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A Bug for All Seasons
(Clostridium difficile, C. difficile Infection)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 14 in the March 10-11, 2007 issue of
The Mississauga News under the feature: Health & Wellness, Medicine Matters
Dr Kujtan image

Some bacteria have all the luck. Take Clostridium difficile for example, the hardy Clostridium genus of the bacteria continues to grab the medical spotlight. There is nothing new about this family, and you heard about its cousins causing serious disease in the past. The age-old "tetanus" shots, which we all receive, are to prevent a nasty disease caused by Clostridium tetanus. The Clostridium bacteria produce a toxin that can paralyze our muscles and make them go into repeated spasm. The bacteria are anaerobes, which means that they can all grow in the absence of oxygen. This is why they can survive in damaged tissue and result in gangrene. They are commonly found in the soil around us, can produce spores and many also produce toxins. Botulism is another member of this family: Clostridium botulinium. Living in the soil means that they can make it into our food supply, and they occasionally do. There are at least three current cases of patients with botulism in Ontario.

Clostridium difficile is a bit of a problem at the present time and is a leading cause of bowel inflammation and diarrhea in sick hospitalized patients. To address this issue, I paraphrase Yul Brenner in Taras Bulba: "The first rule of battle is to study and learn all there is to know about your enemy!" There are many different strains of C.difficile. The bacteria are not the problem, but the toxins that it produces are. Some bacteria produce no toxin, but most others produce two types, A and B. Every medical student knows that the greatest risk for infection is in elderly hospitalized patients with multiple medical problems who have been treated with a "strong" antibiotic, the classical example being clindamycin. When examining the colons of these patients, the bacteria form clumps on the walls looking like a false membrane, and hence the disease state is often called pseudomembranous toxic mega-colon. It re-affirms the need to use antibiotics, herbs and "cleansers", appropriately. Our bowels are living systems, with many beneficial bacteria present to aid in digestion, absorption and proper functioning. The bacteria live in harmony with each other and with us. They have the ability to keep each other in check and prevent overgrowth. We refer to this as the fecal flora. Antibiotics and other substances can affect this harmony. Beneficial bacteria will perish as a consequence of destroying the pathogenic bacteria. It is difficult to target a single bacterial family. The effect disrupts the harmony and allows hardy bacteria such as Clostridium to over-grow. Having good levels of stomach acid seems to offer some protection, since people taking acid suppressing medication are slightly more prone to infection.

C.difficile infection will throw the colon into disharmonic spasm. When your colon doesn't function, ingested substances rush right through producing pain and cramping. The end result is watery diarrhea. Incidentally, the word diarrhea is often misused to refer to a single watery bowel movement. Diarrhea refers to frequent, loose and watery stools. Two movements do not a diarrhea make. In addition to loose stools, patients will exhibit fever, chills and may progress to overwhelming infection called fulminant sepsis.

This bacterium is not airborne and is spread by contamination or ingestion. The diagnosis is made by a simple stool culture test. Healthy people have little to worry about. C.difficile infections are treatable but can recur. They cluster in hospital settings where there is a greater likelihood of finding easy hosts whose immune systems are compromised in some way. Like influenza viruses, they may not be the sole cause of death but can send an already ill person into a fatal tailspin. Preventing spread can be as simple as washing your hands.

Related resources:

Fact Sheet - Clostridium difficile (C. difficile) from Public Health Agency of Canada.

Clostridium Difficile Colitis (Antibiotic-Associated Colitis, C. difficile colitis) - Symptoms, Diagnosis by Dennis Lee, M.D., MedicineNet.com.

Clostridium difficile from Wikipedia, the free encyclopedia.

Overview of Clostridium difficile Infections in Healthcare Settings from Centers for Disease Control and Prevention (CDC).

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