These spores are widespread and can be found in foods, on pets, on lawns, and on many of the surfaces that humans come into contact with daily. Humans acquire CDI by ingesting bacterial spores from their environment.

But what is the mechanism of this host and microbiota defense? The human body has a least 2 defenses against C difficile: (1) the local immune response to the toxins and (2) colonization resistance through the community of microbes that normally inhabit the human colon. 4 By transplanting healthy human donor fecal microbiota into the colon of an affected patient, this technique restores the host's defense against C difficile and stops recurrence in most patients. 3 One strategy for preventing recurrent CDI, fecal microbiota transplantation, has been highly effective. New approaches, such as the use of probiotics to replenish the microbiota, are promising. By themselves, they may further alter the protective gut microbiota.

These treatments play a limited role in the recurrence of CDI. Currently used antimicrobial treatments for CDI, including oral vancomycin, fidaxomicin, and metronidazole, eliminate symptoms by targeting the toxin-producing vegetative form of the organism within the colon. Its spectrum of illness ranges from asymptomatic colonization to mild diarrhea to sepsis and death. However, loss of microbial diversity due to antibiotics, aging, and other stressors provides fertile ground for its growth and the spread of disease.Ĭ difficile exists in 2 forms: an environmentally hardy spore, responsible for transmission, and a vegetative form, which produces the toxins that cause disease. It rarely causes disease in people with a diverse intestinal microbiota. The best example of this disruptive process is CDI. Disruptions in the microbial structure can lead to loss of these functions and the development of human disease. The human gut microbiota is a diverse microbial ecosystem that guides human energy extraction and helps regulate our adaptive and innate immune function. Osteopathic physicians understand that humans possess self-regulatory and self-healing functions and that rational treatment addresses alterations to normal structure and function to restore health. 2 Recurrent disease in turn leads to the shedding of more spores into the environment, which may spread the infection to others. 1 Nearly one-third of patients improve but then have symptoms recur, leading to significant morbidity, expense, and disruption in their quality of life. IntroductionĬlostridium (now called Clostridioides) difficile is a gram-positive, anaerobic, spore-forming bacteria that accounts for more than half a million infections each year in the United States. She asks you why she keeps getting this infection and why this unusual treatment would likely cure her infection. She comes to see you for a procedure called fecal microbiota transplantation because she has read that it is extremely effective for recurrent C difficile infection (CDI). After 4 months of diarrhea and treatment, she is frustrated, socially isolated, and economically devastated by the costs of her treatments. Again, she is well on treatment, but 5 days after completing the treatment course, all of her symptoms recur. Five days later, symptoms recur, and she is given a 2-week vancomycin course followed by a 6-week tapered course. Four days after stopping the oral vancomycin, her diarrhea recurs another 2 weeks of oral vancomycin is prescribed, and she improves again. She is treated with 14 days of oral vancomycin and improves. Her primary care physician orders a Clostridium difficile toxin assay, and the result is positive. Three days after the procedure, she develops watery and foul-smelling diarrhea 10 to 12 times per day, fecal incontinence, and abdominal cramps. She is given oral clindamycin, 300 mg, 1 hour before the procedure. A 72-year-old woman with recurrent urinary tract infections and mitral valve prolapse is seen by her dentist for a tooth extraction.

Clostridium spore