Clostridium difficile

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Clostridium difficile (C. difficile) infection is a bacterial infection of the colon, often associated with antibiotic use, leading to diarrhoea, colitis, and in severe cases, toxic megacolon.

Aetiology

  • Caused by toxin producing Clostridium difficile, a spore forming, Gram pos anaerobic bacterium.
  • Occurs following disruption of normal gut flora, commonly due to antibiotic use.
  • Transmitted via faecal oral route, often in healthcare settings.

Pathophysiology

  • Disruption of gut microbiota allows overgrowth of C. difficile.
  • Toxins A and B damage colonic mucosa, causing inflammation and diarrhoea.
  • Severe cases may progress to pseudomembranous colitis or toxic megacolon.

Risk Factors

  • Recent antibiotic use (especially clindamycin, cephalosporins, fluoroquinolones).
  • Hospitalisation or long term care residency.
  • Older age (>65 years).
  • Immunosuppression (chemotherapy, organ transplantation, HIV).
  • Proton pump inhibitor (PPI) use.

Signs and Symptoms

  • Watery diarrhoea (may be foul-smelling).
  • Lower abdominal pain and cramping.
  • Fever and systemic symptoms in severe cases.
  • Leukocytosis (often marked in severe cases).
  • Complications: pseudomembranous colitis, toxic megacolon, perforation.

Investigations

  • Stool toxin assay: detects C. difficile toxins A and B.
  • Polymerase chain reaction (PCR): detects toxin gene presence.
  • Full blood count (FBC): leukocytosis may indicate severity.
  • Renal function tests: assess for dehydration.
  • Abdominal X-ray/CT: for suspected toxic megacolon or perforation.

Management

1. Supportive Care:

  • Oral or IV rehydration therapy.
  • Stop unnecessary antibiotics if possible.
  • Avoid antimotility agents (e.g., loperamide).

2. Antibiotic Therapy:

  • Mild to moderate infection: oral vancomycin or fidaxomicin.
  • Severe infection: high dose oral vancomycin ± IV metronidazole.
  • Recurrent cases: prolonged vancomycin taper or faecal microbiota transplant (FMT).

3. Management of Severe Cases:

  • Close monitoring for toxic megacolon.
  • Surgical consultation for colectomy in life threatening cases.

4. Infection Control:

  • Strict hand hygiene (soap and water more effective than alcohol gel).
  • Isolation precautions in hospital settings.
  • Environmental cleaning with sporicidal disinfectants.

5. Referral:

  • Infectious diseases: for recurrent or severe infections.
  • Gastroenterology: for severe colitis or consideration of faecal microbiota transplant.
  • Surgery: if toxic megacolon or bowel perforation develops.
Infectious DiseasemypanotesClostridium difficile