Last week we talked about C. Difficile, what it is, and how contagious it is. This week I want to explore the signs, symptoms, and complications it can cause. I also want to examine some promising new research and methodologies that are emerging in treating it.
What are the signs and symptoms of C. Difficile?
C. Difficile bacteria release a toxin in the large intestine or colon that causes inflammation, known as colitis. This inflammation or colitis can cause diarrhea which can range from mild to life-threatening. Mild cases of watery diarrhea are defined as three or more times a day for several days which can be accompanied by abdominal cramps. More severe C. Difficile infection can include watery diarrhea for up to 15 times /day with severe abdominal pain, and may contain blood or pus in the stool. Fever, dehydration, and weight loss may also occur.
When do the symptoms start?
Typically the symptoms begin 4 to 10 days after you start taking antibiotics that kill off the naturally occurring bacteria that protect us from C. Difficile. Sometimes the symptoms may not start until after a few weeks after you stop taking antibiotics.
Are the complications from C. Difficile infections?
Yes, and the complications for C. Difficile infections can be very serious and life threatening especially for the elderly. One of the most common complications is dehydration as diarrhea can lead to significant loss of fluids and electrolytes. This loss of fluid can cause the blood pressure to drop to dangerously low levels. Rapid onset of dehydration can also adversely affect kidney function.
Another complication is toxic megacolon, a condition where the colon is unable to expel gas and stool. The colon becomes greatly extended (megacolon), and if left untreated, it can rupture. Once the colon ruptures, bacteria enter the abdominal cavity, which requires emergency surgery. This condition may be fatal. If C. Difficile is left untreated, even mild to moderate C. Difficile infections can quickly progress to death.
When do you consult with a doctor?
If you have recently been on antibiotics, and have experienced mild diarrhea of three times per day, often accompanied with abdominal cramping over a period of a couple of days, call your doctor. Do not delay, as frequent watery diarrhea can very quickly lead to dehydration.
Your doctor will obtain a stool sample because the toxins produced by C. Difficile bacteria can be detected in a sample of your stool. A lab will confirm the C. Difficile infection.
What is the treatment for C. Difficile?
Ironically the most common treatment for C. Difficile is more antibiotics which treat the diarrhea and other complications. Doctors often prescribe Flagyl which has shown to be effective in treating mild to moderate C. Difficile infection. For more severe or recurring infections, vancomycin antibiotic is prescribed. If you are on one of the antibiotics that has triggered the infection the doctor will order that you discontinue this antibiotic.
In conjunction with antibiotics some doctors are recommending probiotics. Probiotics are organisms, such as bacteria and yeast which help maintain and restore a healthy balance of bacteria to the intestines. Yogurt also contains lactobacillus acidophilus, which is a probiotic. Lactobacillus acidophilus can be purchased as a supplement from a health food store.
Is there any hopeful new research in the treatment of C. Difficile?
Recent research to treat C. Difficile consists of a stool transplant, or fecal microbiota transplant(FMT). The FMT has not yet been approved by the FDA, but clinical studies focus on restoring healthy intestinal bacteria into the intestines of an infected person. Another person’s (donor) stool, which has been carefully screened to ensure that it contains no viruses, parasites, bacteria, and certain antibiotics, is transplanted using a colonscope or nasogastric tube into the infected person’s intestine.
The research has shown that the success rate for FMT (Fecal Microbiota Transplantation) is higher than 90% for treating C. Difficile infections. If you want to learn more about this promising research in treating C. Difficile infections, please view our, “Want to find out more section”, below.
Prevention remains the best treatment for C. Difficile infections.
This disease is highly preventable with proper hand washing with soap and water. If you have a friend or family member in a hospital or long term care facility, don’t be afraid to remind Caregivers to follow strict infection-control guidelines. Also, remind facility workers to assist the patient to be able to wash their hands after going to the bathroom, and before eating. Prevention, by proper hand washing will prevent the spread of this disease, and the illness and death it causes, especially in the elderly.
Want to find out more?
New England Journal of Medicine
Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile
Quick, inexpensive and a 90 percent cure rate
National Institutes of Health
Fecal microbiota transplantation in relapsing Clostridium difficile infection
What is Clostridium difficile colitis?
Helen Trowsdale, President of AA Care Services, is a nurse administrator with over 30 years of experience as a BSN, psychiatric nurse, and geriatric care manager with adults as well as pediatrics in hospitals, private duty home health care agencies, and residential home health care. Her team of caregivers are dedicated to serving their clients with home care in San Antonio, New Braunfels, and Austin; providing clients with consistent, quality care while minimizing the number of caregivers in the home. Learn more about AA Care Services.