Clostridium difficile

Description:
Clostridium difficile often called C. difficile or C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.

C diff is a type of bacteria that causes inflammation and infection of the colon, known as colitis. C diff is also a shortened way of referring to the infection itself. Clostridium difficile colitis is the full name for the colon infection caused by C diff bacterium. This strain of bacteria can cause symptoms in the body ranging from diarrhea to life-threatening cases of C diff colitis or C diff infection.

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Illness from C. difficile most commonly affects older adults in hospitals or in long-term care facilities and typically occurs after use of antibiotic medications. However, studies show increasing rates of C. difficile infection among people traditionally not considered high risk, such as younger and healthy individuals without a history of antibiotic use or exposure to health care facilities.

Each year in the United States, about a half million people get sick from C. difficile, and in recent years, C. difficile infections have become more frequent, severe and difficult to treat.

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, healthcare-associated infections increase the cost of care by US$1.5 billion each year.

Symptoms:
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)

*Appetite loss

*Nausea

*Fever

*Abdominal pain and/or tenderness

With a C. diff infection, the colon becomes inflamed, which is medically referred to as colitis. Sometimes the colon become even more damaged by the release of toxins from the the overgrowth of the C diff bacteria. If this happens, the colon can develop patches of raw tissue that may bleed or pus, which is called pseudomembranous colitis. There are also a greater number of symptoms and more severe symptoms if a C diff infection escalates to this level. Most of the time, pseudomembranous colitis is caused by C diff.

Symptoms of severe C diff infection can include:

*Watery diarrhea 10 to 15 times a day

*Abdominal cramping and pain, which may be severe

*Swollen abdomen

*Nausea

*Loss of appetite

*Pus or blood in the stool

*Fever

*Rapid heart rate

*Dehydration

*Weight loss

*Increased white blood cell count

*Kidney failure

With severe cases, it’s common for people to become so dehydrated (from all that diarrhea) that they need to go to the hospital.

Causes:
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.

So when does C. diff bacteria become problematic and also symptomatic? It’s when C. diff is not kept under control and begins to overgrow. Antibiotics are the most common reason that this can occur since antibiotics not only kill the bacteria they are aiming to kill, but also all the good bacteria as well. Antibiotics that most commonly lead to C diff infections include fluoroquinolones, penicillins, cephalosporins, and clindamycin.

C diff is definitely contagious. Spores from C diff bacteria are passed in the feces and then can spread to food, objects and surfaces when infected individuals do not thoroughly wash their hands after going to the bathroom. If you touch something that has been contaminated with the C diff spores then you may end up unintentionally and unknowingly swallowing the C diff bacteria. Hospitals and long-term care facilities are especially problematic because healthcare workers can unintentionally spread C diff between patients if they do not properly wash their hands after caring for each patient. The other tricky fact about C diff spores is that they can live on objects and surfaces outside of the body for weeks or even months.

Risk Factors:
*Antibiotic use (absolutely the #1 risk factor) especially a broad-spectrum antibiotic or any antibiotic used for an extended period of time

*Hospitalization

*Living in a nursing home or extended-care facility

*Gastrointestinal tract surgery

*Abdominal surgery that requires moving the intestines aside

*Living in a nursing home or extended-care facility

*Colon health issues such as inflammatory bowel syndrome or colorectal cancer

*Having a weakened immune system

*Previous C. diff. infection

*Being 65 years of age or older

Some studies have also shown that stomach acid-reducing drugs, especially proton pump inhibitors or PPIs, may likely play a role in the recurrence of C diff infections.

Diagnosis:

Doctors often suspect C. difficile in anyone with diarrhea who has taken antibiotics within the past two months or when diarrhea develops a few days after hospitalization. In such cases, you’re likely to have one or more of the following tests.

Stool tests:

Toxins produced by C. difficile bacteria can usually be detected in a sample of your stool. Several main types of lab tests exist, and they include:

*Enzyme immunoassay. The enzyme immunoassay (EIA) test is faster than other tests but isn’t sensitive enough to detect many infections and has a higher rate of falsely normal tests.

*Polymerase chain reaction. This sensitive molecular test can rapidly detect the C. difficile toxin B gene in a stool sample and is highly accurate.

*GDH/EIA. Some hospitals use a glutamate dehydrogenase (GDH) in conjuction with an EIA test. GDH is a very sensitive assay and can accurately rule out the presence of C. difficile in stool samples.

*Cell cytotoxicity assay. A cytotoxicity test looks for the effects of the C. difficile toxin on human cells grown in a culture. This type of test is sensitive, but it is less widely available, more cumbersome to do and requires 24 to 48 hours for test results. Some hospitals use both the EIA test and cell cytotoxicity assay to ensure accurate results.

Testing for C. difficile is unnecessary if you’re not having diarrhea or watery stools, and is not helpful for follow-up treatment.

Colon examination:

In rare instances, to help confirm a diagnosis of C. difficile infection and look for alternatives, your doctor may examine the inside of your colon. This test (flexible sigmoidoscopy or colonoscopy) involves inserting a flexible tube with a small camera on one end into your colon to look for areas of inflammation and pseudomembranes.

Imaging tests:

If your doctor is concerned about possible complications of C. difficile, he or she may order an abdominal X-ray or a computerized tomography (CT) scan, which provides images of your colon. The scan can detect the presence of complications such as thickening of the colon wall, expanding of the bowel, or more rarely, a hole (perforation) in the lining of your colon.

Treatment:

The first step in treating C. difficile is to stop taking the antibiotic that triggered the infection, when possible. Depending on the severity of your infection, treatment may include:

Antibiotics. Ironically, the standard treatment for C. difficile is another antibiotic. These antibiotics keep C. difficile from growing, which in turn treats diarrhea and other complications.

For mild to moderate infection, doctors usually prescribe metronidazole (Flagyl), taken by mouth. Metronidazole is not approved by the FDA for C. difficile infection, but has been shown to be effective in mild to moderate infection. Side effects of metronidazole include nausea and a bitter taste in your mouth.

For more severe and recurrent cases, vancomycin (Vancocin), also taken by mouth, may be prescribed.

Another oral antibiotic, fidaxomicin (Dificid), has been approved to treat C. difficile. In one study, the recurrence rate of C. difficile in people who took fidaxomicin was lower than among those who took vancomycin. However, fidaxomicin costs considerably more than metronidazole and vancomycin. Common side effects of vancomycin and fidaxomicin include abdominal pain and nausea.

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.

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

Natural Treatments for Mild C Dif:

1. Stop Antibiotics Whenever Possible

2. Load Up On Good Bacteria
Eat some top probiotic foods that buids up good bacria is 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 you buy a raw variety with the “mother” intact, which means it still contains all its beneficial compounds including probiotics.

3. Avoid or Reduce Certain Foods.
As follows:
*Dairy products have been known to cause additional gastrointestinal upset and lactose intolerance has also been known to occur during a C diff infection.

*Greasy, fatty foods and processed foods that are not easy on the digestive system and may lead to more diarrhea.

*Some foods that are definitely healthy but may cause extra bloating, gas and discomfort such as cruciferous veggies (like broccoli and cabbage), onions, beans, nuts, seeds and whole grains.

*Raw fruits and veggies so cook them to reduce the likelihood of bloating effects

*Processed fat-free foods like Olestra, which have been known to cause more bloating and increased bouts of diarrhea.

*Spicy foods which are known to increase symptoms.

*Large quantities of caffeine since caffeine has diuretic effects, can bother the GI tract and lengthen recovery from infection

4. Thorough Hand Washing

5. Shut the Lid:
Another smart habit to get into if you want to prevent reinfection or the spread of C diff is to close the lid of the toilet before you flush.

6. Consume Natural Antibiotics
As follows:
*Manuka honey

*Raw garlic: Garlic inherently has antimicrobial, antiviral and antifungal properties. For general health promotion for adults, the WHO actually recommends incorporatin

*Oil of Oregano

*Fecal Transplant (Surgical)
The CDC website states, ” Transplanting stool from a healthy person to the colon of a patient with repeat C. difficile infections has been shown to successfully treat C. difficile. These “fecal transplants” appear to be the most effective method for helping patients with repeat C. difficile infections. This procedure may not be widely available and its long term safety has not been established.”

On average, fecal transplantation is said to result in a 91 to 93 percent cure rate while some studies have even shown a 100 percent cure rate when fresh fecal microbiota is used.

*Fecal Transplant (Oral)
If you’re suffering from reoccurring C. difficile infections there is a less invasive fecal transplant option. Recently, successful fecal transplants have been performed by encapsulating healthy freeze-dried fecal matter and having patients ingest the capsules. A 2017 study published in The American Journal of Gastroenterology found that just one administration of the capsules to 49 patients with reoccurring C diff resulted in 88 percent of the patients achieving “clinical success”, which was said to be no recurrence of C diff infection over a two month time period.

Prognosis:
After a first treatment with metronidazole or vancomycin, C. difficile recurs in about 20% of people. This increases to 40% and 60% with subsequent recurrences.

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.

Resources:
https://draxe.com/c-diff/
https://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/drc-20351697
https://en.wikipedia.org/wiki/Clostridium_difficile_infection

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