Clostridioides difficile is a bacterium that causes an infection of the large intestine. Symptoms can range from diarrhea to life-threatening damage to the colon.
The bacterium is often referred to as C. difficile or C. diff.
Illness from C. difficile typically occurs after use of antibiotic medications. It most commonly affects older adults in hospitals or in long-term care facilities.
What are Toxin A and B?
The GI-MAP tests for the genes toxin A and toxin B, which are carried by C. difficile.
Clostridium difficile toxin A (TcdA) is a toxin generated by Clostridium difficile. It is similar to Clostridium difficile Toxin B. The toxins are the main virulence factors produced by the gram positive, anaerobic, Clostridium difficile bacteria.
How do the toxins function?
The toxins function by damaging the intestinal mucosa and cause the symptoms of C. difficile infection, including pseudomembranous colitis.
What are risk factors?
Risk factors for C. difficile infection include antibiotic treatment, which can disrupt normal intestinal microbiota and lead to colonization of C. difficile bacteria.
- 2–10% of population are carriers, most are asymptomatic
- Prolonged use of antibiotics may be causative factor
- Symptoms include inflammation, abdominal pain, cramping, fever, and diarrhea
- Symptoms often present during antibiotic use and often subside once antibiotics are discontinued
- Gastrointestinal (GI) infection can cause reactive arthritis
Therapeutic Approaches & Considerations:
- See calprotectin and secretory IgA (SIgA) levels to determine GI inflammation and immune response.
- Consider Saccharomyces boulardii, high dose probiotics, broadspectrum antimicrobial herbs, and 5R Protocol (Read: "What is the 5R Protocol?")
- Mild infections can be treated with metronidazole (=an antibiotic that is used to treat bacterial infections)
- Heavy infections can be treated with vancomycin and fidaxomicin
- Asymptomatic people may not need treatment
- In asymptomatic people with positive toxins A and/or B, the genes are likely not “turned on,” and thus not causing disease. It is still prudent to avoid antibiotics to prevent CDAD (=Clostridium difficile associated diarrhea). Consider antimicrobial herbal formulas, which can suppress C. diff without activating toxin production.
- Additional testing for toxins A and B may be warranted
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