Clostridium Difficile Diarrhea

Clostridium difficile diarrhea is a very dangerous condition. Being diagnosed at the right time can save the life of those who have it. Find out more in this article!

When we talk about Clostridium difficile diarrhea , we are referring to a type of diarrhea associated with hospitalizations. It is much more common in people who have spent some time in the hospital  than in the rest of the population.

For adults, it is the most common cause of nosocomial diarrhea, that is to say intra-hospital diarrhea, specific to those who have spent a time in clinics or hospitals. And the death toll associated with this infection is very significant.

Clostridium difficile diarrhea is caused by a very resistant microorganism. This bacterium can survive in the environment for a long time, retaining its capacity for infection.

Part of the resistance of this bacteria comes from its ability to form spores. Spores are survival forms of bacteria to resist aggressive environmental conditions.

Clostridium difficile diarrhea is a fecal-oral route of infection . Infected patients shed bacteria through their stool and, due to poor hygiene, disperse the microorganism, which ends up in the mouths of other patients.

Clostridium difficile survives in hospitals and clinics thanks to its ability to form spores.  It is found on furniture in health centers, surgical instruments and staff uniforms.

Risk factors for Clostridium difficile diarrhea

The main risk factor for Clostridium difficile diarrhea is being hospitalized. This is not, however, the only condition that must occur for infection to occur.

Among the risk factors that are associated with the disease because of this bacteria, we have:

• Having received antibiotics:  When a person is admitted to hospital for a cause that requires the use of antibiotics, Clostridium difficile infection is favored.
• Chemotherapy:  Oncology patients who take chemotherapy are more likely to get this diarrhea.
• High-risk hospitalization:  Among patients, the risk is higher among those in intensive care units.
• Age:  there have been more cases in people over 64 years old.
• Immunosuppression:  Patients with a deficiency in their defenses, due to the condition they are suffering from or the drugs they are taking, are at risk of Clostridium difficile diarrhea . These patients usually stay in the hospital for a very long time because of their immunosuppression.
• Undergo endoscopic procedures:  when hospitalization is combined with an invasive procedure – digestive endoscopy, for example – the risk increases. Instruments for endoscopy may carry Clostridium difficile spores .

Clinical forms

Clostridium difficile diarrhea does not always manifest itself the same way. Depending on its severity and the presence or absence of certain symptoms, certain clinical forms of the disease have been established:

• Carrier of the bacteria:  some people are colonized by Clostridium difficile without having diarrhea. In general, these are patients who have experienced a relatively prolonged hospital stay.
• Colitis-free: It  is estimated that a quarter of people who take antibiotics for an extended period of time develop Clostridium difficile diarrhea without additional symptoms. We only see diarrhea, without abdominal pain and fever.
• Non-pseudomembranous colitis:  in this case, the diarrhea is intense and can go up to 15 bowel movements in a day. Usually there is fever, abdominal pain, and blood in the stool. If not treated in time, it leads to dehydration, with the attendant danger.
• Pseudomembranous colitis:  It looks very similar to the previous one clinically, with the same symptoms, but has a different morphology. It is diagnosed when a patient is given a colonoscopy during their infectious setting. In this study, we visualize the yellow membranes stuck to the large intestine.
• Fulminant: This  is the most extreme and dangerous form of Clostridium difficile diarrhea. It is associated with an entity called toxic megacolon: the large intestine becomes excessively tense and paralyzed. A patient with fulminant colitis has a high chance of dying (9 out of 10 cases).

Treatment of Clostridium difficile diarrhea

Once Clostridium difficile diarrhea is diagnosed through endoscopy, serology or cultures, it is treated. In addition to supportive measures to prevent dehydration, antibiotics are used.

One cannot use just any antibiotic for treatment  because diarrhea can come from any of them, as we have seen. Those that are used and have proven their effectiveness are vancomycin and fidaxomicin.

An alternative option is to use metronidazole. However, this choice is reserved for cases where vancomycin and fidaxomicin are not available. This first diagram mentioned is the one that should be used as a priority.

At a second level, for extreme cases with high risk, one must perform colon surgery. The process involves removing the part of the large intestine that is affected by yellow plaques or toxic megacolon.

As you can see, this is a dangerous and serious disease. Professionals in hospitals and clinics are attentive to it and monitor it in certain patients. With timely treatment, the risk of death from this disease can be reduced.