Clostridium difficile (C. difficile) is a bacterium that is related to the bacterium that cause tetanus and botulism. It represents one of the most common hospital (nosocomial) infections around the world. In the United States alone, it causes approximately three million cases of diarrhea and colitis per year. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants rooms, and diaper pails. They even can be carried by pets. The C. difficile bacterium has two forms, an active, infectious form that cannot survive in the environment for prolonged periods, and a nonactive, noninfectious form, called a spore that can survive in the environment for prolonged periods.

Causes

Healthy people are not usually effected to Clostridium difficile. People who have other illnesses or conditions are requiring use of antibiotics. The result is known as diarrhoea.These infections are at greater risk to elder persons. C. difficile bacteria are found in feces. People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouths or mucous membranes. Health care workers can spread the bacteria to other patients through hand contact.

Unlike some other causes of diarrhoea, it is rare for C. difficile to spread to other parts of the body such as the blood stream.

Many infants and young children, and even some adults, are carriers of C. difficile. C. difficile does not cause colitis in these people probably because the bacteria stay in the colon as non-active spores, and the individuals have developed antibodies that protect them against the C. difficile toxins.

Symptoms

Patients with mild C. difficile colitis may have a -

Low-grade fever

Mild diarrhea (5-10 watery stools a day)

Mild abdominal cramps

Tenderness.

An abnormal heart rhythm

Fever

Sweating

Rapid pulse, and

A sudden drop in blood pressure.

Severe kidney and blood problems

Kidney failure

Treatment

For people with mild symptoms, no treatment is required. The symptoms usually clear up once the patient stops using antibiotics. For severe cases, medication and surgical interventions may be required. Two antibiotics are known to be effective in treatment. Metronidazole taken by mouth is often prescribed as the first choice; if this is not effective then another antibiotic, vancomycin, also taken by mouth, can be tried.

The most common laboratory test for diagnosing C. difficile-mediated disease is an enzyme immunoassay that detects toxins A and B. This test provides results within two to six hours and has a specificity of 93 to 100 percent.

Patients with severe toxicity or unresolved diarrhea may need to have their antibiotic treatment modified to use drugs not known to result in C. difficile diarrhea. If the diarrhea fails to improve within 48 h and a decision is made to treat for C difficile, the agent of choice is oral metronidazole.

Probiotic therapy is an exciting new development in the treatment of recurrent C. difficile. Preliminary clinical studies suggest that these agents may help restore the normal healthy intestinal bacteria and increase resistance to the growth of C. difficile.