Clostridium difficile (C diff)
What is Clostridium difficile (C diff)?
Cases of C. diff picked up by patients in hospitals have been falling thanks to better hygiene controls.
Clostridium difficile infection is still a major cause of hospital-acquired diarrhoea.
C. diff is a bacterium that is related to the bacteria that cause tetanus and botulism. The C. diff bacterium has two forms, an active, infectious form that cannot survive in the environment for prolonged periods, and a non-active, "non-infectious" 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. diff spores are found frequently in hospitals, nursing homes, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linen, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and nappy bins. So, these environments are a ready source of infection with C difficile.
How does C difficile cause infection?
C difficile spores are present in the colon in about 3 in 100 healthy adults and around 2 out of 3 healthy children. They may be acquired by person to person transmission on contact with spores on surfaces in contaminated environments, especially healthcare settings. They usually lie dormant inside the colon until the person takes an antibiotic. The antibiotic disrupts the other bacteria that normally live in the colon and which prevent C difficile from transforming into its active, disease causing bacterial form. As a result, C difficile transforms into its infectious form and then produces toxins (chemicals) that inflame and damage the colon. The inflammation results in an influx of white blood cells to the colon. The severity of the infection can vary. In the more severe cases, the toxins kill the tissue of the inner lining of the colon, and the tissue falls off.
Not everybody infected with C difficile develops infection. Many infants and young children, and even some adults, are carriers (they are infected but have no symptoms) of C difficile. C difficile does not cause infection 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.
What are the symptoms of C difficile infection?
Patients with mild C difficile infection may have a low-grade fever, mild diarrhoea (5-10 watery stools a day), with mild abdominal cramps and tenderness. Patients with severe C difficile infection may have a high fever (temperature of 39-40 Celsius (102-104 degrees Fahrenheit), severe diarrhoea (more than 10 watery stools a day) with blood, and severe abdominal pain and tenderness. Severe diarrhoea also can lead to dehydration and disturbances in the electrolytes (minerals) in the body. Rarely, severe infection can lead to life threatening complications such as megacolon (markedly dilated colon), perforation of the colon and peritonitis (inflammation of the lining of the abdominal cavity).