Re: the next chemical holocaust

January 2, 2006

Thanks to the prolific use of antibiotics and those wonder pills -- proton

pump inhibitors -- that cure your Acid Reflux DISEASE, they have managed to

create yet another scourge for us to deal with -- a scourge that can potentially

kill you. So deadly is this bacteria that I know a massage therapist who

will no longer treat her clients if they have had a recent bout of diarrhea.

Stomach acid keeps this critter at bay, but the latest drugs such as Nexium,

Prevacid, etc. inhibit stomach acid and allow the bacteria to flourish. UGH!

Stomach Bug Mutates Into Medical Mystery

Antibiotics, Heartburn Drugs Suspected

By Rob Stein

Washington Post Staff Writer

Friday, December 30, 2005; A01

First came stomach cramps, which left Shultz doubled over and

weeping in pain. Then came nausea and fatigue -- so overwhelming she couldn't

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, a 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 Mc 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, however, be the latest example of a common, relatively benign bug

that has mutated because of the overuse of antibiotics.

" This may well be another consequence of our use of antibiotics, " said

G. Bartlett, an infectious-disease expert at s Hopkins University in

Baltimore. " It's another example of an organism that all of a sudden has gotten

a

lot meaner and nastier. "

In addition, 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 earlier 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, Mc 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

that 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. "

But 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 .

" Because this strain is resistant, it can take advantage of that situation

and establish itself in the gut, " Gerding said.

Experts said the resistant germ's proliferation offers the latest reason why

people should use antibiotics only when necessary, to reduce both their risk

for C. diff and the chances that other microbes will mutate into more

dangerous forms.

" That's one theory for what's happening here, " said J. Lamont of

Harvard Medical School. " 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. "

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.

In addition to being resistant, the dangerous 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 people who had never been in the hospital and 10

women who had been hospitalized only briefly to deliver a baby, the agency

reported this month. Eight of the patients had never taken antibiotics.

" This is the first time we've started to see this not only in people who have

never been in the hospital but also in those who are otherwise perfectly

healthy and have not even taken antibiotics, " Mc said.

" It's probably going on everywhere, " he said.

It remains unclear whether the cases occurring outside the hospital are being

caused by the same dangerous strain.

" We don't really know what's going on here, " Mc said. " We know it's

changing in some ways; we know it's changing the kinds of patients it's

attacking, and we know it's causing more severe disease. But we don't know

exactly

why. "

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 it does go away

and 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. "

January 2, 2006