Photo via National Institutes of Health
A nasty gut bacteria called Clostridium Difficile (or C. Diff) is reportedly attacking patients who've recently been to the doctor at a rate of nearly 500,000 infections per year according to a paper published Wednesday in the New England Journal of Medicine. If you get it, you may soon be dealing with the three worst words in the English language: painful, deadly diarrhea.We hear about stuff that can kill us all the time, of course, and it's hard to tell how worried we should be about individual maladies—remember Ebola? With so much health-related white noise in the news, how concerned should we be about C. Diff?The short answer: If you've taken antibiotics lately, or you know someone who has, you really should be a little concerned. That's what Elizabeth Hohmann, a gastroenterologist who is also a pioneer in the treatment of C. Diff infections, told me.I interviewed Dr. Hohmann to figure out where "pooping yourself to death due to a C. Diff infection" should slot into my buffet of medical fears. She didn't exactly put my mind at ease, but she did remind me about the exciting news that fecal transplants are coming to a hospital near me.VICE: How scared should we be about getting deadly diarrhea?
Elizabeth Hohmann, MD: A little bit more worried than we were before that paper was published. I think the key finding of the paper is that there's even more of this than we thought and an even greater appreciation that it can be a fatal disease, especially in fragile old people.Why are people at risk after going to the doctor?
Most people get C. Diff after antibiotics are given for another illness. They kill a lot of those beneficial bacteria in our intestines, which can create fertile ground for C. Diff to grow up, take hold, reproduce, and create toxins and bring about the mayhem that it does. I think this is yet another wake up call about antibiotic abuse. When we don't need antibiotics we should not be using them.Is it considered an "antibiotic resistant" bacterial infection?
That's a tough question actually. It's an anaerobic bacterium, meaning it doesn't grow in the air, so it's actually very difficult to assess its sensitivity to antibiotics. To grow it you have to keep it in a strict environment with no air present. Unlike bacteria you just throw on an agar plate and grow it in a 37-degree incubator, it's actually quite a thing to assess.But it's related to that issue, right?
It's certainly a product of antibiotic overuse.What are some of the symptoms people deal with?
Basically diarrhea. Abdominal pain, cramping, sometimes fever, nausea, vomiting. But the first signal is diarrhea.But obviously not everyone with diarrhea has it.
It gets complicated because a lot of people on antibiotics, like for sinusitis, get antibiotic-associated diarrhea that's not C. Diff. So a lot of doctors think, Oh, it's just antibiotic-associated diarrhea. It's gonna go away, and then it gets worse and worse and worse.Would you say this report came out to correct those misdiagnoses?
[That] and nobody wants to talk about it. And patients who have this are sometimes treated like pariahs! I've had patients who told me, "Once it got out that I had this no one wanted to come to my home." It's a spore-forming bacteria, which is why doctors and hospitals get agitated about it.Oh God, is it really that contagious?
No. I take care of patients with C. Diff all day long some days. I'm a perfectly healthy person though, and I'm like bathing in it probably, around all these people with diarrhea, but I don't get sick. Because it's not enough to just be exposed.So you have to be exposed to it to get it, and on antibiotics. Anything else?
Another thing that makes people more susceptible is having no stomach acids. A lot of people are on these powerful medications [like omeprazole] that really knock out your stomach acid. I ask them, and they don't even know why they're on it.So other than antibiotics, how are you treating it C. Diff?
After that, you start talking about things like fecal transplant. Really, it's taking poop from a healthy person and putting it into the colon. You can do that by an enema. You can do it by colonoscopy. You can use a nasogastric tube. Or you can do with—as we have made—a capsule. You can make one from processed stool, and give it to people as capsules.But just to be clear, people who think they might have C. Diff trying to give themselves fecal transplants…
Bad idea. Very bad idea. It needs to be medically supervised. You need the right kind of screening for the donor, and a medically safe form of administration.Follow Mike Pearl on Twitter.
Annons
Elizabeth Hohmann, MD: A little bit more worried than we were before that paper was published. I think the key finding of the paper is that there's even more of this than we thought and an even greater appreciation that it can be a fatal disease, especially in fragile old people.Why are people at risk after going to the doctor?
Most people get C. Diff after antibiotics are given for another illness. They kill a lot of those beneficial bacteria in our intestines, which can create fertile ground for C. Diff to grow up, take hold, reproduce, and create toxins and bring about the mayhem that it does. I think this is yet another wake up call about antibiotic abuse. When we don't need antibiotics we should not be using them.Is it considered an "antibiotic resistant" bacterial infection?
That's a tough question actually. It's an anaerobic bacterium, meaning it doesn't grow in the air, so it's actually very difficult to assess its sensitivity to antibiotics. To grow it you have to keep it in a strict environment with no air present. Unlike bacteria you just throw on an agar plate and grow it in a 37-degree incubator, it's actually quite a thing to assess.
Annons
It's certainly a product of antibiotic overuse.What are some of the symptoms people deal with?
Basically diarrhea. Abdominal pain, cramping, sometimes fever, nausea, vomiting. But the first signal is diarrhea.But obviously not everyone with diarrhea has it.
It gets complicated because a lot of people on antibiotics, like for sinusitis, get antibiotic-associated diarrhea that's not C. Diff. So a lot of doctors think, Oh, it's just antibiotic-associated diarrhea. It's gonna go away, and then it gets worse and worse and worse.Would you say this report came out to correct those misdiagnoses?
[That] and nobody wants to talk about it. And patients who have this are sometimes treated like pariahs! I've had patients who told me, "Once it got out that I had this no one wanted to come to my home." It's a spore-forming bacteria, which is why doctors and hospitals get agitated about it.Oh God, is it really that contagious?
No. I take care of patients with C. Diff all day long some days. I'm a perfectly healthy person though, and I'm like bathing in it probably, around all these people with diarrhea, but I don't get sick. Because it's not enough to just be exposed.So you have to be exposed to it to get it, and on antibiotics. Anything else?
Another thing that makes people more susceptible is having no stomach acids. A lot of people are on these powerful medications [like omeprazole] that really knock out your stomach acid. I ask them, and they don't even know why they're on it.So other than antibiotics, how are you treating it C. Diff?
After that, you start talking about things like fecal transplant. Really, it's taking poop from a healthy person and putting it into the colon. You can do that by an enema. You can do it by colonoscopy. You can use a nasogastric tube. Or you can do with—as we have made—a capsule. You can make one from processed stool, and give it to people as capsules.But just to be clear, people who think they might have C. Diff trying to give themselves fecal transplants…
Bad idea. Very bad idea. It needs to be medically supervised. You need the right kind of screening for the donor, and a medically safe form of administration.Follow Mike Pearl on Twitter.