Infection with Clostridium difficile

Clostridium difficile (C. difficile) is a bacteria that is found in many people in their gastrointestinal tracts. This is a type of bacteria that forms spores. Spores are like defensive shells that protect the bacteria from dying. C. difficile is one of the well-known spore-forming bacteria that has made eradication of the bacteria very challenging. When the spore-forming bacteria encounters adverse conditions like extreme environmental changes like high or low temperatures, disinfectants or anti-bacterial agents they end up forming the spores and going into a dormant stage. Some bacteria can stay in the dormant stage for years. The bacteria come out of the spores when the environment improves and the conditions are right for its survival.

Due to the spore-forming capabilities C. difficile has survived in difficult environments like the hospital where anti-bacterial precautions are taken seriously. Many people are infected with C. difficile and the bacteria stays in the gut. It produces toxins and these cause diarrhoea and may other symptoms that sometimes end up being life-threatening like the toxic megacolon which needs emergency surgery.

It is widely believed to be acquired through faecal-oral transmission. This happens when an infected person is discharging the bacteria during an episode of diarrhoea and due to improper hygiene practices the bacteria and its spores are distributed on surfaces like the handrails, door handles, buttons in the lift etc. where other people touch and when these people consume food without proper hygiene practices they consume the bacteria and get infected.

Intake of antibiotics is also believed to play a significant role as the natural bacteria and micro-organisms resident in the bowel that can resist the growth of C. difficile are destroyed by the antibiotics. While the other bacteria and good organisms are destroyed C. difficile survives due to the formation of spores.

Therapies for C. difficile infections 

In many conditions limiting antibiotics and preserving the microbial flora of the intestines works in limiting the expansion and effects of C. difficile.

Antibiotics – Some antibiotics, antiprotozoals and other medications when used singly or in combination have been shown to have beneficial effects in C. difficile infection. Metronidazole a combined antibiotic and antiprotozoal medication has been used as the first line treatment to manage C. difficile infections. But in high doses it has been known to cause peripheral nerve damage. Antibiotics like vancomycin, teicoplanin, rifampicin and rifaximin have all been used to treat C. difficile. Some of these have more advantages over the others in terms of absorption and toxicity effects.

Nitazoxanide is another drug that is being used in combination with other drugs to control C. difficile infection.

Cholestyramine is an absorbant drug that is used in adjunct with other drugs in the treatment of C. difficile. It helps by absorbing the toxins generated by C. difficile and keeps the symptoms at bay.

Lactobacillus GG which is known as Vaalia yoghurt in Australia and Culturelle in the US is a probiotic that suppresses the growth of C. difficile. Its advantage over the pharmaceutical drugs is that it is void of side effects.

Introduction of micro-organisms to compete – Some micro-organisms can be introduced that multiply and mask the numbers of C. difficile or counteract the effects of the toxins. The fungus, Saccharomyces boulardii has been shown to be beneficial in a few cases but hasn’t been able to eradicate C. difficile totally. Clostridium butyricum (Myiari 588 Strain) is another bacteria that is related to C. difficile and is used to populate the human gut flora and is safe.

Antibodies – Anti-C difficile globulin is a human gammaglobulin that has antibodies to the toxins of C. difficile and is used to relieve symptoms in extreme cases.

Surgery is performed in extreme cases where the complications of C. difficile flare-ups like fulminant colitis or toxic megacolon threaten the patient’s life. Though surgery is performed it can just be done to remove the affected segments of the colon. It does not remove the C. difficile infection.

Faecal microbiota implantation – Though the name sounds unacceptable this therapy has been found to be promising in quite a few studies. It is yet to be approved on a massive scale due to variations and ethical complications. It consists of introducing healthy microbial flora (either cultured in the lab or from another healthy human subject) into the colon. It can be done through colonoscopy or through enema thus bypassing the acidic environment of the stomach region.

Further Reading

Clostridium Difficile Infection. (CDI) Department of Health. Government of Australia.