Fwd: Stomach Bug Mutates Into Medical Mystery

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> Antibiotics, Heartburn Drugs Suspected

> By Rob Stein

> Washington Post Staff Writer

> Friday, December 30, 2005; A01

>

> First came stomach cramps, which left Christina 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 McDonald

> 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

> John G. Bartlett, an infectious-disease expert at Johns 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, McDonald 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. Thomas 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, "

> McDonald 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, " McDonald 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. "

>

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

> AR2005122901575_pf.html

>