C. diff (Clostridioides difficile) Infection: What You Need To Know (2024)

What are the symptoms of C. diff infection?

The most common symptom, and usually the first to appear, is watery diarrhea. A mild infection will cause diarrhea at least three times a day, often with some abdominal cramping or tenderness.

As C. diff infection becomes more severe, diarrhea increases. It may occur as much as 10 to 15 times a day. You may notice traces of blood in your poop (stool). You may also develop other symptoms, such as:

  • Persistent abdominal pain.
  • Swollen, distended abdomen.
  • Nausea and vomiting.
  • Loss of appetite.
  • Fever.
  • Rapid heart rate.

C. diff symptoms may resemble food poisoning or stomach flu at first, but they don't go away as easily. If you're taking antibiotics, it's possible to mistake C. diff diarrhea for a normal side effect of the antibiotics.

It’s also important to note that C. diff infection can occur without diarrhea. Some people with C. diff may have other health conditions or medications affecting their bowels, which may prevent diarrhea.

What does C. diff poop look like?

C. diff diarrhea is typically mushy or porridge-like, but not completely liquid. Sometimes it has a green tint, though other bacterial infections can also cause this. Occasionally, it contains blood, mucus or pus.

What does C. diff poop smell like?

Many people have noticed a distinctive odor with C. diff diarrhea. They describe it as unusually strong and oddly sweet. This smell may be because C. diff increases the levels of bile acids in your poop.

How does a person get C. diff?

You may already have C. diff in your gut at birth, or may acquire it by accidentally ingesting it. It lives in the intestines of humans and other animals and spreads through their poop into the environment.

Researchers estimate that about 5% of the population has C. difficile in their colon without signs or symptoms of infection. You can have C. diff under control, but still carry and spread it to others.

How does C. diff spread?

C. difficile reproduces by releasing spores. These spores live in the environment, especially where infected people and animals live. They can enter your gastrointestinal (GI) tract through your mouth.

Why is C. diff so contagious?

C. diff spores are very hard to kill, both inside and outside of your intestines. They’re resistant to heat, acid and many antibiotics and disinfectants. They can also survive for months on surfaces.


What causes C. diff infection?

A healthy immune system normally protects your gut from C. diff infection by keeping C. diff levels under control. If they grow out of control, it’s because something has compromised your gut immunity.

The most common cause is:

  • Antibiotics. A course of antibiotics is the most common cause of C. diff infection. Most antibiotics, including broad-spectrum antibiotics meant to target a wide range of microorganisms, are ineffective against C. difficile. But they’re effective against the other bacteria living in your gut, both the bad and the good kind. Using them upsets the balance in your gut microbiome, allowing C. diff to dominate while diminishing other bacteria.

Medical conditions that may reduce your defenses against C. diff infection include:

  • Inflammatory bowel disease (IBD). Chronic inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, wear down the integrity of your intestines over time. They degrade the mucosa in your intestinal lining, which affects your gut immunity.
  • Immunodepression. You may have reduced immunity in general, not just in your gut, if you have an immunodeficiency disorder or another chronic disease that affects your immune system — like cancer, HIV, kidney disease or diabetes. The same is true if you take immunosuppressants.

Other risk factors associated with C. diff infection include:

  • Age. Being older than 65 increases your risk of C. diff infection tenfold. This may be related to diminished overall immunity, taking multiple medications regularly or living in a hospital or care home. Infants, whose immune systems are still developing, also get C. diff more often.
  • Hospitalization or institutionalization. C. diff spreads easily in hospitals and nursing homes, where it may infect an estimated 20% of people. Spores can live for months on common surfaces and spread from caregivers’ hands to the many people they care for.

Sometimes it isn’t clear what allowed C. diff to take over. While many factors can affect your gut immunity, it’s important to know that infection can occur even if you don’t have any known risk factors.

What complications can occur with C. diff infection?

Complications can occur with more severe infections. How severe your infection becomes will depend on several factors, including the strain of the bacteria you have and how strong your immune system is.

People who have more risk factors for getting a C. diff infection in the first place may be more at risk of a severe infection. They may also have repeat infections, which cause more damage over time.

Common complications include:

  • Recurrent infection. This is the most common complication, affecting as many as 20% of people. Recurrent CDI is a relapse that occurs within two to eight weeks of completing treatment. Among those who have a relapse, as many as 40% will have another relapse after that.
  • Dehydration and electrolyte losses. As diarrhea becomes more frequent, you may begin to lose fluids and electrolytes faster than you can replace them. This can have dangerous side effects, including low blood volume, low blood pressure and in severe cases, acute kidney failure.
  • Pseudomembranous colitis. CDI causes a particular type of colitis, known as pseudomembranous colitis. This is due to the toxins that the bacteria produce. These toxins attack the cells in your intestinal lining, eventually destroying them. This damage causes a strong inflammatory response. You may develop ulcers in your colon, which may bleed. Eventually, yellow-white plaques form over your injured intestinal lining, called “pseudomembranes.”

As toxic damage in your colon progresses, you may have further complications, including:

  • Fluid leakage. Your colon may begin to leak fluids into your abdominal cavity (ascites), causing it to swell. You may also lose proteins from your colon, such as albumin. Low albumin can cause your blood vessels to leak, leading to edema (swelling in your hands, feet and face).
  • Reactive arthritis. Severe infection may trigger reactive arthritis, which can cause inflammation, swelling and pain in your joints and other places in your body. This is a response from your immune system. In a small number of people, it can last beyond the original infection.
  • Toxic megacolon. Toxic megacolon is rare but serious. It happens when swelling from inflammation is so severe that it disables your colon. First, your colon stops moving (paralytic ileus). As it continues to stretch and dilate, it can leak toxins or even tear (gastrointestinal perforation), spreading infection. Infection in your abdominal cavity (peritonitis) can spread to your bloodstream (septicemia). This can lead to sepsis and septic shock, which can be fatal.
C. diff (Clostridioides difficile) Infection: What You Need To Know (2024)


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