Sandbox Sickness: Diarrhea-Causing Bacteria Found on Playgrounds
Don't let your kid eat sand, OK?
A small study by researchers in Spain finds that dangerous germs are lurking on playgrounds. 
C. diff is usually considered a hospital-acquired infection; but the rates of infection outside of hospitals are increasing, the authors of the study write.
One possible source of C. diff exposure is sandboxes, the researchers found. The bacterium may wind up there from the feces of humans and other animals. (Cats + sand = litter box.) The bug can survive for weeks or months outside of the body.
C. diff in sandboxes is especially dangerous for young children, the primary group at risk of catching the bug from playgrounds. Why? Because kids have high rates of geophagia. In other words, they eat sand and dirt.
Studying the Nitty-Gritty of C. Diff in Sandboxes
For the study, researchers tested sand from 40 sandboxes in public parks in Madrid, Spain, including 20 that were designated for children and 20 that were for dogs. C. diff was found in 9 of the sandboxes intended for kids, and 12 of the sandboxes intended for dogs.
An analysis of the different C. diff strains revealed that 2 of the samples from the kids’ sandboxes and 6 samples from the dogs’ sandboxes had “toxigenic” strains, meaning that they produced toxins. These toxins can lead to a damaged colon lining and diarrhea. Some strains of C. diff produce more toxins than others.
Every sample that the researchers tested was resistant to at least 2 antibiotics, making the infection more difficult to treat.
The researchers wrote that because of the risks posed by C. diff, tests for the bacterium should be included in future environmental-risk assessments.
Lead researcher Dr. Jose Blanco, from the Department of Animal Health at Complutense University of Madrid, said:
“This study shows the wide distribution of [these] bacteria in the environment, and the need for more studies to elucidate its presence in our communities.” 
Past studies in the U.S. have found other pathogens in sandboxes, including Toxoplasma gondii, which can cause flu-like symptoms, and parasitic Ascaris (nematode worm) eggs that can cause abdominal discomfort.
If you’re not totally disgusted yet, this should do it: Different types of roundworms have been found in playgrounds. Baylisascaris procyonis, spread by raccoons, can cause neurological damage and death. Thankfully, it’s extremely rare. Then there’s Toxocara roundworms – these stomach-turning creatures cause about 70 cases of blindness in U.S. children each year.
About Clostridium Difficile
C. diff infection can be hard to treat. The bacteria cause an intestinal infection that can lead to severe diarrhea which, in turn, can lead to dangerous dehydration. The symptoms of mild to moderate C. diff infection typically include:
- Watery diarrhea 3 or more times a day
- Mild abdominal cramping and tenderness 
Serious infections can cause:
- Watery diarrhea 10 to 15 times a day
- Abdominal cramping and pain, which may be severe
- Rapid heart rate
- Blood or pus in the stool
- Loss of appetite
- Weight loss
- Swollen abdomen
- Kidney failure
- Increased white blood cell count 
Severe complications can arise from C. diff infection, including:
- Toxic megacolon, a condition in which the colon is unable to expel gas and stool, causing it to become greatly distended (megacolon). If not treated in time, the colon can rupture, causing bacteria from the colon to enter the abdominal cavity, requiring emergency surgery. Toxic megacolon is sometimes fatal.
- Bowel perforation, a rare condition caused by extensive damage to the lining of the large intestine or after toxic megacolon.
- Death 
A single course of antibiotics can cause C. diff. infection.
How to Prevent C. Diff Infection
To help prevent your little ones from getting sick from sandboxes, the American Academy of Pediatrics recommends:
- Keeping sandboxes covered when not in use to keep insects and animals out.
- Letting sand dry before covering the sandbox, as wet sand is an ideal place for bacteria to grow.
- Raking the sand regularly to remove debris, clumps, and other foreign material.
- Not allowing pets to play in the sandbox… for the obvious reasons. 
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 Mayo Clinic
Julie Fidler is a freelance writer, legal blogger, and the author of Adventures in Holy Matrimony: For Better or the Absolute Worst. She lives in Pennsylvania with her husband and two ridiculously spoiled cats. She occasionally pontificates on her blog.