Talk:Clostridium difficile

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The abreviation for Clostridium is Cl.


C. is the abreviation for Corynebacterium, e.g. C. diphtheriae, and so C. diff. sounds as if the organism is the causative organism of diphtheria. Frosty wind 12:30, 15 February 2007 (UTC)

Contents

[edit] Contradiction needs fixing

The bacteriology section states that c.d. is particularly resistant to antibiotics, yet it also states that infections with the bacterium are treated with antibiotics. This is somewhat contradictory and needs an explanation or clarification. ~PB —Preceding unsigned comment added by 24.126.151.171 (talk) 04:52, 10 May 2008 (UTC)

[edit] Who are "Hall and O'Toole"

Could someone please supply information on who these people are "Hall and O'Toole". They apparently discovered this particular organism in 1935 —Preceding unsigned comment added by 81.108.237.254 (talk) 22:04, 27 April 2008 (UTC)

you are correct, there should be a reference for an article written in 1935. however It does not matter: it will not be digital so having or not having that reference actually makes no difference as nobody will go looking for the paper.
Missed it. it is there --Squidonius (talk) 00:54, 7 May 2008 (UTC)

[edit] Studying C. Difficile

As part of my study at University, I have to study this organism and many of the subject areas around it. I am actually suprised by the amount of research linked to this one bacteria. Much more interesting than I was first expecting!

solo card 23:35, 24 February 2006 (UTC)

[edit] Metronidazole

Hi, I know pretty much nothing about this organism. :) So, I don't know if this sentence near the bottom of the article is correct, incorrect, or just poorly worded.

"Two antibiotics are effective against C. difficile. Metronidazole is first choice because of superior tolerability, lower price and comparable efficacy."

This sentence implies that Metronidazole has both a lower price and comparable efficiency, but this sounds odd as it's supposed to be the first choice when fighting this thing. If it does indeed have a lower efficiency, that's fine, but if it has a superior one, then I think the sentence should be rephrased as "...superior tolerability, comparable efficacy and lower price." If someone could clarify this, that would be great. --Sparky the Seventh Chaos 05:23, May 22, 2005 (UTC)


Fact is - Metronidazole is a failure in more than %90 of the time. Metronidazole may work in a chem lab dish but it does not effectively cure this disease. The point is Metronidazole just does not work effectively and causes a more prolonged and severe condition. Please help yourself and kill the disease correctly. Be very careful with milk. If you have any questions please post them, This paramedic is here for you, and I apologize for any delay in getting your questions resolved.

Larry Gray

Larry, please back this up if you could. What's the source of your data? JFW | T@lk 07:30, 24 Jun 2005 (UTC)

I will back it up. I took flagyl and it did not work. I took flagyl again and it did not work again. I took flagyl again and it did not work again. Vancocin worked very slowly but did have a positive effect. Eventually the “Z” combo antibiotic IV worked most effectively and took about two weeks of administering to zap this bacterium. The ramifications of flagyl (Metronidazole) were that the micro-organism had a longer opportunity to cause damage. A key in the treatment of this disease is catching it as early as possible. I asked a couple of doctors about flagyl and they also stated that flagyl rarely has any effect on C-diff. This information is very important because when your turn with this disease rolls the dice on you, it is very important to get the correct treatment the first time. Flagyl is the incorrect treatment. Flagyl is a biological failure.

In my experience with this disease I was one out of five in this out break. This is a situation were an individual had gotten their hands on contaminated cephelexin and began intentionally distributing the cephelexin in various forms in Aurora Illinois USA. The attacker initially poisoned herself and then discovered the poison and retaliated. Her mental condition that resulted from the self inflicted consumption of the poison caused her to feed the poison to several children and several adults. The local authorities ignored the call for help and she continued to distribute the poison as far as she possibly could and is still distributing the poison and no one will ever stop her. I share this experience because I ask “Are most C-diff” related outbreaks a result of terrorism?

Another shark attack is when the doctors give the flagyl to pediatrics. the pediatrics can not communicate back and reveal that the flagyl is incompetent.

OK Larry, can you tell me the following: (1) Can you back up this rather unconvincing story of cephalexin terrorism with any links/publications? (2) Can you tell us what the "combo Z antibiotic" is? Do you own the patent? Or is it Zyvox®? (3) How can you justify giving 160mg of potassium over 8 hours indiscriminately? Will you stand by to resuscitate the patients when they develop a fatal arrhythmia?
I urge you to back up your claims with serious evidence, or to stop bombarding us with your theories. JFW | T@lk 29 June 2005 10:10 (UTC)


I speak the truth - Stop confusing all and realize the only significance of this thread is that Flagyl is failure. What is your experience with this Disease? Cephelexin is mode of catching C-diff disease. Cephelexin couses C-diff outbreaks. the "Z" antibioyic is a combination antibiotic given intravenously. I understand that potassium is administered for loss of blood - due to the c-diff cousing internal bleeding. I ask you where does the fatal arrhythmia come in or is this just a comment to frown upon the people who seek information about this disease. My question is also are c-diff outbreaks mostly a result on intention or accident. You J obviusly dont know, so give others chance to have a voice about the disease. Tell J what is your expereince with C-Diff disease ?

Always distrust someone who claims to possess the absolute truth. As a hospital doctor I have dealt with many (mostly cephalosporin-induced) cases of C. diff, most of which responded well to oral or intravenous metronidazole. Only on one occasion have we had to resort to teicoplanin, and that was because we needed something that could be administered intramuscularly.
Always? 69.140.157.138 09:00, 24 June 2006 (UTC)
Most cases are not associated with internal haemorrhage at all, and even so potassium levels are never corrected blindly by just randomly blasting 160 mmol at a patient. In someone who is normokalaemic, this could lead to ventricular arrhythmias and cardiac arrest.
I am far from denying you a voice about C. diff and its complications, but many of your statements are outrageous enough to warrant backing up. Using cefalexin as a terrorist agent is a poor choice - it would only affect a small proportion of people.
If Z is a combination antibiotic, could you tell me its constituents, or its presumed mode of action? It is bacteriostatic or bacteriocidal? Does it have Gram-negative or Gram-positive cover? Is it active against anaerobes? Is it potentially carcinogenic? JFW | T@lk 1 July 2005 06:48 (UTC)
PS Googling for cefalexin and Aurora gives no results. Wikipedia:Wikipedia is not a news outlet, so unless there are actual reports of this case we cannot take responsibility for publishing it.
From a Doctor = always distrust someone who claims to speak the truth indicates that you as a doctor dont beleive the signs and symptoms of your patients. bad doctor but some good information has been provided, thankyou.
I didnt intend it to be a news. Anyways flagy is a failure. J please add more to this talk so people looking for information have more than enough information. Here are some ideas Doctor; Diet, what to eat what not to eat. Complications of prednisone in combination with C-diff disease. Is there a better quality than prednisone or does everyone have to use that third world medicine also. Just thirty years ago I heard there was no cure at all for c-diff disease. Thus the disease was painfully fatal. Please add more information to this talk page. How did you detect the c-fiff in the patients that did not have any signs and symptoms ?

"indicates that you as a doctor dont beleive the signs and symptoms of your patients" - this is nonsense. I don't distrust my patients, I just distrust you. So far nothing you have said makes sense.

"How did you detect the c-fiff in the patients that did not have any signs and symptoms ?" - well, not all C. diff infections cause hemorrhage. Hospitals screen patients with diarrhoea for C. diff toxin.

This talk page is not for information, it is to discuss the content of the article. Please explain what your concern is with prednisolone. And what was that "combination antibiotic Z" you were talking about? JFW | T@lk 01:15, 7 August 2005 (UTC)

Cephalexin can cause a c diff infection, but it not due to any terrorist activity. Cephalexin is a commonly used, broad spectrum antibiotic that kills the natural gut flora. This flora naturally inhibits growth of C diff in people who happen to have a colonization of said bacteria in their gut. This allows the C diff to overgrow into a large infection causing a pseudomembranous colitis and, more commonly, a severe diarrhea. And by the way, an infection of C diff WILL cause signs and symptoms.

[edit] Surveillance

how do we chat? noticed you did not see the connection between clostridium difficile and clinical surveillance. Maybe its the clinical surveillance site that is not a good one yet. But the reality is, information systems are becomming the new microscope of this new century. How does one create a up to date link that touches upon the social and public outcome measurement of population data and apply it to ones very specific illness?

my name is stef, my wiki name is culturejam. thank you for the discussion.

should the notable outbreak section evolve into a more encyclopedic "Epidemiology" would do this myself...would try and be unbiased and just the facts kind of writing.--Culturejam 23:20, 21 August 2005 (UTC)

I reverted you because most of what you wrote was very abstract. "We use computers to track C diff" is a rather blanket and noninformational statement.
In your new additions it is unclear which information is referenced to Tadataka, and which is from the Markov lectures. Please also note that Markov is a disambiguation page, and it is unclear what exactly you mean.
In other words, perhaps you ought to work on clarity a bit. JFW | T@lk 23:42, 21 August 2005 (UTC)

[edit] New strains

This has just appeared online on NEJM.ORG. Why, for heaven's sake, is the first author called "Loo" by her last name? JFW | T@lk 01:46, 2 December 2005 (UTC)

Well, unfortunately, that's her last name. See her page. I think it's possibly a Chinese last name, say, "盧" (lú). Anyway, she's not a toilet. :) -- Toytoy 16:02, 2 December 2005 (UTC)

Of course, but I thought it was fairly ironic in the context. JFW | T@lk 20:01, 3 December 2005 (UTC)

saw the article: it decribes what many doctors suspected for some time: there was another article, and comments from Barlet about how certain medicines increase the rates of change. quinolones can create all sorts of resistance patterns. there is an mit lecture somewhere about how markov models being applied to resistant bugs, ect--Culturejam 13:23, 15 December 2005 (UTC)

[edit] Resistant strains no longer rare

http://www.cnn.com/2005/HEALTH/conditions/12/02/deadly.bacteria.ap/index.html

It seems to be becoming more resistant and more commonplace. The CDC is a bit befuddled.

[edit] Pharmacology

By the way, pharmacology means the effect of the antibiotic on the pathogen. What is important to know in an infection is not the pharmacology; it is which antibiotic will be efficient, the dosage, duration of treatment, contraindications, second and third-line therapies, treatment of relapses, and in the case of C.diff, prophylaxis with probiotics is being tried in almost every hospital in Quebec which had the resistant strain. All this info is called pharmacotherapy. I'm a student in third year in pharmacy, Montreal, Canada, and my reference is the 2005 edition of DiPiro's Pharmacotherapy, the pharmacists' bible.

[edit] Lactobacillus

I re-added the Lactinex reference. A family member has had a bad run (pun) of c dif for a year and has been told to suppliment treatment with Lactinex. Since people are often given this recommendation, it seems appropriate that it is mentioned in the article by name. Superclear 15:34, 21 December 2005 (UTC)

WP:NOR. JFW | T@lk 19:12, 21 December 2005 (UTC)
Hey Jfdwolff. Your not even close here. Lactinex is the most common type of probiotic (its main ingredient being lactobacillus) suggested by GI specialists to almost all lactose tolerant people with recurring c dif problems (call one, seriously, they'll tell you ... every one of them). This is far from original research. I'm going to put the reference back up since it does belong here. By the way, if probiotic treatment is going to all be considered original research better remove the references to yogurt, etc. Of course, if you object on other grounds we can discuss since you might be right (that even though it is well known research and will educate people who are "prescribed" lactinex, it should not be on this page).Superclear 15:25, 22 December 2005 (UTC)

Ok, WP:CITE then. JFW | T@lk 16:13, 22 December 2005 (UTC)

I can find many many more until you relent :-) If you are the cite police you have an infinitely difficult job, but good luck. Almost nothing has citations on wikipedia. However, a google, medical, or other search engine might be a way to go about this sort of thing instead of assuming everyone is out to make things up (keeps people from getting unnecessarily defensive). Superclear 16:58, 22 December 2005 (UTC)

The first article cites Gorbach SL, Chang TW, Goldin B. Successful treatment of relapsing Clostridium difficile colitis with lactobacillus GG. (Letter) Lancet 1987;2(8574):1519. This is fine as a reference. JFW | T@lk 17:29, 22 December 2005 (UTC)

[edit] C diff and Weight Loss Surgery

Another susceptible population for C. diff. is weight loss surgery patients, specifically those who have had intestinal reconstruction that includes a non-alimentary limb. These include patients who have had a Roux-en-Y gastric bypass and duodenal switch. These surgeries create a Y shaped intestinal tract, usually for the purpose of separating the biliopancreatic secretions from the food for a certain portion of the passage of food down the alimentary limb. This introduces an element of deliberate malabsorption (the bile acids and pancreatic enzymes are needed to solublize and break down fats, complex carbohydrates and protein, in order of decreasing malabsorption) and is for the purpose of enabling and maintaining weight loss by creating malaborption of those calorie sources.

The source of the C. diff. problem seems to be the biliopancreatic tract, as this portion of the intestine has much less flow of fluids to keep things moving, and therefore a relatively static condition sets in that allows for a bacterial overgrowth. This seems to be a good environment for C. diff. to take hold. In addition, many weight loss surgery patients are on chronic acid-reducing medication, which has been shown to potentiate C. diff. infection. --DCox 05:10, 30 July 2006 (UTC), 3 years out from my duodenal switch and so far C. diff.-free


[edit] The Treatment section may require "Cleanup"?

This cannot be taken seriously.

[edit] Pronunciation

I would dispute the pronunciation given in the sound file at the beginning of the article. The specific epithet, difficile is a four-syllable word in Latin, stressed on the second syllable (-fi-). In traditional English-Latin pronunciation, it should rhyme with 'Sicily'. Sdoerr 20:17, 5 December 2006 (UTC)

Since most people I know do not speak Latin, I'm afraid the Latin pronunciation does not signify with the people I work with in Clearwater, Florida. If anyone bothers with the full pronunciation, the say "dif'-i-sil". With the "i" having the same value as in "ick". I suppose others may pronounce it differently. Most of us leave it at "c. dif". Cheers, :) MikeReichold 21:26, 23 January 2007 (UTC)

Still, this is supposed to be an article giving correct, accurate information, so it is only reasonable to expect that the correct pronunciation is given, i.e. "dif-fiss-ilee" to rhyme with Sicily, rather than the commonly mistaken pronunciation currently given in the article. Somehow I doubt the average inhabitant of Clearwater, Florida is an authority on this issue, so it really doesn't matter how they say it. http://www.bmj.com/cgi/content/full/315/7100/0/j http://blogs.telegraph.co.uk/ukcorrespondents/christopherhowse/oct06/difficult.htm http://www.saltspring.com/capewest/pron.htm http://www.linguism.co.uk/archives/9

If we're talking about classical pronunciation, the 'c's are always hard. Therefore, it should be something like di-fik-il-e. (I'm aware that there are several more modern pronunciation styles.)
Narj 17:17, 11 October 2007 (UTC)

I doubt that many in Clearwater speak French either, - from whence is the incorrect "diffyseal" pronunciation. As it is after all the "latin name" of the species diff ee kill ee is preferableCwasson 09:42, 14 October 2007 (UTC)

I agree entirely with the latin pronunciation of this word. The whole genus-species system is based on latin, and so we should try to keep as close as we can to a standard latin pronunciation. The correct pronunciation is not, however as given above, since the 'c' is hard and it should rhyme with lay, not Sicily! DIFF-EE-KILL-AY.

The other pronunciations mentioned here would have a spelling difisil or difisili. That was clearly not the intention.

C. dificile with the french pronunciation sounds like 'so difficult'. Mike0001 09:59, 16 October 2007 (UTC)

Classical Latin pronunciation is not appropriate for Scientific Latin in an English context. By and large, this has remained fixed in the old Latin pronunciation used by English speakers until the late 19th century. That's why we call Cicero ['sɪsərəʊ] and (to use a scientific example) penicillium [pɛnɪ'sɪlɪəm]. So c can indeed be soft in 'English Latin' - whenever it's followed by e, i, or y, in fact. (Cf. vice versa.)--Sdoerr 18:22, 15 November 2007 (UTC)

What puzzles me is why educated people like BBC newsreaders insist on pronouncing it as if it's French. Deipnosophista (talk) 08:14, 1 March 2008 (UTC)

The reason for this is obvious - Latin has not been studied in most British (or American) schools for 30 years or so, and so BBC newsreaders are too young to know the correct version so they confuse it with the French (which, by and large, they do know). They might be educated, but they aren't educated in Latin. —Preceding unsigned comment added by Sidevalve (talk • contribs) 20:27, 3 March 2008 (UTC)

No, they're not educated in classical Latin, but unless the education system has collapsed completely they ought to have a sketchy knowledge of biology and hence a vague idea of how Linnaean names are pronounced in English. So your point doesn't really answer the question. Deipnosophista (talk) 21:38, 6 March 2008 (UTC)

[edit] Mangosteen helps in treatment

Elsewhere in Wikipedia is an article about how Saccharomyces boulardii protease mediates effects of Clostridium difficile toxins. Please check it out Helizna 23:43, 13 March 2007 (UTC)

Sounds like pseudoscience to me, especially since the mangosteen would be digested before it reached the colon. --Charlene 12:08, 26 March 2007 (UTC)

[edit] Netherlands?

A representative of the Patients Association (a British pressure group) is quoted in this BBC News article as saying that the Netherlands "have got infection rates close to zero". She's speaking generally, but C.diff is certainly one of the bugs she's including. Is she right about Dutch success, and if so should that be included in this article? I simply don't have the requisite expertise to know. Loganberry (Talk) 00:16, 26 April 2007 (UTC)

[edit] new section ? Future treatments

After treatment or pharmacology could we have some mention of future treatments now in development or clinical trials - eg Tolevamer has at least started phase 3 trials. and there may be another dozen treatments in development. I'll have a stab at this myself if no one else wants to. Rod57 11:16, 13 June 2007 (UTC)

Please provide sources so we can comment on suitability. JFW | T@lk 22:42, 17 June 2007 (UTC)

The lantibiotic nisin has been shown to be more active against Clostridium difficile in vitro than either vancomycin or metronidazole (J Chemother. 2004 Apr;16(2):119-21. Abstract). Similar data have been presented in a patent filed by AMBI Inc back in 1997 [1] (Table 2) and the technology has subsequently been licenced to Biosynexus Inc [2] who seem to have shifted their attention to Staphylococcus aureus [3]. I don't know what has become of the Clostridium difficile trials. Perhaps somebody can comment/edit the main articles on C. difficile and Nisin? It's not my policy to edit Wikipedia articles. (Denni Schnapp: denni_schnapp@yahoo.co.uk --My PhD research dealt in part with antimicrobial peptides, but not lantibiotics.) —Preceding unsigned comment added by 84.92.241.124 (talk) 17:13, 11 October 2007 (UTC)

(I fixed the references in the above paragraph--Denni)

Excellent idea to include a section on future treatments. There are a few notable ones to include in addition to Tolevamer mentioned above, like ramoplanin, OPT-80, IVIG, rifaximin, etc. This article has some good information...a bit out of date perhaps,[4] but Dale Gerding gave a talk at the 2007 IDSA meeting in November that was really good -- it was very up to date and it's available online. Gerding is one of the big dogs in CDI research and his information is regarded as being pretty close to the gospel by his peers.[5] If anyone wants to take a crack at it, go ahead, and if not, I might put something toegether in the next couple of weeks. Rhode Island Red (talk) 01:45, 23 February 2008 (UTC)

[edit] Review

Bartlett, one of the C. diff hunters from the beginning, has written a useful review in Ann Intern Med: PMID 17116920. JFW | T@lk 22:42, 17 June 2007 (UTC)

==Bacteriology Section--

Citations are needed. —Preceding unsigned comment added by 71.204.15.239 (talk) 23:36, 2 March 2008 (UTC)

[edit] Pronunciation

Not that it really matters, but I am not sure if I incorrectly corrected someone. Help:Pronunciation difficile is difficult in latin, italian and french. so I though it was dɪFFɪʃɪlɛ, as you would pronounce it in italian. Latin is a language where the exact pronunciation is lost, but I was told that the mediterranean pronunciation was preferable to the anglosaxon one. Is the phonetic pronunciation in this page correct? --Squidonius (talk) 19:16, 6 May 2008 (UTC)

[edit] A bit confusing

I know I could research for the answer elsewhere, but the writer of the section on Toxins might already know the answer:

Under Toxins we say: Pathogenic C. difficile strains produce various toxins. The most well-characterized are enterotoxin (toxin A) and cytotoxin (toxin B).

The hyperlink to enterotoxin says: Enterotoxins are frequently cytotoxic

The hyperlink to cytotoxin leads you to cytotoxicity.

Now if enterotoxin is a sort of cytotoxin, then why do we give it separate mention calling it toxin A whilst for the collective cytotoxin the term toxin B? LouisBB (talk) 21:32, 26 May 2008 (UTC)

[edit] What would be the best way to add this information?

http://health.yahoo.com/news/ap/deadly_bacteria.html http://seattletimes.nwsource.com/html/localnews/2004444806_cdiff29m.html?syndication=rss etc etc

It is all over the News today, due to The Zilberberg study. Would a new entry The Zilberberg study be worthy of a page? Or rolled into this entry?

Study shows drastic increase in infections and deaths from Clostridium difficile, which is due to overuse of antibiotics.FX (talk) 12:27, 29 May 2008 (UTC)