Clostridium difficile (C. diff) bacteria exists invisibly all around us. It’s in the water, air, soil as well as human and animal feces. It can also be found in the human intestines, although many people never suffer from any symptoms.
The most common reason why people experience negative symptoms from C. Diff is through taking antibiotics. While antibiotics kill off harmful bacteria, they also kill off the good bacteria, or probiotics. Consequentially, this disrupts the balanced microbiome of GI tract and allows C. diff to proliferate rapidly. As colonies of C. diff grow in the colon, the intestinal lining may become inflamed, resulting in colitis and the symptoms below.
C. diff Symptoms
Signs and symptoms of a mild C. diff infection include:
- Watery stools or diarrhea at least three times per day for a period of two or more days
- Moderate stomach cramps and tenderness
Signs and symptoms of a severe C. diff infection include:
- Watery stools or diarrhea between ten and fifteen times a day
- Severe stomach cramps
- Increased heart rate
- Pus or blood in the stool
- Loss of appetite
- Weight loss
- Increased white blood cell count
- Kidney failure
If you are suffering from a severe case of C. diff, you may need to be hospitalized if you are dehydrated and your colon has become inflamed.
C. diff Causes and Risk Factors
- diff bacteria are often spread through hospitals or nursing homes. In these cases, health workers are more likely to come into contact with it than patients or residents are. You may contact C. diff through person-to-person contact, or if you touch sheets, clothing or surfaces which have come into contact with feces, and then your touch your nose or mouth.
People who are most at risk of C. diff infection include:
- People aged 65 or over
- People with a compromised immune system
- Those who are hospitalized and/or are being treated with a course of antibiotics
C. diff Diagnosis
The exact incubation period for C. diff is not known, but medical experts believe that it is about seven days providing the conditions are favorable for the bacteria to grow. However, a person may acquire the bacteria without experiencing any symptoms and carry the bacteria until an infection develops.
If your doctor suspects you have a C. diff infection, then he or she will recommend one or more of the following tests.
- Stool tests: diff bacteria release toxins which can be detected in a stool sample.
- Colon examination: In certain cases, your doctor may recommend a colonoscopy to examine areas of inflammation the colon.
- Imaging tests: Your doctor may order imaging tests if he or she is concerned about possible complications of diff. This assessment may include computerized tomography (CT) scan or an abdominal X-ray. These tests can detect such complications as a perforation in your colon, expanding bowel, or a thickening of the colon wall.
C. diff Treatment
The first treatment step is, if possible, to stop taking the antibiotic that triggered the C. diff infection. Standard treatments include:
Antibiotic: The two main antibiotics are metronidazole and vancomycin. Both are bacteriostatic which keeps the diff bacteria from growing. If the infection is mild, your doctor will usually prescribe metronidazole (Flagyl). Although this antibiotic is not FDA approved for C. difficile infection, it has been shown to be an effective treatment in mild to moderate cases. For more severe or recurrent bouts of C. difficile infection, vancomycin (Vancomycin) is used.
- Fidaxomicin is a bacteriocidal antibiotic which actually kills C diff. It has a narrower spectrum of activity compared to metronidazole and vancomycin so it disrupts normal gut flora less. In one study comparing fidaxomicin with vancomycin found that cure rates were similar and that reoccurrence rates with fidaxomicin were lower compared to vancomycin. However, the reoccurrence rate was not better when the patient was infected with hypervirulent strains of C diff.
- Rifaximin is an antibiotic that is usually used in conjunction with traditional antibiotics for C diff. One study found that taking a two week course of rifaximin after the last course of vancomycin prevented reoccurences of C diff. However, taking repeated courses of rifaxmin has been noted to cause C diff to become resistant to rifaxmin
- Surgery: If you have experienced severe pain, inflammation of the colon lining, toxic megacolon, or organ failure because of difficile infection, you will need surgery to remove the diseased section of the colon.
Fecal Microbiota Transplant (FMT)
- A fecal transplant involves taking fecal bacteria from a healthy person and transplanting it into a recipient. This process may be used during or after a diff infection, to restore healthy colonic microflora. There are several methods for fecal transplantation:
- Enema: patients are given an enema containing stool from a healthy donor. With an enema, probiotics can only reach the distal part of the large intestine.
- Colonoscope: The transplant is performed using a colonoscopy. A colonoscope is inserted through the rectum and the colon is irrigated with liquefied donor fecal material. The advantage of FMT performed via colonoscope is that it allows for inspection of the colon at the same time the procedure is performed. It can also reach the end of the small intestine where C diff can reside.
- Oral: The transplant is performed using an oral capsule containing freeze-dried fecal matter. One study comparing the efficacy of colonoscope FMT with FMT via capsules in 116 patients randomized to either found that rates of prevention of recurrent C diff infection were 96 percent in both groups.
Some researchers have started to combine cultured intestinal bacteria along with probiotic pills to treat C diff infection. A cultured intestinal bacteria synthetic stool containing 33 different intestinal bacteria was able to cure C diff in two patients who failed antibiotic therapy multiple times. A follow up study found that the cultured intestinal bacteria was present in 25% of the patients’ bacterial population. Fecal transplant remains the only method providing lasting transplantation of probiotics into individuals with C diff. However, there is a role for traditional over the counter probiotics as an adjunct to traditional treatment C diff treatments.
Probiotics for C. Diff
Meta-studies have shown that probiotics are able to prevent C diff associated diarrhea (CDAD). An analysis of 20 randomized studies found that probiotics reduced CDAD by 66%. Another review of 19 randomized studies found that probiotics reduced CDAD by 58%. Probiotics come in many different strengths and strains. However, only certain strains and strengths have demonstrated efficacy for CDAD: Lactobacillus acidophilus, Lactobacillus casei, Saccharomyces boulardii, and Lactobacillus rhamnosus. Doses greater than 10 billion CFUs per day may also be more effective.
Lactobacillus rhamnosus: One of the most widely used probiotic strains, Lactobacillus rhamnosus is well documented for its ability to relieve GI infections and diarrhea. Its other benefits include supporting a healthy urinary tract and immune support.
Lactobacillus acidophilus is a strain of lactic acid bacteria which lives in the human stomach and intestines. It can promote recovery from diarrhea, particularly in young children at a dose greater than 10 billion CFUs per day.
Lactobacillus casei is found in the human intestines and mouth. It is often used in the manufacture of cheese and yogurt and for fermenting green olives. This probiotic supports intestinal functions.
Saccharomyces boulardii: This probiotic yeast has been shown to be effective for the treatment of diarrhea as well as a number of other gastrointestinal disorders which cause inflammation. It also helps restore healthy gut flora.
After Infection: C. difficile Precautions and Natural Alternatives
If you have already suffered a C. diff infection, you can reduce the risk or recurrence by making some simple lifestyle changes. The place to start is your diet.
Naturally Probiotic Rich Foods
As discussed earlier, Clostridium difficile is a disease that results from the disruption of natural flora and the lack of probiotics. Add these probiotic rich foods to your diet to support the natural flora in your gut.
Prebiotics are types of food or food ingredients which help promote the growth of beneficial bacteria in the GI tract. They nourish beneficial bacterial and help them thrive. Prebiotics consist of indigestible plant fibers, also known as oligosaccharides. As they pass through the stomach without being affected by stomach acid, prebiotics stimulate beneficial changes throughout the digestive tract by providing nutrient sources to beneficial bacteria that live in the gut and intestines. Along with probiotics, prebiotics play an important role in supporting digestive and immune health. Natural sources of prebiotics include:
- Chicory root
- Cooked or raw onions
- Raw jicama
- Jerusalem artichokes
Avoiding C Diff Infection
With the right hygiene practices and supplementing your diet with probiotics and prebiotics, it’s relatively easy to keep C. difficile at bay. When you take antibiotics, be sure the take a high quality multi-probiotic with a dose > 10 billion CFUs.
It is not very common for people who are not taking a course of antibiotics to become infected with C. difficile, but it is still very important to avoid spreading the bacterial spores. You will continue to be infectious as long as you are still having diarrhea. Following these hygiene practices will help you avoid spreading C diff.
- Hand washing: You should wash your hands each time you have used the bathroom and before meals. Wash hand properly by wetting them with water and using soap. Rub your hand together for about 30 seconds. Pay special attention to between the fingers and the fingernails. Alcohol-based hand rubs are not effective against difficile
- Contact Precautions: If you are hospitalized with difficile, you will most likely be placed on contact precautions. This means that anyone who enters your room must wash their hands before they enter and after they leave. Visitors must also cover their clothes with a gown and wear gloves. Back at home and work, person-to-person infection is rare but is still possible as the C diff spores are very resilient. We recommend using bleach wipes to sanitize surfaces such as door knobs and toilet seats.
Many people who contract C. difficile pick it up in a hospital or nursing home. Usually, sufferers are also taking a course of antibiotics. Though a different form of antibiotics is given to treat an infection, it often recurs a second or third time. You can reduce your risk of infection or reinfection by using appropriate hygiene practices, modifying your diet, and taking a daily probiotic, to support a healthy GI tract and to strengthen your immune system.