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Clostridium Difficile: Symptoms & Treatment

Instructor: Thomas Higginbotham

Tom has taught math / science at secondary & post-secondary, and a K-12 school administrator. He has a B.S. in Biology and a PhD in Curriculum & Instruction.

Clostridium difficile, or C. diff as it is commonly called, is an intestinal bacterium that occurs normally in humans. It becomes a problem when it has an overgrowth, creating mild to severe GI issues. Learn about this illness and treatment in this article.

The Road to Hell

'The road to hell is paved with good intentions.' While this is probably one of the most overused phrases in the English language, an uncomfortable intestinal illness that comes from an overabundance of the bacterium Clostridium difficile is an instance where the phrase fits.

Clostridium difficile, or C. diff as it is known more commonly in medical communities, is a gram-positive bacterium that is one of the hundreds of bacteria that normally occur in the human digestive tract - along with Escherichia coli and Lactobacillus. These bacteria are known collectively as the intestinal microflora. Under normal circumstances, C. diff is one of the good guys, a bacterium working with the body's digestive enzymes to break down food's nutrients, making them usable to the body and absorbable into the bloodstream.

However, when conditions cause the intestinal microflora to get out of whack, individual bacterial species can dominate the population, causing all kinds of problems in there. C. diff is notorious for flaring up and causing problems. This often occurs when people are on extended courses of antibiotics having other illnesses treated (thus, the 'road to hell' analogy).

Scanning electron micrograph of C. diff in a stool sample
Clostridium difficile

Symptoms of a C. diff Illness

Like many Clostridium bacteria, C. diff releases toxins. Theirs attack and degrade the intestinal lining during infection. While nowhere near as toxic as some of its 'cousins' (e.g., C. botulinum and C. tetani), C. diff is markedly more prevalent and causes problems for many more people.

Mild cases of C. diff illness result in mild watery diarrhea, cramping, and intestinal discomfort. Mild cases often resolve with treatment. More severe cases of C. diff illness may include more intense watery diarrhea up to 15 times daily, severe abdominal pain, fever, blood or pus in the stool, and loss of appetite and weight loss. Resulting severe dehydration can be fatal if untreated. Untreated, C. diff can also eat a hole in the lining of the intestine, which can be acute and fatal if left untreated.

One of the problems with C. diff is that in some people, once they have an infection it can be difficult to fully resolve. Recurrent infections are common, often resulting in more aggressive treatments. People at risk for C. diff infections include those who have been on long-term antibiotic treatments, are older or have otherwise compromised gastrointestinal conditions. Chemotherapy patients are often at risk as well.

Treatments for C. diff Illness

Several effective treatments exist for C. diff, including antibiotics, probiotics, dietary modifications, and one other notable treatment that will be described at the end of this section.

Ironically, since the extended use of antibiotics are very often the cause for a C. diff illness, the first round of treatment for C. diff is usually stopping the original antibiotic, and using a different antibiotic, where it is clinically feasible to do so. In about 20% of cases, antibiotics are unsuccessful and a second round of antibiotics is prescribed.

Probiotics are often used as well, especially to prevent recurrence in patients. Probiotics are essentially an infusion of healthy microflora into the intestinal tract.

Severe instances of infection may require hospitalization and the use of intravenous fluids to keep the patient hydrated.

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