Tag: C. Difficile

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Health

C. Difficile…so difficult!

Clostridium difficile is a bacterium that is resistant to many antibiotics – hence the name “difficile” since it’s difficult to treat! It is the most common cause of infectious diarrhea in hospitals and nursing homes in Canada and other industrialized countries.

Most cases occur in patients taking certain antibiotics that kill a wide range of bacteria (referred to as broad-spectrum antibiotics) in high doses or for a long period of time. The normal bacterial flora in the digestive system that keep c. difficile in check is destroyed by the antibiotic, allowing the resistant c. difficile to take over. These infectious bacteria produce toxins that damage the bowel, and cause diarrhea and inflammation in the lining of the bowel.

Some people can have c. difficile in their bowel and not show symptoms, likely because other bacteria are keeping its growth in check. There are different strains of c. difficile and some cause more serious illness.

Stomach acid helps to kill unfriendly bacteria like c. difficile if we happen to swallow some. Acid-suppressing drugs, especially proton pump inhibitors (like Losec®, Tecta®, and Nexium®) that strongly block acid production, can increase the risk of a symptomatic infection of c. difficile.

How is it passed from person to person?

C. difficile bacteria and their spores are found in feces. People can get infected if they touch surfaces contaminated with feces and then touch their mouth… (How gross!) This helps you understand how important it is to wash your hands regularly!

If you are healthy, generally there is actually little risk of developing an infection. But in the elderly and those with other illnesses whose immune system may be less healthy, there is a greater chance of infection.

It’s important to keep the normal gut bacteria healthy. When there are fewer normal healthy bacteria in the gut, c. difficile have a better chance to grow and cause infection. Include fermented foods that contain live bacteria in your diet, and take probiotics after a course of antibiotics. This will help to replace the good bacteria that are often destroyed along with the bad ones that caused the infection and maintain a healthy gut flora.

What are the symptoms?

C. difficile infection causes watery diarrhea, fever, decreased appetite, nausea, and abdominal pain or tenderness. The diarrhea usually does not respond to regular diarrhea medications and will last more than the 2 or 3 days of diarrhea from other causes. A stool sample is often tested to confirm that the cause of the diarrhea is c. difficile.

How can you prevent c. difficile?

Wash your hands often with soap and water. Healthcare workers should always wash their hands after touching every patient to prevent passing bacteria and other infectious organisms from one patient to another (or to themselves!). At home, always wash your hands after caring for an ill person, using or helping with toileting and before preparing or eating food.

Alcohol-based hand washes help but are not as effective as soap and water as they do not kill c. difficile spores. Wearing disposable gloves when caring for someone with c. difficile is recommended and hands should be washed with soap and water when the gloves are removed.

How is c. difficile infection treated?

The antibiotic that caused the infection should be stopped right away, and a new antibiotic that kills c. difficile will often be started. Very mild cases may clear on their own.

C. difficile is resistant to many antibiotics, hence the name “difficile – difficult to treat! Metronidizole (Flagyl®) is an antibiotic that may be effective for mild to moderate infections. Vancomycin (Vancocin®) is used for more severe infections and it is considerably more expensive than metronidazole. A new antibiotic, fidaxomicin (Dificid®) showed better results against c. difficile in studies, but it is very expensive.

Taking probiotics (good bacteria in capsule form) in large doses has been reported to help when all else has failed, or as an add-on to antibiotic treatment. It also helps to prevent reinfection, which occurs in 20% of cases.

In extreme cases, the diseased part of the bowel may be surgically removed. Fecal microbiota transplantation (also known as stool transplant) is another new therapy that may be tried in recurrent infection. Donors are screened for infections, parasites, viruses and other bacteria. Stool from the donor is then placed into the infected person’s bowel using a colonoscope or nasogastric tube.

References

https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

http://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/treatment/txc-20202426

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Book review Health

Bacteria for Breakfast, Probiotics for Good Health – A book review

Did you know that at least 90% of our bodies’ cells are not human? They are bacteria that live mostly in our digestive system (about 3 pounds worth!), as well as on our skin, in the lungs, and within the urinary and genital tracts.

These are “good” bacteria that help prevent disease by reducing growth of “bad” bacteria that can cause harm. These good bacteria also produce some nutrients that we need, help digest our food, provide energy in the form of short chain fatty acids, and stimulate our immune systems. And, just being there in sufficient numbers, they crowd out other bacteria that could cause us harm. The make-up of this bacterial flora varies from person to person, and may account for our variable risks for certain diseases.

Pharmacist, Dr. Kelly Dowhower Karpa, wrote Bacteria for Breakfast, Probiotics for Good Health after using probiotics (supplements of good bacteria) to cure her 2-year-old son’s infection of C. Difficile bacteria that was resistant to all antibiotics that his doctors tried. She did extensive research into how these good bacteria keep us healthy before beginning to write and, although some parts of her book are quite technical with explanations designed to answer questions doctors may have, the book is written for the general public. The goal of her book is to educate patients themselves, and to enable them to discuss their gut health with physicians. I will present a brief overview of some of the topics she discusses.

The book focuses on bacteria that live in our digestive systems, from the mouth where they prevent bad breath and dental cavities that can be caused by unfavourable bacteria, to the intestines where imbalances can promote inflammatory diseases. It explains how the stomach is designed to produce acid that kills bacteria that may be in our food but when acid is chronically suppressed with commonly used medications, such as Zantac, Losec (Prilosec), Nexium, etc., or is naturally reduced these bacteria are more likely to survive and the risk of gut infections is increased.

Food allergies can occur when overgrowth of bacteria damages the lining of the bowel, allowing undigested food particles to pass through into the blood stream, triggering allergic reactions to these large proteins that are not normally found in blood (termed “leaky gut syndrome”). This “leakiness” is also associated with inflammation, severe infection, organ failure and even death. Wide-spread activation of the immune system can lead to inflammation, severe allergies, asthma, eczema and even anaphylaxis (a life-threatening allergic response).

The incidence of these immune-related conditions has exploded in the past 50 years, suggesting non-genetic factors are involved. Two major changes are increased hygiene resulting in less exposure to various bacteria, and change in diet with more sterile pre-packaged food and less fresh, fermented and dried foods that would contain various bacteria. Our first exposure to bacteria usually occurs during birth, when passing through the birth canal, so babies born by Cesarian Section do not receive this initial dose of good bacteria and sometimes never develop an ideal gut flora. As well, if the mother has a less than ideal balance of bacteria, then this is what is passed on to the baby.

The effect of our bacterial flora can easily be seen in changes in the daily elimination function of the bowel. After treatment with a course of antibiotics, which kill healthy bacteria along with the infectious bacteria being treated, bowel function often changes with development of either diarrhea or constipation that can be corrected with supplements of good bacteria (probiotics). You may have noticed a difference in your digestion after eating fermented foods that still contain live bacteria. Chronic constipation that is resistant to various laxatives or returns as soon as the laxative is discontinued, will also sometimes respond to a course of probiotics. Keep in mind that probiotic supplements generally contain much more bacteria than you would get in foods like yoghurt, and might be preferred when trying to correct a serious imbalance in gut bacteria.

Dr. Karpa also explains an additional hypothesis for how bacteria may increase our risk for disease in detail with supporting evidence from studies. Although complex, I will try to explain this briefly…

The gastrointestinal tract is considered to be the largest immune system organ, and it communicates with the immune system throughout the body by producing immune particles called cytokines. Good bacteria activate the immune system, by stimulating production of cytokines that create a low-level inflammation. Some of these cytokines also enable production of the thick layer of mucous that protects the cells that line our digestive system. Still other cytokines are produced that limit the amount of inflammation that is created.

If we do not have the correct balance of cytokine-producing bacteria, we could be missing the protective mucous layer (allowing damage to occur in the intestinal wall with resulting leakage of undigested food proteins), we could be lacking enough stimulation of the immune system (leading to poor protection against common infections) or we could become less able to block excessive inflammation (leading to autoimmune diseases like allergies, asthma, inflammatory bowel disease, rheumatoid arthritis, etc.). The book cites many examples of improvement in chronic health conditions with adequate supplementation of probiotics (or good bacteria) and explains in detail how changes in gut flora are connected with various health conditions.

Disturbed gut flora has been described as potentially playing a critical role in the development of various autoimmune diseases (where the body’s immune system attacks an organ system) such as:

  • Inflammatory bowel disease

  • Type 1 diabetes

  • Rheumatoid arthritis

  • Hashimoto’s Disease (thyroiditis)

The book also briefly describes the benefit that some patients experience by also adding pancreatic enzymes or plant enzymes to help digest food, leading to a reduction in food allergies presumably by increasing the breakdown of proteins they contain. This might be another avenue to discuss with your physician if you have chronic severe food allergies.

As a pharmacist, I believe it is preferable to prevent disease or to treat the root cause, if possible, rather than to simply control the symptoms. I think this is why I found this subject fascinating and wanted to share a little of this information with you.

Other recent research I have stumbled across, suggests that gut bacteria may also be associated with changes in the frontal lobe of the brain that could be associated with autism or schizophrenia. Another report suggests a possible association between gut bacteria and the ability to create the protective myelin sheath (the covering that insulates nerve cells) that is destroyed in degenerative nerve diseases like Multiple Sclerosis. Probiotics have even been noted to increase the beneficial effect of vaccines. So you can easily see that many problems may originate with imbalances in the digestive system’s bacteria, and research continues to look for these associations and how they occur.

If you are interested in reading further, here is information on the book I have reviewed:

Bacteria for Breakfast; Probiotics for Good Health, Dr. Kelly Dowhower Karpa, Trafford Publishing, ISBN 1-4120-0925-0.