Stomach Bug Mutates Into Medical Mystery

[Guest guest]

> Stomach Bug Mutates Into Medical Mystery

> Antibiotics, Heartburn Drugs Suspected

>

> By Rob Stein

> Washington Post Staff Writer

> Friday, December 30, 2005; Page 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. "

>

>

>