Stomach Bug Mutates Into Medical Mystery - Clostridium difficile - Antibiotics, Heartburn Drugs Suspected

[Guest guest]

" 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. "

YOu cannot mess with mother nature. I'm sure she isn't on probiotics

either. The HUGE use of antibiotics during pregnany, delivery, continuing

thru infancy, toddlerhood, childhood and adulthood is to blame and it is

JUST NOT NECESSARY

See a homeopath to begin with and avoid all this grief

Sheri

Stomach Bug Mutates Into Medical Mystery

Antibiotics, Heartburn Drugs Suspected

By Rob Stein

Washington Post Staff Writer

Friday, December 30, 2005; A01

http://www.washingtonpost.com/wp-dyn/content/article/2005/12/29/AR2005122901

575.html

[foto] Shultz, 35, has battled Clostridium difficile for six

months. Until recently, it was largely confined to older patients and was

easily cured.

Photo Credit: By Cj Gunther For The Washington Post

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. "

© 2005 The Washington Post Company

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