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A Bug for All Seasons
(Clostridium difficile)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 11 in the August 2-3, 2008 issue of
The Mississauga News under the feature: Health & Wellness, Medicine Matters.

Some bacteria have all the luck. Take C. Difficile (Clostridium difficile) for example. The hardy Clostridium genus of bacteria continues to grab the medical spotlight. There is nothing new about this family, and you heard about its cousins causing serious diseases in the past. The age-old "tetanus" shots, which we all receive, are to prevent a nasty disease caused by Clostridium tetanus. This bacteria produces a toxin that can paralyze our muscles and make them go into repeated spasm. The Clostridium bacteria are anaerobes, which means that they can all grow in the absence of oxygen. This is why they can survive in damaged tissue and result in gangrene. They are commonly found in the soil around us, can produce spores and many also produce toxins. Botulism is another member of this family, Clostridium botulinium. Living in the soil means that they can make it into our food supply, and occasionally do.

Clostridium difficile is a bit of a problem at the present time, and is a leading cause of bowel inflammation and diarrhea in sick hospitalized patients. There are many different strains of C. difficile. The bacteria are not the problem, but the toxins that they produce are. I paraphrase Yul Brenner as Taras Bulba: "The first rule of battle is to study and learn all there is to know about your enemy!" Some bacteria produce no toxin, but most others produce two types, A and B. Every medical student knows that the greatest risk for infection is in elderly hospitalized patients with multiple medical problems who have been treated with a "strong" antibiotic, the classical example being clindamycin. When examining the colons of these patients, the bacteria form clumps on the walls looking like a false membrane, and hence the disease state is often called pseudomembranous toxic mega-colon. It reaffirms the need to use antibiotics, herbs and "cleansers", appropriately. Our bowels are living systems, with many beneficial bacteria present to aid in digestion, absorption and proper functioning. The bacteria live in harmony with each other and us. They have the ability to keep each other in check and prevent overgrowth. We refer to this as the fecal flora. Antibiotics and other substances can affect this harmony.

Beneficial bacteria will perish as a consequence of destroying the pathogenic bacteria. It is difficult to target a single bacterial family. The effect disrupts the harmony and allows hardy bacteria such as Clostridium to overgrow. Having good levels of stomach acid seems to offer some protection, since people taking acid suppressing medication are slightly more prone to infection. C. difficile infection will throw the colon into disharmonic spasm. When your colon doesn't function, ingested substances rush right through, producing pain and cramping. The end result is watery diarrhea. Incidentally, the word diarrhea is often misused to refer to a single watery bowel movement. Diarrhea refers to frequent, loose and watery stools. Two movements do not a diarrhea make. In addition to loose stools, patients will exhibit fever, chills and may progress to overwhelming infection called fulminant sepsis. This bacterium is not airborne and is spread by contamination or ingestion. The diagnosis is made by a simple stool culture test. Healthy people have little to worry about. C. difficile infections are treatable but can recur. They cluster in hospital settings where there is a greater likelihood of finding easy hosts whose immune systems are compromised in some way. Like influenza viruses, they may not be the sole cause of death but can send an already ill person into a fatal tailspin.

Preventing spread can be as simple as washing your hands. More importantly, perhaps it is time to re-examine the "open" hotel-style concept that hospitals are adopting, and start providing dedicated and mandatory change and sanitary facilities for all staff accessing patients. There was a time, when appearing on a medical ward in "street" clothes would result in a tongue-lashing by the head nurse. The facilities to change, shower and maintain this barrier have been largely replaced by gel bottles mounted on walls. Segregated and nourishing eating areas have been replaced by profitable mini-malls that are hospital fixtures. Food wrappers, coffee cups, winter clothing, dirty boots, shopping bags, and lunches are fixtures in patient care areas out of necessity, while staff attired in hospital gear wander the outside grounds and shopping malls. I applaud the idea of examining the need to control the spread of deadly diseases. I wonder if any such commission would consider saving millions of dollars, and take a few retired head nurses out for dinner. The insight would be worth its weight in microbiological gold.

Related resources:
Infectious Disease: C. difficile from MayoClinic.com. Definition, Symptoms, Causes, Risk factors, Tests and diagnosis, Complications, Treatments and drugs, Prevention.
Clostridium difficile from Wikipedia, the free encyclopedia.
Fact Sheet - Clostridium difficile (C. difficile) What is Clostridium difficile (C. difficile)? From Health Canada. Symptoms of C. difficile, Health Risks of C. difficile, Minimizing Your Risk. "Clostridium difficile, commonly called C. difficile, is a bacterium that causes diarrhea and other serious intestinal conditions. It is the most common cause of infectious diarrhea in hospitalized patients in the industrialized world."
A simple guide to Clostridium difficile from Department of Health, UK. Who gets C. difficile infection? How does it spread? How is it diagnosed? What is type 027 and why is it of concern? Prevention and control.
Clostridium Difficile Colitis. Antibiotic-Associated Colitis, C. difficile Colitis - from MedicineNet.com.
Overview of Clostridium difficile Infections from Centers for Disease Control and Prevention (CDC). Clostridium difficile is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis. Prevention and Control, Data and Statistics.

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