What is Clostridium?
When we mention Clostridium, we primarily refer to Clostridium difficile, one of the seven Clostridium subspecies. These are groups of anaerobic, rod-shaped, gram-positive bacteria, typically harmless to humans and classified as saprophytes.
However, Clostridium difficile is a common hospital-acquired infection, although it can also develop at home. It is the most frequent cause of persistent diarrhea during hospitalization. A hypervirulent strain of Clostridium difficile is the primary agent behind its rapid spread in Europe and North America.
Prevalence and Risks
Statistics indicate that Clostridium difficile is present in about 2–5% of adults as part of the gut microbiota, rising to 10–20% in the elderly and up to 20–50% in hospital settings. This infection is often triggered by excessive and prolonged antibiotic use or poor hygiene (e.g., handwashing). Broad-spectrum antibiotics can disrupt the healthy gut flora by eliminating “good” bacteria sensitive to the antibiotics, while Clostridium difficile, resistant to many antibiotics, remains and proliferates. This bacterium produces two toxins: toxin A and toxin B. The presence of these toxins, disrupted healthy gut flora, and the overgrowth of Clostridium difficile can lead to damage of the lower digestive tract’s mucosa and inflammation of the large intestine. This condition, characterized by a buildup of fibrin, dead tissue, and white blood cells on the inflamed intestine surface, is known as pseudomembranous colitis. It is marked by persistent watery diarrhea (up to 15 times daily), dehydration, abdominal pain, cramps, nausea, loss of appetite, and fever. In cases without complications, symptoms may be milder, such as cramps, diarrhea, and abdominal pain.
Stool Test for Clostridium difficile
This is an immunochromatographic test based on the antigen-antibody reaction that detects Clostridium difficile products:
- Toxin A
- Toxin B
- Glutamate dehydrogenase (GDH)
A sample of unformed stool is used, collected spontaneously without special preparation. Results are reported as positive or negative and are available the same day.
When to Test for Clostridium difficile?
Testing is recommended if you have unformed or frequent stools (more than seven times daily), with or without fever, especially if you have recently been hospitalized or have been on long-term antibiotic therapy. Testing is especially advised for:
- Older adults, as the risk increases with age
- Patients with weakened immune systems
- Patients with acute or chronic colon diseases
- Those with a previous Clostridium difficile infection
- Patients who have recently undergone gastrointestinal surgery
- Patients undergoing chemotherapy
Symptoms of Clostridium difficile Infection
Symptoms usually appear 5 to 10 days after starting antibiotics but can emerge as early as the first day or up to three months later.
Mild to Moderate Infection
Common symptoms include:
- Watery diarrhea three or more times daily for over a day
- Mild abdominal pain and tenderness
Severe Infection
Severe infection with C. difficile often leads to significant fluid loss and dehydration, which may require hospitalization. It can also cause inflammation of the large intestine, sometimes creating patches of raw tissue that may bleed or produce pus. Severe symptoms include:
- Watery diarrhea, 10 to 15 times daily
- Severe abdominal pain and discomfort
- Rapid heartbeat
- Dehydration
- Fever
- Nausea
- Elevated white blood cell count
- Kidney failure
- Loss of appetite
- Abdominal bloating
- Weight loss
- Blood or pus in stool
A sudden, severe C. difficile infection may lead to colon inflammation and enlargement, known as toxic megacolon. It can also cause sepsis, where the body’s response to infection damages its own tissues. Patients with toxic megacolon or sepsis are admitted to intensive care. However, these complications are uncommon in C. difficile infections.
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