posted
Haven't been here lately, so I don't know if this has been posted here yet.
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Scientists find germ's behavior baffling, even deadly By ROB STEIN The Washington Post First came stomach cramps, which left Christina Shultz doubled over and weeping in pain. Then came nausea and fatigue -- so overwhelming that she could not get out of bed for days.
Just when she thought things couldn't get worse, the nastiest diarrhea of her life hit, repeatedly forcing her into the hospital.
Doctors finally discovered that the 35-year-old Hilliard, Ohio, woman had an intestinal bug that used to be found almost exclusively among older, sicker patients in hospitals, and was usually easily cured with a dose of antibiotics.
But after months of treatment, Shultz is still incapacitated.
``It's been a nightmare,'' said Shultz, the mother of two young children. ``I just want my life back.''
Shultz is one of a growing number of young, otherwise healthy Americans who are being stricken by the bacterial infection known as Clostridium difficile -- or C. diff -- which appears to be spreading rapidly around the country and causing unusually severe, sometimes fatal illness.
That is raising alarm among health officials, who are concerned that many cases may be misdiagnosed and are puzzled as to what is causing the microbe to become so much more common and dangerous.
``It's a new phenomenon. It's just emerging,'' said L. Clifford McDonald of the federal Centers for Disease Control and Prevention in Atlanta. ``We're very concerned. We know it's happening, but we're really not sure why it's happening or where this is going.''
It may be the latest example of a common, relatively benign bug that has mutated because of the overuse of antibiotics.
``It's another example of an organism that all of a sudden has gotten a lot meaner and nastier,'' said John G. Bartlett, an infectious-disease expert at Johns Hopkins University in Baltimore.
Also, new evidence released last week suggests that the enormous popularity of powerful new heartburn drugs may also be playing a role.
The antibiotics Flagyl (metronidazole) and vancomycin still cure many patients, but others develop stubborn infections like Shultz's that take over their lives. Some resort to having their colon removed to end the debilitating diarrhea. A small but disturbingly high number have died, including an otherwise healthy pregnant woman who succumbed this year in Pennsylvania after miscarrying twins.
The infection usually hits people who are taking antibiotics for other reasons. But a handful of cases have been reported among people who were taking nothing, another unexpected and troubling turn in the germ's behavior.
The infection has long been common in hospital patients taking antibiotics. As the drugs kill off other bacteria in the digestive system, the C. diff microbe can proliferate. It spreads easily through contact with contaminated people, clothing or surfaces.
There are no national statistics, but the number of infections in hospitals appears to have doubled from 2000 to 2003, and there may be as many as 500,000 cases each year, McDonald said. Other estimates put the number in the millions.
The emerging problem first gained attention when unusually large and serious outbreaks began turning up in other countries. In Canada, for example, Quebec health officials reported last year that perhaps 200 patients died in an outbreak involving at least 10 hospitals. Similar outbreaks were reported in England and the Netherlands.
After the CDC began receiving reports of severe cases among hospital patients in the United States -- and in people who had never, or just briefly, been hospitalized -- it launched an investigation.
In the Dec. 8 issue of The New England Journal of Medicine, the CDC reported an analysis of 187 C. diff samples found that the unusually dangerous strain that caused the Quebec cases was also involved in outbreaks at eight health-care facilities in Georgia, Illinois, Maine, New Jersey, Oregon and Pennsylvania.
``This strain has somehow been able to get into hospitals widely distributed across the United States,'' said Dale N. Gerding of Loyola University in Chicago, who helped conduct the analysis. ``We're not sure how.''
Scientists do have a few clues. The dangerous strain has mutated to become resistant to a class of frequently used antibiotics known as fluoroquinolones. That means anyone taking those antibiotics for other reasons would be particularly prone to contract C. diff.
Experts said the resistant germ's proliferation offered the latest reason why people should use antibiotics only when necessary, to reduce their risk for C. diff and the chances that other microbes will mutate into more dangerous forms.
``If we reduce the number and amount of antibiotics given for trivial infections like colds and stuffy noses, we'd all be a lot better off,'' said J. Thomas Lamont of Harvard Medical School.
Overuse of antibiotics can make germs more dangerous by killing off susceptible strains, leaving behind those that by chance have mutated to become less vulnerable to the drugs. The resistant strains then become dominant.
Besides being resistant, the C. diff strain also produces far higher levels of two toxins than do other strains, as well as a third, previously unknown toxin. That would explain why it makes people so much sicker and is more likely to kill. In Quebec, C. diff killed 6.9 percent of patients -- which is much higher than the disease's usual mortality rate -- and was a factor in more than 400 deaths.
Adding to the alarm is evidence that the infection is occurring outside of hospitals. When the CDC began looking for such cases earlier this year, investigators quickly identified 33 cases in New Hampshire, New Jersey, Ohio and Pennsylvania, including 23 persons who had never been in the hospital and 10 women who had been hospitalized only briefly to deliver babies , the agency reported this month. Eight of the patients had never taken antibiotics.
It remains unclear whether the cases occurring outside the hospital are being caused by the same dangerous strain.
Canadian researchers, however, have found one possible culprit: popular new heartburn drugs. Patients taking proton pump inhibitors, such as Prilosec and Prevacid, are almost three times as likely to be diagnosed with C. diff, the McGill University researchers reported in the Dec. 21 issue of The Journal of the American Medical Association. And those taking another type called H2-receptor antagonists, such as Pepcid and Zantac, are twice as likely. By suppressing stomach acid, the drugs may inadvertently help the bug, the researchers said.
Whatever the cause, the infection often resists standard treatment. That is what happened to Shultz, who had been taking antibiotics to help clear up her acne when C. diff hit in June. Because the bacterium can hibernate in protective spores, patients can be prone to recurrences. It can take multiple rounds of antibiotics -- or sometimes infusions of antibodies or ingesting competing organisms such as yeast or the bacteria found in yogurt -- to finally cure them.
``I'm trying to stay positive,'' Shultz said. ``People tell me ... I will get rid of it someday. I'm looking forward to getting my life back, but I'm not convinced I'll ever be normal again.''
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
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I haven't been around here in quite awhile either, so this is NEWS to me.
After reading the article, I'm curious as to why they didn't further investigate whether probiotics were considered effective in warding off the potential to coming down with this new infection ???
I notice yogurt, and 'competing organisms' are mentioned as a potential cure for the c. diff. so I'm gonna choose not to worry about this one, altho I WILL be bringing this to my LLMD's attention.
Thanks again, Tu-Tu!
Hugs & Kisses,
-------------------- DR. Wiseass NOT a real doc - just a real wise Posts: 792 | From USA | Registered: Jan 2005
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posted
I was just reading up on saccharomyces boulardi yesterday. There are studies showing that it is effective in reducing the risk of c. diff. However, I just read another study, citing an increased risk for S. Cerevisiae Fungemia. (S. Cerevisiae is another saccharomyces). The researchers in this study recommended reconsidering the use of saccharomyces. Both were recent studies. Would anyone else like to take a stab at understanding all of this?
Posts: 422 | From Herndon, Virginia | Registered: Oct 2005
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Truthfinder
Frequent Contributor (1K+ posts)
Member # 8512
posted
Thanks for posting this! A friend of mine nearly died from C. Diff. just before Christmas. She was not on antibiotics and had not been in or near a hospital.
By the time she got herself to the ER, she was literally "expelling" the lining of her intestines. Sorry to be a bit graphic, but this is a serious problem, and D. Diff. is highly contageous. (So far, my friend appears to have responded well to the prescribed antibiotic treatment.)
Tracy
-------------------- Tracy .... Prayers for the Lyme Community - every day at 6 p.m. Pacific Time and 9 p.m. Eastern Time � just take a few moments to say a prayer wherever you are�. Posts: 2966 | From Colorado | Registered: Dec 2005
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GiGi
Frequent Contributor (5K+ posts)
Member # 259
posted
It's time to clean up our act. We have made a mess of our earth. This mircroorganism is just one that started to take over along with many others.
The earth is not really in danger. It's the humans -- the higher species that have evolved here under certain conditions that are really threatened. Is it closer than we know?
Take care.
Posts: 9834 | From Washington State | Registered: Oct 2000
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posted
Maybe failure to wash hands properly should be considered unprofessional medical/nursing conduct and subject to harsh disciplining.
I've often thought that if hospitals and dr. offices used a water purifier that eliminated most of the chlorine in their tap water, health professionals would be more willing to wash more frequently. Chlorine dries out your skin and makes it subject to cracking thus exposing the person who frequently washes to infection- so I understand there is more than apathy involved in the shody compliance regarding hand-washing.
This latest concern with c.dif makes it essential to finally face up to this problem and find solutions. The c.dif issue is not just about antibiotic use, from what I can understand.
-------------------- "Help Or Be Helpless" Please visit "Activism" board daily. See the threads regarding the IDSA Guidelines crisis and the threads about Dr. Charles Ray Jones and decide how best to help today! Posts: 1265 | From does not list | Registered: Jun 2004
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timaca
Frequent Contributor (1K+ posts)
Member # 6911
posted
I was just tested for this today, along with a general stool culture for pathogens.
My GI tract was FINE with all the antibiotics I took. But, due to a fungal infection in my picc line (somewhere); but not in me, I was taken off all antibiotics and given a strong anti-fungal drug.
That drug (or something else) upset my GI tract, and I've been intimately and frequently acquainted with "john" at our home. And due to these rapidly occuring events, my LLMD recommended I have the unsurpassed pleasure of submitting stool samples to the lab for the above cultures.
And while I was at it to give a bit more blood to check again for fungal infections.
Did I mention that I've been to the hospital lab so much recently, that they mailed me a holiday card with all of them signing it that had Santa on the front with test tubes in his sack? And the words inside said "Wishing you the best for the New Year." I guess they felt I needed all the best wishes I could get!!
I got the nickname today of "Culture Queen!"
Timaca
Posts: 2872 | From above 7,000 ft in a pine forest | Registered: Feb 2005
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dontlikeliver
Frequent Contributor (1K+ posts)
Member # 4749
posted
I read that C Diff is not easily killed by handwashing unfortunately.
Posts: 2824 | From The Back of Beyond | Registered: Oct 2003
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posted
In "Letters to the Editor" section of Washington Post today, Gabe Mirkin points out that more than a quarter of the patients in the study were NOT on abx. And, "the new bacterium appears to be associated with only one class of antibiotics, the quinolones, which includes Cipro, Levaquin, Avelox, Tequin, Factive, Floxin, Noroxin and Trovan. Avoidance of these abx and proton pump inhibitors, and consistent use of probiotics should put us on a level playing field.
Posts: 422 | From Herndon, Virginia | Registered: Oct 2005
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WildCondor
Unregistered
posted
C.difficile can be just as bad as Lyme Disease. I got it a year ago from Ketek, and my gut is still not the same. The GI doctors you see for this can be just as clueless as a duck who tells you Lyme doesn't exist. I have dealt with quite a bunch of GI's and they are mostly closed minded, or uneducated on the current reality of infections. They rely so much on the testing.
When I first came down with it I was in the hospital for 3 days with a 104 fever and severe diarrhea. They put me on IV fluids and Tylenol wile they waited for the stool cultures to come back. They came back negative and sent me home saying I had the stomach flu, gave me Phenegran and Tylenol, and I slept for 3 days. the fever kept coming back and the diarrhea and painful abdominal cramps never stopped.
Finally I went to a new GI and they tested me again for c.diff. What I found out was that the hospital only tested me for c.difficile toxin A, not toxin B, which is what I had, and still had a month later. When I finally got that test result, I was put on Flagyl, and Flagyl alone for 10 days.(Not long enough) Felt better in one day, fever broke, and diarrhea went away. Of course 4 days after stopping the Flagyl, it came back, this time much worse, and much more painful. I landed in the hospital again, and had an evil week of IV Flagyl and oral vancomycin before a colonoscopy showed microscopic colitis and not c.difficile. Pentasa, Asacol, Nexium, Questran, all of that stuff did not help. Pills for pain and cramping only made me sleep. Xanax helped a wee bit, but again, the sleepies. Remind you of something?
The doctors just dont know! When admitted to the hospital I was already on oral vancomycin so it probably threw off the test. They waited 6 days before doing the colonoscopy w/biopsies, so again, the testing could be false negative. What a mess, I swear its just like Lyme and at many times worse. Since then gut is still a ball of pain and cramping, cant take antibiotics, have been off a year.
Hopefully another new GI (#4) will be able to help! Probably need long term treatment and a gradual taper. If one more duck GI says I have Irritable Bowel Syndrome, I'll be really ready to explode! Make sure you take TONS of probiotics are needed and sacc. boulardi (florastor is great)
Just sharing some personal info. on c.diff, it can really ruin your intestines, so be SUPER careful to take tons of probiotics and if you ever do suspect c.diff, make sure the lab you do stool cultures at tests both toxins A& B.
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And due to these rapidly occuring events, my LLMD recommended I have the unsurpassed pleasure of submitting stool samples to the lab for the above cultures. ![[Eek!]](eek.gif)
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