C. Diff Diarrhea Is Getting More Common, and is Hard to Treat

Clostridium difficile, commonly shortened to "C. diff." is a bacterium that causes symptoms ranging from diarrhea to life-threatening inflammation of the colon.  Illness from C. diff usually affects older people in hospitals or long-term care and typically occurs during or shortly after a course of antibiotics.  Mild to moderate cases exhibit watery diarrhea, three or more times a day, with abdominal cramps and tenderness.  Severe cases have diarrhea 10-15 times a day, with blood and mucus, fever, dehydration, and weight loss.  The colitis can prove fatal, though people in good health don’t usually fall sick from C. diff.

The standard treatment for C. diff is another antibiotic, usually metronidazole (Flagyl®) or vancomycin.  However, 25% of patients may fall sick again, due to re-infection, or resistance of the bacterium to treatment.  This means researchers are looking for effective means to treat recurrent cases.   Two original approaches were reported at the recent American College of Gastroenterology.

The first method describes the use of the curry spice, turmeric, to prevent infection (or re-infection) with C. diff.  The growth of the bacterium was inhibited in lab studies, but results form ‘real-world’ studies are not available, yet.  However, Indian people have been using turmeric for more than 2,000 years to ward off diarrhea, so maybe it will work for C. diff.  We’ll see.

The next method was the use of fecal transplantation by colonoscopy, reported in 3 small studies.  It’s done like this.  Fresh stool from healthy ‘donors’ (who’ve been pre-screened for C. diff, hepatitis A, B, C, and HIV) is prepared by liquefaction with saline, and roughly 400 mL infused into the cecum and along the colon during withdrawal of the colonoscope.       

In the first study, 15 of 16 patients had complete relief of diarrhea after 5 months’ follow-up.  In the second study all 12 patients, who had recurrent disease, experienced complete relief of symptoms during the 7-month follow-up.  The third study involved 2 patients, who had complete resolution of symptoms immediately following the transplant, and maintained this for more than 9 months’ follow-up.

Finally, there’s a preliminary report from the same meeting that suggests that there’s a decreased risk of contracting C. diff  in hospital if the subject is taking aspirin regularly – and 325 mg (a standard aspirin) is more helpful in this respect than a ‘baby’ aspirin (81 mg). 

These are fairly spectacular results for a procedure that may seem unpleasant, but in fact is relatively simple.  Maybe C. diff won’t present such a frightening prospect in future.