Wednesday, October 30, 2013

Pills Made From Poop? Don’t Laugh!

It's no laughing matter to those 550,000 in the U.S. who at some point each year - come down with c.diff. or clostridium difficile infection. C. diff. now kills 14,000 a year and is ranked by hospitals as one of the top two or three 'superbugs' getting out of control. This is especially as there are now too many cases in the community itself, outside of hospitals.

What is c. diff.? It's a bowel infection but that barely begins to describe it. My wife got it back in December, 2006, after taking a prescription of amoxicillin for a stubborn sinus infection. But within a few days, the antibiotic had eradicated nearly all the 'good' bacteria in her gut, paving the way for a much less benevolent (indeed, vile) gut bacteria to take up residence. This was none other than c.diff. Related to the botulism and tetanus bacteria, this bug is described in med lit as a "gram positive, anaerobic, spore -forming rod which exists as a non-infectous spore (in the gut) and as an infectious form that can't exist long in the environment for prolonged periods." It was the latter form that we suspected got released from latent spores that created havoc in Janice's intestinal tract - causing gallons of fluid to literally pour out - in up to 22-25 diarrhetic releases per day.

Within days she had to be hospitalized on account of dehydration, whereupon she was put on an antibiotic called flagyl- 2nd ranked to the univeral powerhouse vancomycin. But then the bug got through it within a week, so, she was re-hospitalized and this time - and had to be administered vancomycin. This time, after the new course and being isolated in her own room, it finally worked. Most of those who die do so after being left with peritonitis, toxic megacolon, and peforation of the colon - from the violent expulsive force (which I pointed out to my wife - seemed to resemble cholera).

Since that bout of c. diff. infection 7 years ago, medical centers have scrambled for a treatment that doesn't require use of antibiotics - given how close we are to full antibiotic resistance. (See the excellent PBS Frontline series on this ). One of the first alternative measures was the use of 'poop enemas' - delivered uniquely to the victim - harvested from her family and bearing loads of good gut bacteria. At some point the enemas result in the bad guys being overwhelmed by the good, and the gut health restored to normal.

Now, thanks to Canadian researchers such as Thomas Louie at the University of Calgary, an alternative method has been developed where, instead of using enemas - the healthy variety of poop is administered via pills. Basically, it's being described as a "less invasive way" to get healthy poop into guts ravaged by the deadly c.diff. bacteria. So far, according to reports in the Canadian press, clinicians have treated 27 people succesfully after antibiotics failed to alleviate symptoms. This is huge news given a particularly virulent form of infectious c.diff. is all but indifferent to even vancomycin.

The process of extraction and preparation, according to Dr. Louie, isn't that difficult. A relative is first brought in and assorted stools obtained. Next, the material is processed in the lab to remove food, extract the bacteria and clean it. The residue is then infused into triple-coated gel capsule capable of surviving all the way into the gut. Be aware, as Dr. Louie points out, there's no stool as such left, only the necessary bacteria. The c.diff. victims thus are not technically eating poop, but instead just "stool bugs" after stools have been processed, diluted, cleaned. There are no smelly "shit" burps because the contents aren't released until they are well passed the stomach.

Louie has thus far found that 24 to 36 capsules are generally needed for treatment and patients can down them in one sitting. The pills thereby find their way to the colon and seed it with the healthy bacteria.

Don't laugh! This is all quite true, and the treatment had been announced two weeks ago at an infectious disease conference in San Francisco. This may well be the remaining life saver left for many more patients who contract c. diff.

For those who still wonder why I never got treatment for my severe bronchitis reported back in July (July 7 blog post) it was because I feared the use of antibiotics and the triggering of c.diff. I am certain I have the spores residing in my gut and that they've been there since Janice was ill - perhaps picked up by contact with contaminated surfaces, and then ingested with food - by hand. Who knows? At least now, I am not so deadly paranoid of getting c.diff. if I do have to take antibiotics at some future date.

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