If you’ve ever dealt with diarrhea, you know how quickly it leaves you feeling depleted. Now imagine a case that rages on and on — or comes back again and again.
This is the reality for nearly 500,000 Americans each year who have the bacterial infection known as Clostridioides difficile, or C. diff. Virulent diarrhea and inflammation of the colon can even turn life-threatening.
This primer will help you understand how C. diff spreads and releases toxins, what the common symptoms are, and who is most vulnerable. Dr. Jessica Allegretti, director of the fecal microbiota program at Harvard-affiliated Brigham and Women’s Hospital, also touches on promising preventive strategies and treatments.
How does C. diff spread?
Like many bacteria, C. diff is present in our stool. It’s carried by virtually everyone — on our skin and even on the soles of our shoes. When C. diff bacteria are outside the body, they are inactive spores. They only have a chance to become active when they’re swallowed and reach the intestines.
Even then, many people who swallow C. diff spores never become ill. The spores only sicken people whose gut microbiome — the trillions of organisms living in their intestines — becomes imbalanced for one of the various reasons described below. When an imbalance occurs, the spores start to multiply and create toxins that lead to a C. diff infection.
“Many of us are colonized with C. diff bacteria without any consequences,” says Dr. Allegretti. “We’re swallowing C. diff spores all the time. Only under the right circumstances will the spores germinate and release a toxin. It’s the toxin that makes you sick.”
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What are the symptoms of a C. diff infection?
The symptoms mimic those of many other types of gastrointestinal ailments. Initially, this may make it difficult to tell the infection apart from milder illnesses.
Symptoms to watch for include
- persistent diarrhea lasting three or more days
- nausea
- fever
- stomach pain or tenderness
- appetite loss.
“C. diff isn’t something that people in the general population should be walking around scared of,” Dr. Allegretti says. “But if you need to take an antibiotic, be on the lookout for diarrheal symptoms after finishing the course of antibiotics. Diarrhea that’s associated with antibiotics alone should resolve once you finish taking the medication.”
Who is most vulnerable?
A few sobering facts from the Centers for Disease Control (CDC):
- C. diff is the top cause of health care-associated infections in the US.
- It disproportionately strikes people in hospitals and nursing homes.
- Among people over 65, one in 11 of those diagnosed with a health care-associated case of C. diff dies within a month.
However, other groups are also susceptible to the infection. Health care-associated C. diff infections are plateauing, Dr. Allegretti notes, while so-called community-based infections that occur among the general population are increasing.
People most likely to experience such infections:
- Are taking antibiotics or have just finished a course of antibiotic therapy. People are up to 10 times more likely to get C. diff while on antibiotics or during the month afterward, according to the CDC. “Not everyone who takes an antibiotic gets C. diff, and not everyone who gets C. diff gets recurrent C. diff,” says Dr. Allegretti. “It has a lot to do with your host response, your gut microbiome, and your individual risk factors, such as immunosuppression or inflammatory bowel disease.”
- Have a weakened immune system due to cancer, organ transplant, or treatment with immunosuppressive drugs (such as people with inflammatory bowel disease or autoimmune conditions).
- Have close contact with someone who has been diagnosed with C. diff.
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