Clostridium difficile infection (CDI or C-dif) is a symptomatic infection due to the spore-forming bacterium, Clostridium difficile. Symptoms include watery diarrhea, fever, nausea, and abdominal pain. It makes up about 20% of cases of antibiotic-associated diarrhea. Complications may include pseudomembranous colitis, toxic megacolon, perforation of the colon, and sepsis.
Clostridium difficile infection is spread by bacterial spores found within feces. Surfaces may become contaminated with the spores with further spread occurring via the hands of healthcare workers. Risk factors for infection include antibiotic or proton pump inhibitors use, hospitalization, other health problems, and older age. Diagnosis is by stool culture or testing for the bacteria’s DNA or toxins. If a person tests positive but has no symptoms, the condition is known as C. difficile colonization rather than an infection.
C. difficile infections occur in all areas of the world. About 453,000 cases occurred in the United States in 2011, resulting in 29,000 deaths. Rates of disease globally have increased between 2001 and 2016. Women are more often affected than men. The bacterium was discovered in 1935 and found to be disease-causing in 1978. In the United States, health–care associated infections increase the cost of care by US$1.5 billion each year.
Many people have C diff living in their intestines and the bacteria doesn’t cause any problems for them. When kept in check by other good bacteria, C diff can cause no symptoms. However, when something (most often antibiotic usage) throws off the balance of bacteria in the body then this is when a problem can occur and C diff can start growing rapidly.
C. difficile bacteria can release toxins that attack the lining of the colon by not only destroying cells, but also creating patches of inflammatory cells that cause watery diarrhea.
Symptoms of overgrowth C diff can include:
*Watery diarrhea (at least three bowel movements per day for two days or longer)
*Abdominal pain and/or tenderness
Symptoms of severe C diff infection can include:
*Watery diarrhea 10 to 15 times a day
*Abdominal cramping and pain, which may be severe
*Loss of appetite
*Pus or blood in the stool
*Rapid heart rate
*Increased white blood cell count
A C diff infection is caused by C diff bacteria. C. difficile bacteria can be found in several common places including human and animal feces as well as soil, air and water. The bacteria can also be found in some foods such as processed meat. The human intestines have somewhere around 100 trillion bacterial cells and up to 2,000 different kinds of bacteria. Much of this bacteria is good because it keeps possibly problematic bacteria in check and guards the body against infection. According to Mayo Clinic, “A small number of healthy people naturally carry the bacteria in their large intestine and don’t have ill effects from the infection.”
C. difficile colitis is associated most strongly with the use of these antibiotics: fluoroquinolones, cephalosporins, and clindamycin.
Some research suggests the routine use of antibiotics in the raising of livestock is contributing to outbreaks of bacterial infections such as C. difficile.
People are most often infected in hospitals, nursing homes, or other medical institutions, although infection outside medical settings is increasing. Individuals can develop the infection if they touch objects or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers could possibly spread the bacteria to patients or contaminate surfaces through hand contact. The rate of C. difficile acquisition is estimated to be 13% in patients with hospital stays of up to two weeks, and 50% with stays longer than four weeks.
Long-term hospitalization or residence in a nursing home within the previous year are independent risk factors for increased colonization.
Acid suppression medication:
Increasing rates of community-acquired CDI are associated with the use of medication to suppress gastric acid production: H2-receptor antagonists increased the risk 1.5-fold, and proton pump inhibitors by 1.7 with once-daily use and 2.4 with more than once-daily use.
As a result of suppression of healthy bacteria, via a loss of bacterial food source, prolonged use of an elemental diet elevates the risk of developing C. difficile infection.
Prior to the advent of tests to detect C. difficile toxins, the diagnosis most often was made by colonoscopy or sigmoidoscopy. The appearance of “pseudomembranes” on the mucosa of the colon or rectum is highly suggestive, but not diagnostic of the condition. The pseudomembranes are composed of an exudate made of inflammatory debris, white blood cells. Although colonoscopy and sigmoidoscopy are still employed, now stool testing for the presence of C. difficile toxins is frequently the first-line diagnostic approach. Usually, only two toxins are tested for—toxin A and toxin B—but the organism produces several others. This test is not 100% accurate, with a considerable false-negative rate even with repeat testing.
Assessment of the A and B toxins by enzyme-linked immunosorbent assay (ELISA) for toxin A or B (or both) has a sensitivity of 63–99% and a specificity of 93–100%.
Previously, experts recommended sending as many as three stool samples to rule out disease if initial tests are negative, but evidence suggests repeated testing during the same episode of diarrhea is of limited value and should be discouraged. C. difficile toxin should clear from the stool of previously infected patients if treatment is effective. Many hospitals only test for the prevalent toxin A. Strains that express only the B toxin are now present in many hospitals, however, so testing for both toxins should occur. Not testing for both may contribute to a delay in obtaining laboratory results, which is often the cause of prolonged illness and poor outcomes.
Other stool tests:
Stool leukocyte measurements and stool lactoferrin levels also have been proposed as diagnostic tests, but may have limited diagnostic accuracy.
Testing of stool samples by real-time polymerase chain reaction is able to pick up the disease about 90% of the time and when positive is incorrectly positive about 4% of the time. Multistep PCR testing algorithms can improve overall performance. Repeat testing may be misleading, and testing specimens more than once every seven days in patients without new symptoms is highly unlikely to yield useful information.
Carrying C. difficile without symptoms is common. Treatment in those without symptoms is controversial. In general, mild cases do not require specific treatment. Oral rehydration therapy is useful in treating dehydration associated with the diarrhea.
According to the CDC: “Whenever possible, other antibiotics should be discontinued; in a small number of patients, diarrhea may go away when other antibiotics are stopped. Treatment of primary infection caused by C. difficile is an antibiotic such as metronidazole, vancomycin, or fidaxomicin. While metronidazole is not approved for treating C. difficile infections by the FDA, it has been commonly recommended and used for mild C. difficile infections; however, it should not be used for severe C. difficile infections. Whenever possible, treatment should be given by mouth and continued for a minimum of 10 days.”
Another important fact that the CDC points out is that when antibiotics are used to treat a primary C diff infection, the infection ends up coming back in around 20 percent or a fifth of patients. Even worse, for some C diff patients, the infection doesn’t just come back once, but again and again. You can imagine how difficult that must be on a person’s body. When the infection comes back the first time, the same antibiotic is typically used, but if the infection comes back more than once then stronger antibiotics are employed.
*Stop Antibiotics Whenever Possible
*Load Up On Good Bacteria
Also get lots of probiotic-rich foods from your diet that will help to balance the intestinal flora and fight C diff. Some top probiotic foods to consume regularly: cultured dairy products (such as kefir, goat milk yogurt or cultured probiotic yogurt made from raw cow’s milk), raw apple cider vinegar, fermented vegetables (sauerkraut, kimchi, kvass) and probiotic beverages (kombucha and coconut kefir). To get the most out of apple cider vinegar, make sure to buy a raw variety with the “mother” intact, which means it still contains all its beneficial compounds including probiotics.
*Avoid or Reduce Certain Foods
According to the C Diff Foundation, there are some of the foods most people find helpful to avoid during a C Diff infection. For example dairy products,greasy, fatty foods and processed foods,some foods that are definitely healthy but may cause extra bloating, gas and discomfort,raw fruits and veggies,Processed fat-free foods like Olestra,spicy foods and large quantities of caffeine.
*Thorough Hand Washing
*Consume Natural Antibiotics like manuka honey,raw garlic, and oil of Oregano.
Prevention is by limiting antibiotic use, hand washing, and terminal room cleaning in hospital. Discontinuation of antibiotics may result in resolution of symptoms within three days in about 20% of those infected. Often the antibiotics metronidazole, vancomycin or fidaxomicin will cure the infection. Retesting after treatment, as long as the symptoms have resolved, is not recommended, as the person may remain colonized. Recurrences have been reported in up to 25% of people. Some tentative evidence indicates fecal microbiota transplantation and probiotics may decrease the risk of recurrence.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.