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C. difficile Infection

When Diarrhea Isn’t a Side Effect

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Updated June 19, 2014

We all know that diarrhea is an all too common problem in people living with HIV. Many times, the diarrhea is an unfortunate side effect of the very medications used to treat HIV. But there are times when diarrhea is more than just an irritating side effect. Diarrhea can be the result of an infectious organism known as Clostridium difficile, more commonly known as C.diff. What is C.diff and why is it nothing to ignore?

What is C. diff?

C. diff is a microorganism that is one of the many bacterial organisms normally found in the gastrointestinal (GI) tract. There are many such bacteria that are normally present in the body; they aid in digestion and absorption of food and nutrients. C. diff is present as normal GI flora in about three percent of all healthy adults and about 10 to 30 percent of hospitalized or chronically ill patients.

If C-diff is a normal GI flora, why does it make people sick?

C-diff usually is not harmful in the patients that have it in their GI tract. However, under certain circumstances, C-diff can grow out of control in the GI tract. This overgrowth of C-diff produces toxins within the GI tract that result in severe infectious diarrhea and inflammation of the large intestine (colitis). It is when these things occur that C. diff goes from normal, harmless GI flora to dangerous infectious organism. In fact, C. diff is the most common cause of hospital-associated diarrhea.

Why Does C-diff Overgrow?

In the GI tract, there can be “good” bacteria and “bad” bacteria. Good bacteria assists in digestion and the absorption of nutrients but also helps control the growth of “bad” bacteria. In other words, good bacteria protects the GI tract from “bad” bacteria. C-diff overgrowth occurs when the good bacteria fails to prevent the overgrowth of C. diff. This can happen for several reasons.

  • Antibiotic Use – We all know that antibiotics are used to kill bacteria that are causing infection somewhere in the body. At the same time, the antibiotic can kill the “good” bacteria in the GI tract, allowing the “bad” bacteria such as C. diff to grow unchecked, producing the toxins that cause severe diarrhea. Some estimates say that about 90 percent of all health care associated C. diff is related to broad spectrum antibiotic use.

  • Anti-ulcer Medications – Anti-ulcer medications decrease the acidity of the stomach which in turn prevents gastric reflux and ulcer formation. However, altering the acidity of the stomach and GI tract can kill off “good” bacteria, allowing C-diff to grow out of control. In addition, altering the acidity of the GI tract can create an environment that is perfect for “bad” bacteria such as C-diff to grow unchecked.

  • Long Hospital Stays – A combination stress from illness, weakness from laying around in a hospital, and the potential for C-diff contamination from patient to patient makes extended hospital stays a risk factor for C. diff infection. In fact, C. diff infections within hospitals is a major problem for all infection control departments. Special isolation procedures are in place to limit the spread of C. diff from patient to patient via health care workers.

  • Underlying Chronic and Acute Illness – As mentioned earlier, acute and chronic illness can weaken a body’s defenses, making it more susceptible to C. diff infection.

  • Age – Like many infectious illnesses, people older than 65 years of age seem to be more at risk for C. diff. In addition, younger children and infants are also at a greater risk. Most likely, the risk is greater in these age groups due to weak or immature immune systems that are unable to fight a C. diff infection.

  • Immune System Suppression – Chronic diseases like HIV and cancer that are characterized by suppressed or weakened immune systems have proven to increase the risk of C. diff.

How Does C. diff Spread?

C. diff is present in the stool of infected people. It forms spores that can be transferred by direct contact to toilets, bed rails, towel racks, etc. People can also spread the spores from hand to mouth when coming in contact with contaminated surfaces. C. diff spores can live and infect up to 5 months on environmental surfaces. Unfortunately, C. diff spores are not killed by traditional disinfectants used by hospitals when cleaning. Chlorine bleach at a concentration of 1:10 is the only agent that effectively kills C. diff spores on environmental surfaces.

What are the Symptoms of C. diff Infection?

There are three primary symptoms of C. diff infection:

  • watery diarrhea that may contain blood or pus
  • fever
  • abdominal pain, cramping or tenderness

Proceed to page 2 to learn about the prevention and treatment of C. diff.

  1. About.com
  2. Health
  3. AIDS/HIV
  4. HIV-Associated Illnesses
  5. Associated Illnesses
  6. Clostridium Difficile Infection - Guide to C. Diff.

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