The paper Herald Scotland has reported today that a new strain of Clostridium Difficile is only found in Fife and nowhere else in the world.

Many papers have previously reported on the national alert that went into effect when the C Difficile 332 strain killed three people who had caught the infection whilst in hospital, including the Daily Mail, and a critical report by the Daily Record.

Herald Scotland further reports that the NHS service is refusing to disclose the two hospitals involved, but both are in Fife and the authorities have been unable to find the source of contamination.

A report titled ‘Clostridium difficile Colitis by Ciaran P. Kelly, Charalabos Pothoulakis, and J. Thomas LaMont highlights;

The following chain of events results in C. difficile colitis: a disruption of the normal bacterial flora of the colon, colonization with C. difficile, and the release of toxins that cause mucosal damage and inflammation. Antibiotic therapy is the key factor that alters the colonic flora and allows C. difficile to flourish. The colon is home to more than 500 species of bacteria, and normal stool may contain as many as 1012 bacteria per gram. How these microbes resist colonization by C. difficile is not clear. Almost any antibiotic may cause C. difficile infection, but broad-spectrum antibiotics with activity against enteric bacteria are the most frequent agents (Table 1). Clindamycin is notorious for its propensity to induce the disease9. In current practice, however, broad-spectrum penicillins and cephalosporins are the most common culprits, reflecting their widespread use.

Once antibiotic therapy has made the bowel susceptible to infection, colonization by C. difficile occurs by the oral-fecal route. C. difficile forms heat-resistant spores that persist in the environment for months or years. Infection results from oral ingestion of these spores, which survive the acid environment of the stomach and convert to vegetative forms in the colon. Environmental contamination by C. difficile is particularly common in hospitals and facilities providing long-term care. The organism can be cultured from hospital floors, toilets, bedpans, bedding, mops, scales, and furniture, especially in hospital rooms or wards where patients with diarrhea from C. difficile infection have recently been treated. Health care personnel may carry the bacteria from room to room on their hands, under rings, or on stethoscopes, but fecal carriage by staff is rare11,12. Higher rates of infection have been reported among patients in double rooms, as compared with those in single rooms, and after exposure to an infected roommate.

Clostridium difficile commonly affects older adults in hospitals or in long-term care facilities and typically occurs after use of antibiotic medications. However, more studies are emerging that show Clostridium difficile infection is on the increase with those not previously considered at risk, or without a history of antibiotic usage, or exposure to health care facilities.

Clostridium difficile can be carried by some people in their intestine without ever becoming sick, but can infect others. Clostridium difficile usually develops during or within a few months after a course of antibiotics.

The most common symptoms for mild to moderate infection, include;

  • Watery diarrhea three or more times a day for two or more days
  • Mild abdominal cramping and tenderness

Severe symptoms may also include the need to be hospitalised as the symptoms include;

  • Watery diarrhea 10 to 15 times a day
  • Abdominal cramping and pain, which may be severe
  • Fever
  • Blood or pus in the stool
  • Nausea
  • Dehydration
  • Loss of appetite
  • Weight loss
  • Swollen abdomen
  • Kidney failure
  • Increased white blood cell count

Only three deaths have occurred in the Fife area, out of a total of five infections.

NHS Fife have stated;

This new strain does not change the existing level of risk to the public from C. difficile infection and there are no additional precautions or areas of concern.

The normal strain of C. difficile can be treated, ironically, with antibiotics which keeps the C. difficile from growing, treats diarrhea and other complications. For more serious infections, surgery may be a requirement to remove the diseased portion of the colon. It is also recommended that plenty of fluids and good nutrition is taken to combat some of the side effects.

Photo Credit: by Sanofi Pastuer released under a Creative Commons Licence.

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