C. Diff: New Threat From Old Bug (recently found in North American meat)

[Niko]

C. Diff: New Threat From Old Bug

Epidemic Gut Infection Causing Rapid Rise in Life-Threatening Disease

By Daniel DeNoon, WebMD Medical News

Reviewed By Louise Chang, MD, Thursday, October 12, 2006

Oct. 12, 2006 -- The ongoing epidemic of severe C. diff diarrheal disease -- driven by a 20-fold more toxic mutant strain of the bacteria -- is fast getting worse.

C. diff is shorthand for Clostridium difficile. About 3% of the population carries the bug without knowing it. Normal gut bacteria usually keep C. diff in check. Many antibiotics that kill normal bacteria don't kill C. diff. That lets it take over the gut during or after antibiotic treatment.

Spread by spores that can live for months on dry surfaces, the bug makes a toxin that poisons the intestine. Disease ranges from mild diarrheadiarrhea to life-threatening colon infection with profuse diarrhea.

Once mostly confined to elderly, hospitalized patients, a bad new strain of the bug is attacking healthy, young people outside the hospital. The full extent of this community spread of C. diff isn't yet known. But it's a growing problem, says CDC medical epidemiologist L. Clifford McDonald, MD.

"We have seen this bacteria in people not usually infected with it," McDonald tells WebMD. "We see generally healthy, young people who had not been in the hospital coming down with severe C. diff disease."

McDonald's CDC team made one of several reports on the alarming C. diff epidemic at this week's annual meeting of the Infectious Diseases Society of America (IDSA), held Oct. 12-15 in Toronto, Ontario.

Nasty New C. Diff Bug

It's not yet clear what is behind the new epidemic of C. diff disease. There are several factors:

* The bug is becoming resistant to the most commonly used antibiotics.
* A kind of heartburnheartburn drug called a proton-pump inhibitor -- including Aciphex, Prevacid, Nexium, Prilosec, and Protonix -- appears linked to C. diff infections.
* A bad new strain of C. diff is spreading across the globe.

It's that bad new bug that most worries Fred Arthur Zar, MD, medical director at the University of Illinois Hospital and professor of medicine at the University of Illinois at Chicago.

"The new strain of C. diff has become the most predominant strain," Zar tells WebMD. "The reason it is more nasty is it mutated and figured out a way to make 20-fold more toxin than the normal strain. ... If you have it, you get sick, and you need medical attention."

In addition to making about 20 times more of the two toxins produced by normal C. diff, the new strain makes a new, third toxin similar to a toxin seen in other disease-causing bacteria.

According to the CDC, the new strain of C. diff already has invaded at least 19 U.S. states: California, Connecticut, Florida, Georgia, Illinois, Maine, Maryland, Massachusetts, Missouri, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Tennessee, Texas, Washington, and Wisconsin.

It has spread throughout Canada and, according to McDonald, is "wreaking havoc" in England, the Netherlands, Belgium, and France.

Vancomycin to the Rescue?

As it happens, Zar had been studying the best way to treat C. diff infection when the current epidemic broke out. In a clinical trial, he's been comparing the currently recommended treatment for C. diff -- the antimicrobial drug Flagyl -- with a powerful antibiotic called vancomycin.

Vancomycin is known to work against C. diff. But doctors have been reluctant to use it -- not only because it costs more, but also because it's the last line of defense against a number of other nasty infections. Once it's in common use, it's only a matter of time before many of these germs become vancomycin resistant.

However, Zar's team reported to the IDSA that vancomycin cures severe C. diff disease 97% of the time -- compared with a 76% cure rate for Flagyl.

"Fortunately, we've seen no vancomycin resistance in C. diff -- yet," Zar says. "But we know that the bug can develop resistance to this antibiotic."

Community Infections Spreading

McDonald isn't yet ready to blame all of C. diff's resurgence on the bad new strain. Nor is the CDC yet sounding the alarm over the community spread of C. diff. But his CDC team has documented a growing problem.

Together with Duke University researchers, McDonald's CDC team analyzed more than 1,200 C. diff cases treated at six North Carolina hospitals.

"The general picture is that about one in five cases of C. diff in North Carolina hospitals were community-associated -- we think community-acquired -- in people not hospitalized for at least three months, most of them not for two years," he says.

That comes out to as many as 30 cases per 100,000 population per year -- as much as a threefold jump over previous rates. Even though doctors don't routinely report C. diff infections, the CDC has documented a sharp rise in cases. The latest statistics show that this increase continues to accelerate.

"This tells us that community-acquired C. diff is a lot more common than we would have thought," McDonald says. "In the past, we felt it was a prerequisite for people to have antibiotic exposure to get C. diff. And these community cases we looked at, over half had no antibiotic exposure. That is making a lot of us scratch our heads."

It may be that C. diff disease will become as big a problem as the current epidemic of drug-resistant staph infectionstaph infection.

"This epidemic is very concerning because it is so dynamic," McDonald says. "We are seeing a very steep curve upward in C. diff cases. Anything moving that quickly we need to address seriously -- and we are."

What to Do

McDonald and Zar stress two points. The first is that taking antibiotics is not without risk -- and one of the risks is C. diff disease.

The other point is that C. diff infection can be prevented -- by hand washing. Unfortunately, alcohol-gel hand sanitizers don't kill C. diff. McDonald and Zar warn anyone who has contact with a diarrheadiarrhea patient to thoroughly wash their hands with soap and warm water.

Finally, McDonald and Zar warn people to be on the lookout for C. diff symptoms.

"If you get diarrhea that lasts more than three days, or if you get diarrhea accompanied by fever or blood in the stool, seek medical attention," McDonald says.

SOURCES: 2006 Annual Meeting of the Infectious Diseases Society of America, Toronto, Ontario, Oct. 12-15, 2006. Clifford McDonald, MD, medical epidemiologist, CDC, Atlanta. Fred Arthur Zar, MD, medical director, University of Illinois Hospital; professor of medicine, University of Illinois at Chicago. CDC web site.


http://psychologytoday.webmd.com/content/article/128/117108

 

[ruthbeme]

Feared bacteria found in Canadian meat

Feared bacteria found in Canadian meat

Feared bacteria found in Canadian meat
Oct. 15, 2006. 06:10 PM
HELEN BRANSWELL
CANADIAN PRESS

<!-- icx_story_begin -->C. difficile bacteria have been found in a variety of ground and processed meats bought from grocery stores in Canada and the United States, an unexpected discovery some experts say may be linked to recent baffling changes in the pattern of the disease.
Some of the U.S. meats contained the hypervirulent C. difficile strain responsible for severe outbreaks in hospitals in Quebec, Britain and parts of the U.S. over the past few years, The Canadian Press has learned. In Quebec alone, the so-called epidemic strain is blamed for roughly 2,000 deaths in 2003 and 2004.
Though still largely a plague of the elderly in hospitals, C. difficile-associated disease has undergone unexplained shifts of late ? some deaths in younger people, more infections outside the hospital. At the same time there has been a rapid spread of the epidemic strain across North America and to Europe.
Experts keen to figure out what?s going on with this bug say the meat finding may provide a clue and must be explored.
?I don?t think we know what it means, but it?s a serious concern and it could potentially be contributing to cases, not only in the community but in hospitals as well,? said Dr. Dale Gerding, of Hines Veterans Affairs Hospital in Chicago, who was not involved in the research.
But it is too early to conclude people can develop the severe, recurrent and sometimes fatal C. difficile diarrhea by eating meat containing the bacterium, Gerding and other experts insisted.
?The bottom line is that we don?t have any evidence to say that C. difficile is a foodborne illness, that people get it from foods,? said Dr. Clifford McDonald of the U.S. Centers for Disease Control in Atlanta.
Two teams of researchers ? under Dr. Glenn Songer at the University of Arizona and Dr. Scott Weese at the Ontario Veterinary College in Guelph ? found C. difficile spores in some samples of ground beef, veal, turkey and pork, pork sausage, chorizo, summer sausage and liverwurst.
Nearly 30 per cent of the meats tested in Arizona and18 per cent tested in Ontario contained C. difficile. The Guelph team did not find the human epidemic strain.
A preliminary report of the Guelph work was to be presented Monday to the World Buiatrics Congress in France. (Buiatrics is the science of treating cattle diseases.)
Each team bought meat over a period of several months from three different grocery stores in Tucson, Ariz., and in the Guelph, Ont., area respectively. The two projects were conducted independently.
The Ontario researchers, who only tested ground beef and ground veal, are currently working on a larger sampling study, including meat bought in Quebec.
Both research teams had already shown C. difficile infects food animals like dairy calves and pigs. And some of the strains found in those animals ? and the sampled meat ? were virtually identical to some that cause disease in humans.
CDC laboratories confirmed the University of Arizona testing.
The CDC?s McDonald said it is a matter of ?public health urgency? to find out if meat is playing a role in the worsening profile of disease outbreaks.
?That?s one of our priorities, to start doing the types of studies to determine whether people who eat certain foods would be at increased risk over other persons who don?t eat those foods,? he said.
Songer, a veterinary microbiologist, hadn?t expected to find the bacterium when he started the meat testing, so when it turned up in virtually each type of product he sampled, he was startled. He said when he found the epidemic strain. ?I really about had a seizure.?
Still, Songer doesn?t think consumers should be alarmed at this point. ?What we need is more information, not panic.?
For one thing, no one knows if this is a new phenomenon, or if C. difficile spores ? which are widely dispersed in soil and water ? have always found their way into some meats. (Gerding noted though that a study of hospital food in the 1980s did not find C. difficile.)
Earlier this month, Songer and McDonald met with officials of the U.S. Food and Drug Administration and the U.S. Department of Agriculture?s Food Safety and Inspection Service to lay out the findings and discuss the need for further research.
Weese, whose lab did the Canadian sampling, said the fact that C. difficile is a spore-forming bacteria heightens the need for answers. Spores can potentially survive cooking, though exposure to temperatures of 80 C for 10 minutes will kill C. difficile, Gerding said.
?It?s something we need to explore,? said Weese.
?Currently, there is no objective evidence indicating that C. diff is a foodborne pathogen, but the recent changes in C. diff epidemiology and the emergence of C. diff as a community-associated pathogen necessitates looking at areas such as food to explain these changes.?
It has been known for about 25 years that C. difficile is a cause of severe and sometimes life-threatening diarrhea in people, typically elderly hospitalized people taking antibiotics. Antibiotics destroy the normal balance of bacteria in the gut, allowing C. difficile to run rampant.
Within the last eight years, though, the pattern of disease has shown signs of shifting.
Hospitals in Pittsburgh, then Quebec, Maine, Florida and later Britain began to report persistent outbreaks with sharply elevated death rates. Some deaths were among younger, previously healthy patients.
More recently, researchers are finding the disease in people who hadn?t been hospitalized, many of whom hadn?t recently taken antibiotics. How they became infected and why they were susceptible is a puzzle to scientists, who believe that C. difficile cannot cause illness unless the bacterial balance of the gut has been seriously disrupted.
Meat may provide some answers, experts acknowledge.
?The question is: Is it contributing to the current epidemic situation? Obviously we don?t know whether that?s a contributing factor or not,? Gerding said.
?But one of the things we?ve wondered about for years is: How does this epidemic strain get around so readily to such a wide variety of hospitals? And how does it spread from the U.S. to Europe, and country to country in Europe? So this is one possible vehicle for how that might occur.?
But until the issue has been studied further, that?s just a hypothesis. ?I think we?re a long way from saying that meat is an important part of the epidemiology of this disease,? said Dr. John Bartlett, of Johns Hopkins Bloomberg School of Public Health in Baltimore.
http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&col=968793972154&c=Article&cid=1160926565741&call_pageid=968332188492

 

[ruthbeme]

Re: Feared bacteria found in Canadian meat

Re: Feared bacteria found in Canadian meat

Some facts about C. difficile
What is it? ? Clostridium difficile is a spore-forming bacterium commonly found in nature.

What does it do in humans? ? Nothing happens to most people who ingest C. diff spores. But in those whose gut flora (the normal bacteria that inhabit our gastrointestinal tracts) has been disrupted by antibiotics, C. difficile can take root and cause serious disease.

What kind of disease? ? C. difficile triggers a severe, recurrent and hard to treat diarrhea. Relapses are common, sometimes over weeks and months. In severe cases it can destroy the colon. It can be fatal.

What's new? ? Research teams in Ontario and Arizona have found C. diff spores in a range of ground and processed meats, raising suspicions some people may be becoming infected by eating meat. But that is only a theory at the moment.

Quote: ? "As far as we know, we're exposed to C. difficile all our life, from early on in life. And there's not a lot of evidence that being exposed over and over out in the community hurts you. It may even help you. The exception, of course, is when you're taking antibiotics and your defences are lowered." ? Dr. Clifford McDonald, the CDC.

Source: Canadian Press
http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&col=968793972154&c=Article&cid=1160926565741&call_pageid=968332188492

 

[Sonny]

Re: Feared bacteria found in Canadian meat

Re: Feared bacteria found in Canadian meat

BBC NEWS

Scientists have decoded the genetic make-up of a bacterium responsible for many hospital-acquired infections - and shown why it is so difficult to tackle.

Clostridium difficile caused more than 44,000 infections in the UK in 2004 - mostly among the elderly.

Researchers found it can chop and change its genetic structure very easily - maximising its ability to neutralise attack by antibiotics.

The Sanger Institute study is published in Nature Genetics.

Its overall variation is remarkable
Professor Brendan Wren

The researchers hope their work will aid the search for new treatments, vaccines, and diagnostic tests.

The emergence of bacteria resistant to many of the leading antibiotics is a major problem facing healthcare providers worldwide.

C. difficile is a particular problem, because it can only be treated with two antibiotics, metronidazole and vancomycin - and there is concern that these will also soon become ineffective.

Bigger threat than MRSA

The bug is now more prevalent, and causes more deaths than the notorious superbug MRSA.

It causes a range of diseases from antibiotic-associated diarrhoea to a life-threatening colon disease, called pseudomembranous colitis.

The Sanger team found that half of the genes in C. difficile are absent from four of its bacterial cousins, including species that cause botulism and tetanus.

The researchers also found great genetic variation even between different strains of the bug.

Most important, and unlike its nearest relatives, C. difficile can readily exchange genes and resistance elements.

Researcher Dr Mohammed Sebaihia said: "The genome of C. difficile is in a state of flux.

"More than 10% of the genome consists of mobile elements - sequences that can move from one organism to another - and this is how it has acquired genes that make it such an effective pathogen.

"It has gained an array of genes that make it resist antibiotics, help it to interact with, and thrive in, the human gut and help it to change its surface.

"This combination gives it a hugely impressive range of resources to help it prosper in humans."

Few shared genes

Professor Brendan Wren, from the London School of Hygiene and Tropical Medicine, also worked on the study.

He said only 40% of genes were shared between the eight different strains of C. difficile analysed.

"Its overall variation is remarkable. The genetic comparison of these strains will help us understand how C. difficile ticks and help to explain how the hypervirulent strains emerged and spread so rapidly."

The study also found that C. difficile produces a chemical called paracresol, which kills other competing bacteria, and protects it from bile acids in the gut.

C. difficile thrives in the absence of oxygen and can "hibernate" in adverse conditions by forming spores.

It is thought these spores are responsible for most human infections, and because they are highly resistant to most disinfection methods they are very difficult to eradicate, and can spread easily.

Since 2003, a new and more virulent strain (called NAP1/027) has emerged in hospitals in North America and is now present in most UK hospitals.

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/5109384.stm

Published: 2006/06/25 23:09:25 GMT

© BBC MMVI

 

[AlaskaDenise]

Re: Feared bacteria found in Canadian meat

Re: Feared bacteria found in Canadian meat

This sounds like the progression with Johnes - first thought to be animals only, but now some think it's the organism behind some Chrones - micobacterium avian paratuberculosis.

.....But in those whose gut flora (the normal bacteria that inhabit our gastrointestinal tracts) has been disrupted by antibiotics, C. difficile can take root and cause serious disease.

How about guts impacted by chemotherapy? Worsened by the immune-killing work of same.

.

 

[ruthbeme]

Re: Feared bacteria found in Canadian meat

Re: Feared bacteria found in Canadian meat

Health Canada says it will monitor emerging findings on C. difficile in meat


<!-- wrapper01 end -->
Helen Branswell, Canadian Press

Published: Monday, October 16, 2006

TORONTO (CP) - Canadian health and food safety authorities said Monday they do not plan to take any immediate action in the wake of findings of C. difficile spores in ground and processed meats sold in this country and in the United States.
But they said they will closely monitor the emerging science on a possible link between C. difficile-associated disease and meat consumption.
"At this point, it's fairly new findings. So we'll continue to follow that and if there's a need, of course we will take action," said Health Canada spokesperson Paul Duchesne.
Duchesne said to date there is no evidence people can become sick with C. difficile by eating meat - a point of view echoed by C. difficile experts.
Two research groups - under Dr. Glenn Songer at the University of Arizona and Dr. Scott Weese at the Ontario Veterinary College in Guelph - have found C. difficile spores in a variety of ground and processed meats bought from large grocery stores in Tucson and the Guelph area, respectively.
The Ontario scientists found C. difficile in 11 of 60 samples of ground beef and ground veal. Songer found the bacterium in 24 of 81 samples of ground beef, turkey and pork, pork sausage, chorizo, summer sausage and liverwurst.
Most notably, Songer found a few samples of liverwurst, pork sausage, ground beef and summer sausage contained the hypervirulent strain of C. difficile responsible for severe outbreaks in hospitals in Quebec, Britain and parts of the U.S. over the past few years. The strain is blamed for roughly 2,000 deaths in Quebec alone between 2003 and 2004.
The Ontario team did not find the so-called epidemic strain, which produces more than 20 times more toxins that most other strains of C. difficile. But both teams found other strains in meat that were also virtually identical to strains isolated from human patients suffering from C. difficile diarrhea.
The leading C. difficile expert at the U.S. Centers for Disease Control has said it is critical to determine if the presence of the bacterium in meat poses a risk to some people who eat it.
"I think it's of urgent public health urgency to follow up on this and to determine whether meats are an issue - and then to determine exactly what we can do to reduce risk if it were," Dr. Clifford McDonald said.
McDonald and other experts do not know what to make of the findings. C. difficile spores - which are believed to be widely dispersed in soil and water - may have always been present in some meats and may cause no threat to human health, they say.
Alternatively, the findings may represent a change in the pattern of dissemination of C. difficile spores that could help to explain an apparent upswing of C. difficile cases in people who haven't been recently hospitalized.
Traditionally it has been thought C. difficile occurred almost exclusively in elderly people in hospital who had been on antibiotics. The drugs destroy the normal balance of bacteria in the guts, allowing C. difficile to take root and flourish.

Alain Charette, a spokesperson for the Canadian Food Inspection Agency, said much more work would need to be done before it could be determined if government action needs to be taken.
"That would certainly have to be further looked into - research results replicated and context added to a better understanding of that," Charette said from Ottawa.
"And then second stage, I would say, would be Health Canada's health risk assessment to determine if and how it would have an impact on our activities."

http://www.canada.com/topics/news/agriculture/story.html?id=c4f805fa-f9bb-4d43-b613-e011b5bee2a2&k=24508&p=2​