C. diff, or clostridium difficile, is a bacterial infection that causes inflammation in the colon and profuse diarrhea. C. diff is a spore-forming and toxin-producing bacteria. It is mostly a nosocomial infection, meaning it is usually acquired in the hospital. Due to the highly infectious nature of the disease, it can spread quickly from one patient to another in hospitals when proper infection control measures are not taken. It is less commonly a community-associated infection, meaning it can be spread in the community among healthy individuals. Risk factors for C. diff infection include hospitalization, age (being over 65 years old), prolonged use of antibiotics, obesity, cancer chemotherapy, and gastrointestinal surgery. Prolonged use of proton pump inhibitors or histamine 2 receptor antagonists for gastric acid suppression, such as for treatment of GERD, has also been linked to a higher rate of C. diff infection.

What Causes C. Diff

C. diff causes colitis, or inflammation of the large intestine, and severe diarrhea by producing two toxins. These toxins activate processes in the cell that damage tissue and cause ulcers on the surface of the intestines. After recovery from an initial infection, symptoms may recur due to residual toxins, although the specific process for disease recurrence is not fully understood. Antibiotic use is the biggest risk factor for C. diff infection because antibiotics disrupt the function of normal bacteria in the colon. There are multiple antibiotics which can cause issues. Similarly, suppression of gastric acid by over the counter medications also increases the risk of C. diff by altering the bacterial colonies in the gut.

Signs and Symptoms of C. Diff

Most cases of C. diff are not severe, and 3 or more episodes of watery diarrhea usually resolves within 24 hours. There may be some abdominal pain and cramping, nausea, loss of appetite, and a low-grade fever. The diarrhea may be bloody. Blood tests may show an increased white blood cell count. A colonoscopy may show an inflamed colon. C. diff is suspected when someone shows these symptoms in the hospital setting or if they have used antibiotics recently. Severe cases of C. diff can present with diarrhea, severe abdominal pain, high fever, dehydration, and decreased blood pressure due to loss of body fluids and widespread inflammation. Severe cases require immediate attention from a surgeon in case the colon tissue is severely damaged. In contrast, some people infected with C. diff may not even know it because they do not develop any symptoms. These are called asymptomatic carriers. Asymptomatic carriers do not need treatment. It is said that up to 20 percent of people who have been hospitalized and up to 50 percent of people in nursing homes have been infected with C. diff.

Treating C. Diff

Since C. diff is spread via bacterial spores from the feces of an infected person, it is very important to prevent transmission by practicing good hand hygiene. Someone who is infected should clean their hands with soap and water, especially after using the bathroom. Hospital staff and visitors visiting someone with C. diff should also wash their hands with soap and water after coming into contact with the infected person so as not to infect themselves and spread the spores on the surfaces they touch. Even if someone does not show symptoms after infection, they can still infect others. However, once infected with C. diff, treatment is necessary. Diagnosis is confirmed by laboratory testing for C. diff in the stool. The first step is to discontinue any antibiotics that may have caused the C.diff. If the person is severely dehydrated from diarrhea, they must be given fluid through an IV. If the case is not severe, there are antibiotics that can be used to treat C. diff. Usually 10 days of treatment are needed. Another option is fecal transplant, in which fecal material from a healthy person is transferred to the infected person. Finally, very severe cases may require surgery, when parts of the colon are so damaged that they must be removed surgically.