This bacteria can cause inflammation and ulcers in the colon resulting in diarrhea, fever, abdominal cramping and sometimes blood and mucus in the stools.  It is most frequently seen after the child has taken antibiotics in the past few weeks for another infection (example – an ear infection).  The bacteria can be found in the stool of normal children under 1 year of age without causing any symptoms.  If the child has another illness (such as inflammatory bowel disease), the illness can be severe.

What is Clostridium difficile colitis?

Clostridium difficile colitis is an infection of the colon and intestines.  The term "colitis" means inflammation in the colon.  It is this inflammation that causes diarrhea (due to malabsorption) and blood in the stools (due to ulcers in the colon).  Clostridium difficile colitis is sometimes called "pseudomembranous colitis" because when a colonoscopy is performed, pseudomembranes can be seen.  These pseudomembranes (fake membranes) are actually scabs covering ulcers and inflammation in the colon.  These membranes sometimes are seen in the stool and look like bloody tissue paper.

What causes Clostridium difficile colitis? 

Clostridium difficile is a bacteria that is commonly found in dirt, and the spores of this bacteria can be passed from person-to-person from an infected child or adult.  The spores are often found in hospitals and daycare facilities.  Clostridium difficile infection becomes more likely when a child is exposed to a large amount of the bacteria (or spores) or if the child has taken antibiotics recently.  Antibiotics commonly used for childhood infections (such as strep throat, skin infections, or ear infections) can kill the “good bacteria” that normally compete with the “bad bacteria” in the colon for nutrients.  When the “good guys” overwhelm the “bad guys,” a Clostridium difficile infection can result. 

What are the symptoms of Clostridium difficile colitis? 

• Diarrhea (sometimes with blood)
• Painful abdominal cramping
• Fever

 Red Flags  

• Severe or persistent symptoms
• Blood in stool
• Unable to eat or drink liquids (especially in young children and infants)
• High fever
• Paleness
• Lethargy
• Vomiting

Are there tests for Clostridium difficile colitis? 

Yes.  The best test is a stool test for the toxins produced by the bacteria.  Blood tests may be necessary to determine if the infection is severe.  Infants less than 1 year of age commonly have evidence of C. difficile in the stool (without symptoms). 

Treatment 

• The antibiotic that caused the infection should be stopped as soon as it is safe to do so. 
• If symptoms continue, then another type of antibiotic may be needed… such as metronidazole (also called Flagyl) for about 7 to 10 days.
• Return of the infection after treatment is common and a second course of antibiotics may be necessary.
• Some resistent infections may require another antibiotic called vancomycin.
• Anti-diarrheal medicines should not be used.

 Prevention  

• Proper hand washing
• Infected children should be kept out of school or daycare until the diarrhea resolves
• Children who had close contact with an infected individual should seek medical care if they develop symptoms, otherwise testing or treatment is usually not necessary

Photo - This micrograph depicts Gram-positive C. difficile bacteria from a stool sample culture obtained using a .1µm filter. People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to other patients or contaminate surfaces through hand contact. CDC/ Lois S. Wiggs.  Janice Carr 2004. Used with permission.