Transcripts
DR. TARR:
C. difficile, I would now like
to talk about a problem on the periphery of many
of these infections. The problem is Clostridium
difficile. Now, C. difficile is an organism
which is present probably in low quantities in
many people's gastrointestinal tracts. It's an
anaerobic organism and in the setting of
antibiotics, sometimes in the setting of
chemotherapy, this organism actually overgrows and
can cause a form of diarrhea.
The spectrum of diarrhea is
broad. The diarrhea can just be mildly
disturbing (such as non-bloody diarrhea), or it
can go on at the complete opposite end of the
spectrum to a full-blown colitis which can
sometimes be life threatening.
For reasons that are unclear
there seems to be a disproportionate number of
children who have clear-cut E. coli 0157:H7
infections who are also infected with C.
difficile or at least the tests suggest that
they're infected with C. difficile.
When a child comes into an
Emergency Room on initial presentation we would
strongly discourage any sort of attempt to treat
C. difficile unless and until we were sure that
E. coli 0157:H7 was not present.
The reason I have some
skepticism about the diagnosis is that it was
recently determined that the large plasmid, an
extra piece of DNA that E. coli 0157:H7 has,
encodes a protein which has a lot of structural
similarities as that of C. difficile. And I'm a
little concerned that some of these tests are
actually false positives on the basis of a cross
reactive antibody in the test.
In any case, we've also seen C.
difficile appear at the tail end of an E. coli
infection, such as in a child that's had HUS and
is better, just coming off dialysis and then
they get diarrhea and sometimes it's actually
bloody. And C. difficile is truly found in the
stool. If E. coli is gone, then we would
encourage the appropriate treatment for C.
difficile.
But at least as the illness is
evolving we would maintain a healthy skepticism that
that this is really the cause of the symptoms.
