C. diff (C. difficile Colitis) Treatment, Symptoms & Transmission

Facts you should know about C. diff (C. difficile colitis)

Bacterial Infection The symptoms of C. difficile colitis are fever, diarrhea, and abdominal pain.

Clostridium difficile colitis (C. difficile Colitis, C. diff) is an infection of the colon by the bacterium, Clostridium difficile (C. difficile ).
C. difficile causes colitis by producing toxins that damage the lining of the colon.
The symptoms of C. difficile colitis are fever, diarrhea, and abdominal pain.
Serious complications of C. difficile colitis include dehydration, rupture of the colon, and spread of infection to the abdominal cavity or body. Severe infection is life-threatening.
The most common cause of
C. difficile colitis is treated with antibiotics. The antibiotics are believed to suppress normal colonic bacteria that usually keep C. difficile from multiplying and causing colitis.
Most cases of C. difficile colitis occur in patients in the hospital, but the number of cases that occur among individuals not having been in or recently discharged from the hospital has increased greatly.
The primary means of diagnosing
C. difficile colitis is by testing for the bacterial toxins in samples of stool.
The treatment of C. difficile colitis is with antibiotics, primarily vancomycin and metronidazole. Up to 10% of patients do not respond to a course of one of the antibiotics and require retreatment, more prolonged treatment, or treatment with a different antibiotic. Ten to 20 percent of patients who are successfully treated by their first course of antibiotics have a relapse of the colitis after the antibiotics are stopped.
Among patients who relapse, additional treatment with antibiotics is less successful than the initial treatment in permanently curing the colitis, and multiple relapses in these patients are common.
Among the treatments for multiple relapses of C. difficile colitis, a widely studied and effective treatment is the transplantation of fecal bacteria from relatives or stool banks.

What is Clostridium difficile (C. difficile)?

Clostridium difficile (C. difficile) is a bacterium that is related to the bacteria that cause tetanus and botulism. The C. difficile bacterium has two forms, an active, infectious form that cannot survive in the environment for prolonged periods, and an inactive, "noninfectious" form, called a spore, that can survive in the environment for prolonged periods. Although spores cannot cause infection directly, when they are ingested they transform into the active, infectious form.

C. difficile spores are found frequently in:

hospitals,
nursing homes,
extended care facilities, and
nurseries for newborn infants.

They can be found on:

bedpans,
furniture,
toilet seats,
linens,
telephones,
stethoscopes,
fingernails,
rings (jewelry),
floors,
infants' rooms, and
diaper pails.

They even can be carried by pets. Thus, these environments are a ready source for infection with C. difficile.

What causes Clostridium difficile colitis?

Antibiotic-associated (C. difficile, C. diff) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using Why Are Men More Prone to Cancer?

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What are treatment options for relapses of Clostridium difficile colitis?

Treatment options for relapses of C. difficile colitis include:

A second course of the same or a different antibiotic, primarily vancomycin or fidaxomicin
Six weeks of treatment with decreasing doses of antibiotics
An oral resin by mouth such as cholestyramine (Questran) that binds toxins and inactivates them
Non-pathogen (harmless) yeast by mouth such as Saccharomyces boulardii, for example, Florastor

Doctors usually treat patients who relapse with another 10-14-day course of metronidazole or vancomycin, and a majority of the patients so treated will recover. Nevertheless, some patients will have another relapse. Treatment options for multiple relapses include:

Treatment with one of the options listed above that has not already been tried.
Vancomycin for 6 weeks in decreasing doses (125 mg four times a day for 1
week, three times a day for another week, twice a day for another week and so
on), followed by 4 weeks of cholestyramine (Questran).
Two weeks of
vancomycin or metronidazole along with 4 weeks of S. boulardii (Florastor).
Fecal microbiota (bacterial population) transplants are becoming more common for relapsing patients because of the great success rates. Feces from non-infected donors are made into a suspension. The source of the transplanted fecal microbiota can be healthy family members, acquaintances or from stool banks. The fecal microbiota may be given by enema or by colonoscopy inserted into the rectum, by a feeding tube inserted through the mouth or nose into the upper small intestine, or by way of frozen capsules taken by mouth. The normal bacteria from the donor's stool displaces the C. difficile bacteria.
Passive immunizations with human gammaglobulin has been tried, but has not been demonstrated to be consistently effective. The theory is that patients with multiple relapses typically have low levels of antibodies to C. difficile toxins. By giving patients who relapse gammaglobulin. containing large amounts of antibodies to C. difficile toxins, the patients' levels of antibody to C. difficile toxins are increased. Pooled human gammaglobulin can be administered intravenously. However, this treatment is neither approved nor recommended.
Active vaccination for C. difficile toxins. Vaccination can increase a patient's levels of antibodies to C. difficile toxins. This is a new treatment that has not become widely available.

What is new in C. diff?

The prevalence of C. difficile infection has been increasing steadily particularly in the elderly. There have been reports from several hospitals of a newer, more virulent strain of C. difficile bacteria that produces large amounts of both toxins A and B and as well as a third toxin. This strain produces more severe colitis than the usual strains. Patients infected by this strain are more seriously ill, require surgery more frequently, and die from the infection more frequently than patients infected with the usual strains. Currently, the commercially available diagnostic tests cannot distinguish this strain from the usual strains.

Traditionally, antibiotic use is often considered the most important factor for the development of C. difficile colitis. Increasingly though doctors are diagnosing C. difficile colitis in patients without previous antibiotic exposure. This is especially true in patients with Crohn's disease or ulcerative colitis. In one study of 92 patients with ulcerative colitis and Crohn's disease relapse, 10 patients tested positive for C. difficile. Another change that is occurring with C. difficile infection is that it is no longer restricted to patients in hospitals or nursing homes. A study of data from 2009 through 2011 found community-associated C. difficile infections represent about one third of all C. difficile colitis cases. Traditionally, antibiotic use is often considered the most important factor for the development of C. difficile colitis, but in this study, 36% of the patients had not been treated with antibiotics.

Doctors are witnessing increasing difficulty in treating C. difficile colitis. Firstly, resistance to metronidazole is on the rise. Secondly, colitis (along with symptoms of diarrhea and cramps) is taking longer to resolve and may require higher doses of vancomycin. Thirdly C. difficile colitis relapse (with recurrent diarrhea) is common. More troublesome still, many patients experience multiple relapses, often requiring prolonged (months) antibiotic (such as vancomycin) treatment.