After the case that shook Catanzaro, questions are increasing about a still little-known infection. From antibiotics to symptoms, up to the most effective treatments: let’s clarify with Professor Silvio Danese, one of the world’s leading experts in gastroenterology.
The Catanzaro case has put the spotlight on the Clostridioides difficilea bacterium still little known to the general public but responsible for infections that can become very serious. What attracted attention was the death of an 18-month-old child who attended a private nursery in Tropea. The little boy was initially admitted to the Vibo Valentia hospital for a serious gastrointestinal infection and, after his condition worsened, transferred to the Catanzaro hospital, where he died probably due to sepsis. Other children who attended the same kindergarten demonstrated gastrointestinal symptoms and some were hospitalized: fortunately none had serious consequences. The Vibo Valentia Prosecutor’s Office has opened an investigation to clarify the causes of death and ascertain the possible connection between the different cases: the epidemiological checks they microbiological tests are still ongoing. Beyond the judicial and health issue, which still needs to be clarified, the case has brought attention to an infection that also and above all affects adults, in particular people hospitalized, taking antibiotics or in fragile conditions. But what is Clostridioides difficile? How is it transmitted? What are the symptoms and treatments? We asked the professor Silvio Danesehead of Gastroenterology and digestive endoscopy of theIRCCS San Raffaele Hospital in Milan and professor at the Vita-Salute San Raffaele University, to take stock of a bacterium that is as widespread as it is often little known.
Professor, what exactly is Clostridioides difficile, and how is it transmitted from one person to another? Contact with a sick person is sufficient or special conditions are needed for it to cause uno infection?
The Clostridioides difficile it is a bacterium that can live in the intestine, in the vaginal flora and in the environment in the form of spores, allowing its survival and resistance for a long time even on surfaces and objects. The transmission takes place by fecal-oral routei.e. the contact of spores with mucous membranes through contaminated hands or objects. Coming into contact does not necessarily imply an infection, in fact in most people the intestinal microbiotamanages to keep it under control. The infection develops especially when this balance is altered, for example after a antibiotic therapy. The symptoms associated with the infection are mostly watery diarrhea, fever and abdominal painup to more severe frameworks than colitis And toxic megacolonconditions that can lead to even fatal complications.
It is often associated with hospitals, but the Catanzaro case has brought attention to possible community transmission. How frequent is it really that the bacterium circulates outside healthcare facilities and what are the daily contexts in which an adult can expose himself without realizing it?
For many years the Clostridioides difficile it has been considered almost exclusively a problem of hospitals and healthcare facilities, where fragile patients are concentrated and the use of antibiotics is very frequent. Today we know that the colonization rate in healthy adults is around 4-15%a comparable percentage also in the pediatric population, and that the community-acquired C. difficile infections represent beyond the 30% of cases of infection by this bacterium. Exposure to spores for a healthy adult in everyday environments is quite frequent, however, even in this case, simple contact is rarely enough: a predisposition of the host is almost always required.
In adults, the risk does not only concern those who are elderly or hospitalized. Which categories of people should pay particular attention and what are the most common mistakes that favor infection?
The main one risk factor it is, as mentioned, the assumption of antibioticsespecially if prolonged or repeated. The elderly, even those who are not hospitalized, are also at risk chronic diseases or has immune system deficiency. In addition to an adequate hygienic approach, a appropriate use of antibiotics it is one of the most effective strategies to prevent this infection. Each antibiotic should be taken only when necessary, according to the doctor’s instructions, and the therapy should be continued for a duration appropriate to the type of infection.
What are the symptoms that should lead to suspicion of a Clostridioides difficile infection and prompt an adult to quickly contact the doctor or the emergency room?
The diagnostic doubt of one viral gastroenteritis it may occur especially at the onset of symptoms, but this usually resolves within a few days. However, it is necessary to investigate the situation further if the symptoms continue for several days, if the diarrhea should be associated with persistent fever and especially if this picture were to appear near one antibiotic therapyespecially if prolonged.
Treatment has changed lately: in addition to antibiotics, today we talk about fecal microbiota transplant and strategies to prevent relapses. How effective are these new options and in which patients do they really make a difference?
In recent years the therapeutic armamentarium has expanded considerably, above all to deal with frequent problems in patients who contract this infection: the antibiotic resistance and the recurrence of the infection. In fact, in addition to the traditional first-line antibiotic, the vancomycinwhich has a therapeutic failure rate of over 15%, new molecules have been added such as Fidaxomicin. A biological drug has also recently been introduced, a monoclonal antibody called bezlotoxumabespecially indicated to prevent the recurrence of the infection. The fecal microbiota transplant it is a technique that has proven to be the most effective therapy for recurrent Clostridioides difficile infections: it is currently reserved for patients who have had multiple relapses, guaranteeing in these cases resolution rates higher than 70%. It was recently introduced along the same lines Vowstan oral therapy based on live microbiome spores indicated for the treatment of recurrent infections; to date it is only approved in the United States but may be available in Europe in the near future.
