Digestive Disorders Health Center

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Clostridium Difficile Colitis (Antibiotic-Associated Colitis, C. difficile colitis)

What is Clostridium difficile colitis (C. difficile)?

Clostridium difficile (C. difficile) is a bacterium that is related to the bacterium that cause tetanus and botulism. The C. difficile bacterium has two forms, an active, infectious form that cannot survive in the environment for prolonged periods, and a nonactive, "noninfectious" form, called a spore, that can survive in the environment for prolonged periods. Although spores cannot cause infection directly, when they are ingested they transform into the active, infectious form.

C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and diaper pails. They even can be carried by pets. Thus, these environments are a ready source for infection with C. difficile.

How does C. difficile cause colitis?

C. difficile spores lie dormant inside the colon until a person takes an antibiotic. The antibiotic disrupts the other bacteria that normally are living in the colon and preventing C. difficile from transforming into its active, disease causing bacterial form. As a result, C. difficile transforms into its infections form and then produces toxins (chemicals) that inflame and damage the colon. The inflammation results in an influx of white blood cells to the colon. The severity of the colitis can vary. In the more severe cases, the toxins kill the tissue of the inner lining of the colon, and the tissue falls off. The tissue that falls off is mixed with white blood cells (pus) and gives the appearance of a white, membranous patch covering the inner lining of the colon. This severe form of C. difficile colitis is called pseudomembranous colitis because the patches appear like membranes, but they are not true membranes.

Not everybody infected with C. difficile develops colitis. Many infants and young children, and even some adults, are carriers (they are infected but have no symptoms) of C. difficile. C. difficile does not cause colitis in these people probably because 1) the bacteria stay in the colon as non-active spores, and 2) the individuals have developed antibodies that protect them against the C. difficile toxins.

What are the symptoms of C. difficile colitis?

Patients with mild C. difficile colitis may have a low-grade fever, mild diarrhea (5-10 watery stools a day), with mild abdominal cramps and tenderness. Patients with severe C. difficile colitis may have a high fever (temperature of 102-104), severe diarrhea (more than 10 watery stools a day) with blood, and severe abdominal pain and tenderness. Severe diarrhea also can lead to dehydration and disturbances in the electrolytes (minerals) in the body. Rarely, severe colitis can lead to life threatening complications such as megacolon (markedly dilated colon), peritonitis (inflammation of the lining of the abdominal), and perforation of the colon.