Clostridioides difficile, commonly known as C. diff, is a bacterium that can cause severe gut infection. Its presence often leads to inflammation of the colon (colitis). C. diff infections are frequently observed in individuals who have recently taken antibiotics, as these medications can disrupt the natural balance of bacteria in the digestive system, allowing C. diff to proliferate.
Common Symptoms of C. diff Infection
The most recognized symptom of a C. diff infection is watery diarrhea, which can range from mild to severe, occurring three or more times a day. This diarrhea may be accompanied by mild abdominal cramping and tenderness. In severe cases, the frequency of watery diarrhea can increase significantly, potentially reaching 10 to 15 times a day.
Beyond diarrhea, other common symptoms of C. diff infection include persistent abdominal pain, fever, and a general loss of appetite. Patients may also experience nausea and, in more severe instances, a rapid heart rate. Occasionally, traces of blood, mucus, or pus might be present in the stool, indicating more extensive inflammation of the colon.
The Link Between C. diff and Constipation
While watery diarrhea is the most common and recognized symptom, C. diff infection can, in rare or severe cases, manifest as constipation or a significant reduction in bowel movements. This atypical presentation can make diagnosis challenging, as it deviates from the expected diarrheal pattern. Such instances often involve severe abdominal pain and fever, despite the absence of diarrhea.
One reason for constipation in C. diff infection is the development of ileus, a condition where the bowel temporarily loses its ability to contract and move contents through the digestive tract. This paralysis of the bowel can occur due to the inhibitory effect of C. diff toxin B on intestinal smooth muscle activity. Ileus can occur as the sole manifestation of C. diff infection, often in hospitalized patients with other health conditions.
In very severe cases, C. diff can lead to toxic megacolon, a life-threatening complication where the colon dilates considerably and loses its functional capacity. This extreme inflammation and dilation can result in a pseudo-obstruction, mimicking a physical blockage, and preventing the passage of stool and gas. This rare but serious condition is often accompanied by signs of systemic toxicity and can have a substantial mortality rate.
When to Seek Medical Care
It is important to seek medical attention if you experience persistent diarrhea, especially after recently taking antibiotics. Contact a healthcare professional if you have three or more watery stools a day lasting for more than two days. A new onset of fever, severe belly pain or cramping, or the presence of blood in your stool also warrant immediate medical evaluation.
If you develop any new onset of constipation, particularly after antibiotic use or a recent hospitalization, it is advisable to consult a doctor. Symptoms like a fever over 38.3°C (101°F), shaking chills, feeling light-headed, a fast heart rate, or signs of dehydration such as sunken eyes and a dry mouth, require prompt medical care. It is always best to avoid self-diagnosing or attempting to self-treat these symptoms, as C. diff infections can rapidly become serious.
Understanding Diagnosis and Management
Diagnosing a C. diff infection primarily involves analyzing a stool sample. Laboratory tests look for the presence of C. diff toxins or the genes from toxin-producing strains of the bacteria. Molecular tests are often preferred due to their high sensitivity and specificity.
Management of C. diff infection often begins with discontinuing the antibiotic that may have triggered the infection, if medically appropriate. Specific antibiotics are then prescribed to target the C. diff bacteria. Infection control measures are also important, particularly in healthcare settings. These include rigorous hand hygiene with soap and water, as alcohol-based sanitizers are less effective against C. diff spores. Infected patients are often placed on contact precautions, involving the use of gowns and gloves to prevent spread.