Virulent Intestinal Bug Migrates to the Public

A bacterium called C. difficile used to be found mainly in hospitals. It causes intestinal distress and can be fatal. Now a potent new strain is appearing across the country among people who have not been hospitalized.

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American health officials are tracking a nasty intestinal bug they say has spread across the nation. This germ used to infect mainly hospital patients, but two new studies show it is increasingly common among previously healthy young people; they catch it while going about their normal business.

NPR's Richard Knox reports.

RICHARD KNOX: The germ is called Clostridium difficile, C. difficile for short.

Dr. CLIFF MCDONALD (Epidemiologist, Centers for Disease Control and Prevention): Historically, C. difficile was probably perceived more as a nuisance.

KNOX: Dr. Cliff McDonald is an expert on C. difficile at the Centers for Disease Control and Prevention. He spoke from a meeting of the Infectious Diseases Society of America in Toronto. About two years ago, McDonald began getting calls about unusually severe outbreaks of the infection in hospitals.

Dr. MCDONALD: Piecing some of these reports together, we all found a common strain that was responsible for these outbreaks associated with severe disease. And that is always alarming when you know that there's something new like that moving.

KNOX: Compared to previous forms of the germ, the new strain churns out 20 times more of the toxin that damages the intestinal lining. And it's resistant to fluoroquinolones, one of the most common classes of antibiotics. The CDC discovered that the number of hospital patients with C. difficile began to shoot up suddenly about five years ago.

Dr. MCDONALD: It's over doubling from what was about 68,000 cases annually to approximately 220,000 in 2004.

KNOX: That may be only a third of the real total. The CDC has tracked the superbug to 23 states, but that too is probably an understatement.

Dr. MCDONALD: It's really all over. In fact, there's good reason to believe it's probably in states that have not yet found it, because it looks like it's become very ubiquitous.

KNOX: In one new study, the CDC looked at 1200 C. difficile cases in a half dozen North Carolina hospitals. About one in five involved patients who got infected outside the hospital. That's significant because the infection used to be strictly a hospital infection. Its victims almost always had been treated with large doses of antibiotics for other reasons. Those antibiotics kill off intestinal bacteria that compete with C. difficile, allowing it to flourish.

Dr. Judith O'Donnell, of Drexel University in Philadelphia, tells what prompted another new study.

Dr. JUDITH O'DONNELL (Drexel University): In the first two months of this year, we had three women with severe C. difficile disease. And one was pregnant at the time she presented, and one had just given birth, and the third had come in for a hysterectomy and became sick within a day of her hospitalization. And we thought that that was very odd because they came from the community with their disease.

KNOX: O'Donnell's group found a half dozen severe cases of C. difficile among previously healthy young women in the first six months of this year. Last year there were none. One young woman died, despite surgery to remove large stretches of her infected intestines. The CDC's McDonald said people should be alert to severe diarrhea lasting three days or longer, or diarrhea that involves fever or bloody discharge.

Dr. MCDONALD: They should be concerned, as we are concerned, and at the same time realize that we're not all falling over with diarrhea. Thank goodness. So, not to be an alarmist, but it is concerning.

KNOX: The CDC also urges doctors to go easy on prescribing antibiotics unless they're really necessary, because even ordinary doses of antibiotics apparently can feed this new infectious danger.

Richard Knox, NPR News.

INSKEEP: This is NPR News.

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