research Archives - C. Diff In 30 Minutes: The Book

C. diff in babies: an unsolved mystery

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The following article was excerpted from C. Diff In 30 Minutes: A guide to Clostridium difficile for patients and families by Dr. J. Thomas Lamont, M.D.

C. diff was originally discovered in healthy babies, who seem to tolerate this nasty bug in their stools without getting sick. About 70% of infants during the first year of life carry C. diff. Why they don’t show signs of disease like diarrhea or fever remains a mystery.

Can babies get C. diff - clostridium difficile in infantsOne theory is that the infant’s bowel doesn’t “recognize” Clostridium difficile or its toxins. C. diff toxins cause diarrhea by hooking on to a special toxin receptor, much like a key opens a lock. Once the toxin (the key) hooks on to its receptor (the lock), it opens the floodgates of diarrhea and causes fever, cramps, and other signs of acute infection. Healthy infants lack this receptor, so they don’t get sick even though they are carrying enough C. diff to cause severe diarrhea in an adult. After the first year of life, babies develop the receptor and can develop C. diff just like adults. So, finding C. diff in the stool of an infant is not worrisome. Eventually, C. diff will disappear from the intestinal tract when the infant reaches 10-12 months.

Can babies make other people sick with C. diff?

Can babies spread C. diff to other family members, babysitters, or health-care workers? The answer is yes, but in practice it’s very rare. Sometimes mothers of newborn babies have to take antibiotics for a urinary tract infection. The antibiotics can damage the protective stool barrier allowing C. diff to get in and cause infection. I have treated a few moms who probably caught C. diff from their newborns. I have also treated a neonatologist (a pediatric specialist in newborn diseases) who probably picked up C. diff at work from one of her sick newborns.

Even though babies can carry C. diff, we don’t recommend any special precautions to mothers or other family members. Catching C. diff from a baby is so rare that enforcing special precautions is probably not necessary. Wearing rubber gloves when diapering, or hand washing after changing diapers, is always recommended, especially if the person changing the diaper is taking an antibiotic.

Being a carrier of C. diff is beneficial to the baby. Healthy babies who are carriers develop an immune reaction to C. diff toxins that results in the formation of antibodies that protect against C. diff infection. Immunity to C. diff developing during the first year of life can last a lifetime and protect patients who later come in contact with C. diff. Those who have antibodies become “carriers” with no diarrhea, while those with no antibody can develop full-blown C. diff. Since about 70% of babies are carriers, this implies that they will likely never get C. diff when they grow up!

To learn more about C. diff, download or purchase a copy of C. Diff In 30 Minutes: A guide to Clostridium difficile for patients and families by Dr. J. Thomas Lamont, M.D.

C. diff fecal transplants: What the research says

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The following excerpt about C. diff fecal transplants is from the journal article “Fecal Transplantation for Recurrent Clostridium difficile Infection in Older Adults: A Review,” from the August 2013 edition of the Journal of the American Geriatrics Society. It was authored by Kristin E. Burke, MD, and J. Thomas Lamont, MD. Used with permission.

C. diff fecal transplants

Recurrent Clostridium difficile infection (CDI) is a common nosocomial infection that has a large effect on morbidity and quality of life in older adults in hospitals and long-term care facilities. Because antibiotics are often unsuccessful in curing this disease, fecal transplantation has emerged as a second-line therapy for treatment of recurrent CDI.

A comprehensive literature search of PubMed, Embase, and Web of Science regarding fecal transplantation for CDI was performed to further evaluate the efficacy and side effects of this promising therapy in older adults. Data were extracted from 10 published articles from 1984 to the present that met inclusion criteria, including nine open-label reports and one randomized controlled trial.

Baseline characteristics and outcomes of individuals undergoing fecal transplantation and effects of fecal transplantation on the fecal microflora were reviewed. Methods of fecal transplantation and donor selection were reviewed. Fecal transplantation was performed in 115 individuals aged 60 to 101, with a female predominance.

CDI cure was achieved in 103 (89.6%) individuals over a follow-up period of 2 months to 5 years (mean 5.9 months). There was no significant difference in cure rate between older and younger participants in included studies. Most failed transplantation occurred in individuals infected with the aggressive NAP1/027 strain of C. difficile.

Microbiological studies of fecal biodiversity before and after fecal transplantation demonstrated greater bacterial diversity and shift in flora species to resemble donor flora after transplantation that correlated with clinical remission. Fecal transplantation provides a safe and durable cure for older adults with recurrent CDI. J Am Geriatr Soc 61:1394–1398, 2013.

Keywords: fecal transplantation; recurrent C. difficile infection; fecal microflora

colonoscope used for c. diff fecal transplants or c diff stool transplants - shutterstock image used under license

Colonoscopes are used for C. diff fecal transplants (Shutterstock)

C diff. slides by J. Thomas Lamont, M.D., of the Harvard Medical School

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The following C diff. slides were created by J. Thomas Lamont, M.D., a professor and researcher at Harvard Medical School and the author of C. Diff In 30 Minutes: A guide to Clostridium difficile for patients and families. The slides were part of a 2013 presentation given to doctors and researchers:

If you are interested in learning more about C. diff, check out the many resources listed on this website.

DISCLAIMER: Nothing in this presentation is intended to constitute medical advice, a clinical diagnosis, or treatment. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.