C.difficile (C.diff) - Complications of Clostridium difficile infection

Complications of a Clostridium difficile infection are uncommon, occurring in around 1 in 35 cases. But when they do occur, they can be very serious.

Risk factors that increase the chance of a person developing complications include:

• having a pre-existing condition that affects the colon, such as ulcerative colitis (a condition that causes persistent inflammation of the colon)
• being elderly – the older you are, the higher your risk of complications
• having another serious health condition, such as heart disease or chronic obstructive pulmonary disease (COPD)
• receiving treatments that are known to weaken the immune system, such as chemotherapy or a bone marrow transplant (also known as a stem cell transplant)

Some of the most serious complications of a C. difficile infection are discussed below.

Dehydration and acute kidney failure

Frequent bouts of diarrhoea can quickly lead to dehydration.

Being severely dehydrated reduces the supply of blood to your kidneys, so they stop working properly (one of the main functions of the kidneys is to filter waste products out of your blood). This is known as acute kidney failure.

Symptoms of acute kidney failure include:

• passing much less urine than you used to
• swelling of the feet, ankles or legs because of a build-up of fluid
• drowsiness
• mental confusion

Acute kidney failure can be treated by tackling the underlying infection while also restoring fluids to your body, usually via a drip.

Usually the kidneys will begin working again after treatment.

Perforated colon and peritonitis

If your colon becomes severely inflamed after infection, there is a risk it could split open (perforate) and allow bacteria to move out of the colon and infect the thin layer of tissue that lines the inside of the abdomen (peritoneum). This type of infection is known as peritonitis.

Symptoms of peritonitis often come on quickly and include:

• severe abdominal pain
• a high temperature (fever) of 38ºC (100.4ºF) or above
• chills

Peritonitis is a medical emergency – if left untreated, the infection can quickly spread to other parts of the body, causing multiple organ failure and eventually death.

In many cases of peritonitis, it will be necessary to remove your colon during surgery (colectomy). Without a colon, you will be unable to pass stools out of your body in the usual way.

You'll need a further operation, where the end of your small intestine is re-routed to an opening in your abdomen known as a stoma. An external bag is attached to the opening to collect waste products. This procedure is known as an ileostomy.

Toxic megacolon

Toxic megacolon is when gases can get trapped in the colon, causing it to swell.

This is dangerous as it can send the body into shock (a sudden drop in blood pressure), split the colon and lead to peritonitis.

The symptoms of a toxic megacolon include:

• abdominal pain
• dehydration
• high body temperature (40ºC or 104ºF)
• a rapid heart rate

Toxic megacolon can be treated with intravenous fluids, antibiotics and steroids. At the same time, a tube will need to be inserted into your rectum and colon so the gas can be withdrawn and your colon decompressed.

In more severe cases, a colectomy (the removal of a large part of the colon) will need to be performed.