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C. difficile


Disease: C. difficile C. difficile
Category: Digestive diseases
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Disease Definition:

The bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon is referred to as clostridium difficile, which is often called C. diffecile or "C. diff". Older adults in hospitals or in long term care facilities are the most commonly affected people by C. difficile, which usually happens after using antibiotic medications.


C. difficile infections have become more frequent, more severe and more difficult to treat in recent years.


If a person stops taking antibiotics, mild illness caused by C. difficile may get better. Treatment with a different antibiotic may be required in the case of more severe symptoms.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Some people who have C. difficile can still spread the infection, even though they never become sick. Normally, C. difficile develops while a person is taking a course of antibiotics or a brief period after that. However, for weeks or even months afterward, signs and symptoms may not appear.


Mild abdominal cramping and tenderness and watery diarrhea three or more times a day for two or more days are the most common symptoms of mild to moderate C. difficile.


The colon may form patches of raw tissue that can bleed or produce pus (pseudomembranous colitis), or it may become inflamed (colitis) as a result of more severe cases of C. difficile. The following are included in the signs and symptoms of severe infection:


  • Nausea
  • Fever
  • Dehydration
  • Loss of appetite
  • Watery diarrhea 10 to 15 times a day
  • Weight loss
  • Abdominal cramping and pain that can be severe
  • Blood or pus in the stool


During or shortly after antibiotic therapy, many people have loose stools. If the symptoms last more than three days, or if a person has more than three bowel movements a day, fever, blood in the stool, severe pain or cramping, he/she should see a doctor.


In water, soil, air, and human and animal feces are some of the places where C. difficile bacteria can be found. The bacteria are naturally carried in the large intestine of a small number of healthy people. In hospitals and other health care facilities, where a much higher percentage of people carry the bacteria, C. difficile is most common.


When infected people don’t wash their hands thoroughly, C. difficile bacteria spread to objects, surfaces and food, and are passed in feces. Hardy spores, which can persist in a room for weeks or months, are produced by the bacteria. So a person could unknowingly ingest the bacteria when touching a surface contaminated with C. difficile.


Usually, C. difficile doesn't make people who are in good health sick. There are millions of bacteria in the intestines, many of which help protect the body from infection. However, some of the normal, helpful bacteria as well as the bacteria causing the illness could be destroyed when someone takes an antibiotic to treat an infection. C. difficile can quickly grow out of control without enough healthy bacteria. C. difficile infections are most commonly caused by the following antibiotics:


  • Cephalosporins
  • Fluoroquinolones
  • Penicillins
  • Clindamycin


After C. difficile is established in the intestines, it may produce toxins that attack the lining of the intestine. Inside the colon, these toxins produce patches of inflammatory cells and decaying cellular debris, and destroy cells. 


An aggressive strain of C. difficile has evolved that creates far more deadly toxins than other strains of these bacteria do. This new strain has shown up in people who haven't been in the hospital or taken antibiotics, and it is more resistant to certain medications. Since 2000, this strain has caused several outbreaks of illness.


In health care settings where people are especially vulnerable to infection, where antibiotic use is common and where germs spread easily, C. difficile is most common. In nursing homes and hospitals, on stethoscopes, bedside tables, sinks, toilets, cart handles, thermometers, bedrails, telephones and remote controls, as well as on the hands of caregivers are some of the ways through which C. difficile spreads.


In addition to living in a nursing home, having recently been hospitalized and having recently taken antibiotics, a person has a greater risk of getting C. difficile when:


  • Having colorectal cancer, inflammatory bowel disease or some other disease of the colon.
  • A person is 65 or older. Compared with younger people, people who are 65 and older have a 10% higher risk of becoming infected with C. difficile.
  • Having had a previous C. difficile infection
  • Having a serious underlying illness or a weakened immune system as a result of a medical condition or treatment, such as chemotherapy.
  • Having had a gastrointestinal procedure or abdominal surgery.


Despite all of these, people who don’t have any known risk factors, including children, have gotten sick from C. difficile.



C. difficle infection may cause some of these complications:


Toxic megacolon:

When the colon is unable to expel gas and stool, it becomes grossly distended, resulting in this condition. Bacteria may enter the abdominal cavity from the colon in case the condition is left untreated and the colon ruptures. Emergency surgery is required in the case of a ruptured colon, which can be fatal.


Kidney failure:

Kidney failure may occur in some cases if dehydration occurs very quickly deteriorating the function of the kidneys.



Significant loss of fluids and electrolytes can result from severe diarrhea, which can cause blood pressure to drop to dangerously low levels and makes it difficult for the body to function normally.


Bowel perforation:

Extensive damage to the lining of the large intestine can pierce a hole in the large intestine. A life-threatening infection called peritonitis may result in case a perforated bowel spills bacteria from the intestine into the abdominal cavity.



If not treated promptly, even mild to moderate C. difficile infections can quickly become fatal.


Stopping the antibiotic that triggered the infection is the first step of treating C. difficile. This may be enough to relieve symptoms in the case of mild illness. However, further treatment may be required for many people.



Another antibiotic is the standard treatment for C. difficile. For mild to moderate illness, metronidazole is usually prescribed, while for more severe symptoms, vancomycin may be prescribed. These antibiotics allow normal bacteria to flourish again in the intestine by keeping C. difficle from growing.

A bitter taste in the mouth of the patient and nausea are some of the side effects of vancomycin and metronidazole. When taking metronidazole, the patient should avoid drinking alcohol at all costs.



A healthy balance can be restored to the intestinal tract by probiotics, which are organisms such as bacteria and yeast. Recurrent C. defficile infections can be prevented with the use of antibiotics in conjunction with a natural yeast called Saccharomyces boulardii.



Surgery to remove the diseased portion of the colon may be the only option for people with inflammation of the lining of the abdominal wall, organ failure or severe pain.


Recurrent disease:

Either because people with C. difficile are reinfected with a different strain of the bacteria or because the initial infection never went away, about one-fourth of those people get sick again. The following are included in the treatment of recurrent disease:


Probiotics, such as S. boulardii, given along with an antibiotic medication
Stool transplant also called fecal bacteriotherapy, to restore healthy intestinal bacteria by placing donor stool in the colon of the patient. Research has shown this method to be helpful in selected cases, despite the fact that it is rarely done in practice.
Antibiotics, which may involve one or more courses of a medication, an antibiotic given once every two days or a longer course of treatment. 


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