiotics. Symptoms can be mild (watery stool, 2-3 times a day) or severe (diarrhea 10-15 times a day wi
th fever, dehydration, nausea, swollen abdomen, or blood or pus in the stool). C. Diff has a characteristic foul odor that is familiar to healthcare workers caring for patients with this infection (I can usually tell if someone has C. Diff when I walk into their room. Ew. I know). You should see a doctor if you have three or more watery stools a day and symptoms lasting more than two days or if you have a new fever, severe abdominal pain or cramping, or blood in your stool.

There is a new strain of C. Diff emerging that is resistant to some antibiotics. Fortunately there aren’t any strains (yet) that are resistant to all antibiotics. Those who catch C. Diff have a 20-30% chance of being re-infected from within. These bacteria produce spores (a reproductive structure with a shell-like coating) that can live on dry surfaces from weeks to months. The spores are immune to alcohol-based cleaning agents, but are destroyed by soap and water or bleach.

C. Diff is contagious, but spread can be avoided by careful hand washing, clothing and bedding laundering, and bleaching of all surfaces that may have come in contact with the infected individual. Pro-biotics (found in acidophilus tablets, yogurt, fermented cultures, and Kefir) may prevent C. Diff infection by shoring up the helper bacteria numbers in the gut. C. Diff can be killed by strong antibiotics such as Flagyl or Vancomycin, but they may have unpleasant side effects such as severe nausea and a bitter taste.

Fecal transplants are an emerging treatment for severe cases of recurrent C. diff infections. This involves re-populating the intestines with gut bacteria from another person. It is not yet approved by the FDA because it is hard to be certain that these transplants are free of unwanted infectious agents and viruses, though donors can be screened. Perhaps one day in the future, those of us with exceptionally healthy bowels will volunteer to be stool donors. If the Red Cross has blood banks, will they also eventually have stool banks?

Although you may shudder at the prospect of stool banks, they may be life-savers for those with chronic or resistant C. Diff infections.  Until then, I wash my hands with soap and water and eat yogurt (with live cultures) every day – to keep the C. Diff at bay!

References

http://www.mayoclinic.org/diseases-conditions/c-difficile/home/ovc-20202264
https://www.cdc.gov/hai/organisms/cdiff/cdiff-patient.html

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Dr. Val Jones MD – Health Tip Content Editor
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