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What do you know about Clostridium Difficile? How long can you have it before you get diagnosed?
How hard is it to get rid of? Mmm

never heard of it. what is it?

Gary S
Clostridium difficile, or C. difficile (a gram-positive anaerobic bacterium), is now recognized as the major causative agent of colitis (inflammation of the colon) and diarrhea that may occur following antibiotic intake. C. difficile infection 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. This bacterium is primarily acquired in hospitals and chronic care facilities following antibiotic therapy covering a wide variety of bacteria (broad-spectrum) and is the most frequent cause of outbreaks of diarrhea in hospitalized patients. One of the main characteristics of C. difficile-associated colitis is severe inflammation in the colonic tissue (mucosa) associated with destruction of cells of the colon (colonocytes).

The disease involves, initially, alterations of the beneficial bacteria, which are normally found in the colon, by antibiotic therapy. The alterations lead to colonization by C. difficile when this bacterium or its spores are present in the environment. In hospitals or nursing home facilities where C. difficile is prevalent and patients frequently receive antibiotics, C. difficile infection is very common. In contrast, individuals treated with antibiotics as outpatients have a much smaller risk of developing C. difficile infection. Laboratory studies show that when C. difficile colonize the gut, they release two potent toxins, toxin A and toxin B, which bind to certain receptors in the lining of the colon and ultimately cause diarrhea and inflammation of the large intestine, or colon (colitis). Thus, the toxins are involved in the pathogenesis, or development of the disease.

Transmission Factors - An important characteristic of C. difficile-associated diarrhea and colitis is its high prevalence among hospitalized patients. Thus, C. difficile contributes significantly to hospital length of stay, and may be associated in some elderly adults with chronic diarrhea, and occasionally other serious or potentially life-threatening consequences. One study demonstrated that 20% of patients admitted to a hospital for various reasons were either positive for C. difficile on admission or acquired the microorganism during hospitalization. Interestingly, only one-third of these patients developed diarrhea while the remainder were asymptomatic carriers serving as a reservoir of C. difficile infection. The organism and its spores were also demonstrated in the hospital environment, including toilets, telephones, stethoscopes, and hands of healthcare personnel.

While patient-to-patient spread and environmental contamination can be some of the reasons of cross-infection in C. difficile-associated diarrhea and colitis, antibiotic therapy is the major risk factor for this disease. Thus, antibiotic use only when necessary is the most effective measure of preventing C. difficile infection.

Clinical Features - A wide range of conditions is associated with C. difficile infection. Most cases develop 4 to 9 days after the beginning of antibiotic intake. It should be noted, however, that some patients develop diarrhea after antibiotics are discontinued and this may lead to diagnostic confusion. Although nearly all antibiotics have been implicated with the disease, the commonest antibiotics associated with C. difficile infection are ampicillin, amoxicillin, cephalosporins, and clindamycin.

The most common presentation is either mild colitis, or simple diarrhea that is watery and contains mucus but not blood. Examination by sigmoidoscopy usually reveals normal colonic tissue. General symptoms are commonly absent and diarrhea usually stops when antibiotics are discontinued. C. difficile can also cause non-specific colitis quite reminiscent of other intestinal bacterial infections such as Shigella or Campylobacter. This is a more serious illness than simple antibiotic-associated diarrhea; patients experience watery diarrhea 10 to 20 times a day and lower, crampy abdominal pain. Low-grade fever, dehydration, and non-specific colitis are common manifestations.

Pseudomembranous colitis represents the characteristic manifestation of full-blown C. difficile-associated colitis. Sigmoidoscopic examination reveals the presence of characteristic plaque-like pseudomembranes, scattered over the colonic tissue. The presence of these plaques is a distinctive indicator of C. difficile infection in patients with diarrhea following antibiotic treatment.

The most serious manifestation of C. difficile infection, fulminant colitis (severe sudden inflammation of the colon), is frequently associated with very serious complications. This can be a life-threatening form of C. difficile infection and occurs in 3% of patients; most are elderly and debilitated from other diseases. Patients with this form of the disease experience severe lower abdominal pain, diarrhea, high fever with chills, and rapid heart beat. Timely treatment of fulminant colitis is essential; this condition can be life threatening.

C. difficile infection in patients with other intestinal diseases - It is well documented that C. difficile may complicate the course of ulcerative colitis or Crohn's disease and it is responsible for 4 to 12% of diarrhea in AIDS patients. In this case, patients develop the typical symptoms of C. difficile colitis, including diarrhea, abdominal pain, and fever reminiscent of exacerbation of inflammatory bowel disease. The reason for this complication is not entirely clear. It may be that the frequent hospitalizations and exposure to antibiotics of patients with inflammatory bowel disease or AIDS places them at increased risk for the infection. So far there is no evidence to indicate that C. difficile can complicate the symptoms associated with irritable bowel syndrome (IBS).

Laboratory Diagnosis - The laboratory diagnosis of C. difficile infection is primarily related to the demonstration of C. difficile toxins in the stool of suspected patients. The detection of C. difficile toxins in the stool can be made by a laboratory test (cytotoxicity assay) where the toxins can be easily observed in the microscope. This tissue culture assay is considered the gold standard because of its high sensitivity and specificity. Since there is no correlation between levels of C. difficile toxins in the stool and severity of the disease, the results are reported simply as "positive" or "negative." However, time is a drawback of this assay since it requires 24 to 48 hours to read the results.

Over the past few years several rapid tests that take just a few hours, and which do not require specialized personnel to run, have been developed (immuno-enzymatic assays) for the detection of C. difficile toxins in the stool. These tests are commercially available in the form of diagnostic kits. Although they are relatively less sensitive and demonstrate lower specificity compared to the laboratory tests, they are very useful not only in the every day practice when specialized personnel is not available, but also in emergency situations and in rapid screening of patients during spreading of the disease in hospitals.

Therapy - Therapy of C. difficile is directed against eradication of the microorganism from the colonic microflora. No therapy is required for asymptomatic carriers. In noncomplicated patients with mild diarrhea, no fever, and modest lower abdominal pain, discontinuation of antibiotics (if possible) is often enough to alleviate symptoms and stop diarrhea. When severe diarrhea is present and in cases of established colitis, the patients should receive the antibiotics, metronidazole or vancomycin, for 10 to 14 days. Several clinical trials have shown that these antibiotics are equally effective in cases of mild to moderate C. difficile infection and more than 95% of patients respond very well to this treatment. Diarrhea following treatment with either vancomycin or metronidazole is expected to improve after 1 to 4 days with complete resolution within 2 weeks. However, some patients do not respond despite aggressive medical therapy and require surgical intervention.

Therapy for relapsing C. difficile infection - Although C. difficile infection usually responds well to treatment with metronidazole or vancomycin, approximately 15 to 20% of patients will experience re-appearance of diarrhea and other symptoms weeks or even months after initial therapy has been discontinued. The usual therapy for relapse is to repeat the 10 to 14 day course of either metronidazole or vancomycin and this is successful in most patients. However, a subset of patients continues to relapse whenever antibiotics are discontinued and this represents a therapeutic challenge. Some authorities recommend switching to the alternative antibiotic from the one used initially. A variety of other therapies have also been described for relapsing disease. It is hoped that development of vaccines against C. difficile toxins may someday control the problem of C. difficile infection in hospitals.

You can have it for a while and not get it diagnosed but you would be pretty sick then. To get rid of it you just need to use the metronidizole tablets.

c diff often lives in our guts naturally. it can overpower our system if we are very ill, become infected by another source, or use certain meds. get to a doctor if you have diarrhea that cannot be treated with Immodium. you are in danger of losing too much fluid.
the incubation time for the illness can be up to 4 mos. be sure to wash every surface down in your home, change bedding, and keep clean so as not to transmit it to others.

Neil L
Healthcare associated infections — illnesses you acquire during a stay in a hospital or longterm care facility — aren't new. But in recent years, the infections have reached epidemic proportions in hospitals and nursing homes around the world. One of the most widespread and potentially serious of these illnesses is caused by the bacterium Clostridium difficile, often simply called C. diff or C. difficile.

Refer to the link below for details.

It is a spore forming gram positive rod that is in the Gastrointestinal tract of many people. When they are treated with oral broad spectrum antibiotics sometimes all that is left is the C. diff. which then colonizes and takes over.
The infection causes massive diarrhea. It is very difficult to treat, hence the name. You can have it for a long time prior to diagnosis, as it may not be causing symptoms. It also has a characteristic smell, I can acutally diagnose a C. diff. infection before the lab can. Kind of a gross skill.

what's her name
C-diff is prettycontagious; patients who have it are put on isolation...usually, if someone has persistent diarrhea, they will send a stool sample down to the lab to get it checked...I'm not sure how hard it is to get rid of, however, but I'm sure with proper treatment and precautions it can be erradicated without too much trouble.

Clostridium Difficile is a bacteria that naturally lives in everyone's intestines. We all always have it. C-diff works to break down food along with many other bacteria in the intestines (like e-coli). Normally there is a balance between all these bacteria, and we remain asymptomatic.

Occasionally, something causes c-dff, or other bacteria to reach an unhealthy level. It may not be that c-diff multiplies more. It could be that another bacteria's level decreases. C-diff has a waste product that is slimy, and smells awful. This slime causes loose, foul odored stool (aka stinky diarrhea). That is often the first clue of a c-diff infection. I microbiological testing of a stool sample is the diagnostic tool for c-diff. It takes approx 48 hours for a lab to check for c-diff growth. Just like any illness that causes diarrhea, dehydration, electrolyte imbalance, and weakness are the symptoms that cause someone to seek treatment. The time between becoming symptomatic and seeking treatment varies by how strong the patient is, how well nourished they can remain, and how long they're willing to put up with a really smelly case of slimy liquid stool. Of course, if they are very young, very old, or unable to keep there fluid levels up, the dehydration and electrolyte imbalances can cause enough weakness for the person to faint or become unconscious. Then an ambulance brings them to an emergency room for treatment. Untreated, c-diff will usually result in severe cramping and bloody diarrhea. That usually gets a person's attention enough to make them seek treatment.

Symptomatic c-diff infection can be caused by antibiotic use that kills off competing bacteria, or by ingesting c-diff spores. The spores can live up to 30 days on surfaces outside the body. Most cases of c-diff are caused by inoculation through the fecal-oral route.

Treatment for c-diff is usually the antibiotic metronidizole... which is relatively cheap. If that doesn't work the next antibiotic used for treatment is vancomycin.

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