Treatment/Therapy
As a first step of treatment for a Clostridium infection, an attempt should be made to remove the trigger. This means that all antibiotics should be discontinued as far as possible. Furthermore, due to the diarrhoea disease, care must be taken to ensure an adequate fluid supply.
All medication that inhibits intestinal movement should be avoided. These include especially opioids and the over-the-counter diarrhoea medication Imodium. These can hide and aggravate the disease.
The drug of choice for a first infection is metronidazole, an antibiotic that works well against clostridia. Pregnant women and children should switch directly to vancomycin. In severe infections vancomycin is also used directly or coupled with metronidazole.
Vancomycin can also be given directly into the intestine in severe cases. In the case of recurrent infections, a stool transplantation can be considered, as a healthy microbiome can displace the clostridia. In case of complications, such as toxic megacolon, surgical therapy may be necessary, but this is associated with high complication rates.
Duration/forecast
A mild to moderate Clostridium-induced diarrhea can last from a few days to weeks. However, a severe course with complications can also mean weeks to months in hospital and intensive care units. The disease is approximately seven percent fatal, due to the more dangerous strains currently in widespread use. The likelihood of a fatal course increases with age. After infection, recurrence is relatively common.
Course of disease
The course of a Clostridium infection is very rapid. Those affected initially notice abdominal pain and slimy, foul-smelling diarrhoea, which begins very suddenly. Within a few hours or days, severe courses can develop. This leads to intestinal obstruction and in some cases to severe complications such as toxic megacolon and blood poisoning. The healing usually takes longer than the development, because the normal intestinal flora has to be rebuilt first.
How contagious is the disease?
Clostridia belong to the spore-forming bacteria. These spores are very resistant to environmental influences and can remain on surfaces in hospitals and infect people over long periods of time. The transmission is faecal-oral, which means that the spores are transferred from the intestine via the hands into the mouth.
The risk of infection is therefore very high, especially in hospitals and nursing homes by medical staff. In some intensive care units, spores have even been detected in the air.
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