Talk:Clostridioides difficile infection/Archive 1

Archive 1

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)

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)

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)

• 1
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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)

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)

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

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)

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)

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)

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)

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)

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)

The correct pronunciation of difficile is deefeeseal. It is a French word, and of course may have some Latin background. The spelling in French is exactly as shown in all examples. Why some contributors discuss it used any other way boggles the mind. BBC newsreaders pronounce it in French because it IS a French word. Leonard MacEachern leonard_mac@msn.com —Preceding unsigned comment added by 68.41.73.21 (talk) 02:13, 10 September 2008 (UTC)

This is complete tosh. 'Difficile' is a French word AS WELL AS a Latin one (in the same way that 'table' is both a French word and an English one). But in this context 'difficile' has GOT to be Latin because its function is as an adjective 'agreeing' with the Latin noun 'clostridium', which precedes it. 'Clostridium' isn't French - and neither, here, is 'difficile'. There are many ways of rendering Latin words in modern English, and the 'c' can be hard, soft or a 'ch' sound as in modern Italian and church Latin. But NONE of the ways of pronouncing the word in this context resembles the French pronunciation.

"Difficile" is a perfectly normal Latin word, meaning "difficult". Pronounced "dif-ik-ill-lee". That binomial species names are based on Latin is a general giveaway...Catiline63 (talk) 15:52, 25 October 2008 (UTC)

Pronunciation

I've attempted to improve the pronunciation-related content of this article. Comments? SP-KP (talk) 10:40, 1 November 2008 (UTC)

I think what's currently up there may be technically or pedantically correct, and in the real world most people pronounce it as if it were some conglomeration of Italian and French, thus: dɪFFɪʃɪlɛ or dɪFFɪʃɪl Also, considering the standard abbreviation is pronounced ʃɪ diFF, I think that for the majority of people the American pronunciation is likely diFFiʃil see: http://www.kcom.edu/faculty/chamberlain/website/studio.htm I think this should be changed in the entry. Any comments otherwise? Cardozo (talk) 16:31, 1 November 2008 (UTC)

I don't think what's currently up there is quite what was intended, because the first two alternatives are actually identical (/dɪˈfɪkɪli/), and /dɪˈfɪkil/ does not match a "french" pronunciation of difficile.

Using a "classical" pronunciation, the 'c' in difficile might be hard or soft, and the 'e' might be either /i/ or /ɛ/. The vowel following a soft 'c' would be /i/ rather than /ɪ/ because of the effect of the /s/ sound in bringing the following vowel forward. I've added these in to the article, in order to at least correct the above mistake.

I agree with Cardozo that the majority pronunciation, whether 'right' or 'wrong', is the french-like diFFiʃil, which I've captured as /dɪfɪsi:lˈ/.

Further comments/discussion welcomed. Mooncow (talk) 19:10, 5 November 2008 (UTC)

Why on earth would it be appropriate to pronounce 'difficile' here in the French way? 'Clostridium' isn't a French word (surprise, surprise - it's a Latin one), and neither is 'difficile', which merely goes with it and is just the neuter form of the Latin adjective 'difficilis' (to agree with the neuter 'clostridium').

To pronounce either word as the French do is a complete red herring. Is anyone suggesting that we roll the 'r' in 'clostridium' to make it sound more French too (because that's what logic would require).

Death Stats are way too unbalanced, could cause unnecessary fear.

If I was researching this today, and if I had C.Diff, just by reading the death stats, I'd think being diagnosed with C.Diff was the end of me. Oy vey. Can someone people counter these grim death stats with success statistics which I know vastly exceed the number of deaths? As it stands, reading about C. Diff on this article would be depressing for someone with C. Diff. I know its important to highlight the seriousness of this disease, but I feel it would be just as important, if more so, to highlight the vast survival probability (which I think is in the upper 90s percentile). That and for some reason the support site for C. Diff is no longer in the article. This article reads almost like a death certificate for victims researching this disease on wikipedia. Yikes. Let's give people some hope, ok? Please post some positive stats on the disease, and any useful support sites. inigmatus (talk) 06:53, 5 December 2008 (UTC)

Several points:

• I realize that everyone has their one perspective, but I must admit that I didn't find the article to be particularly downbeat in its portrayal of the disease. C. difficile is a serious infection, true, but most of the test seemed quite matter-of-fact to my ears. I do agree that the article needs some significant formatting and consolidation work (the latter is especially true for the "notable outbreaks" section).
• "Positive" disease stats are generally difficult to come by - few scientific journals publish papers on successful treatments of commonly-treatable conditions and few health agencies prominently feature this kind of data.
• I am the one who has removed the C. diff support site, YouTube videos, and other assorted advocacy/blog/support links. Per the Wikipedia external link guidelines, none of those links appear to add significantly to the article as an encyclopedia entry. Please note: this is not a comment on the usefulness of these types of sites to patients, just that they don't really belong in an encyclopedic reference source. I have added a link to the dmoz directory category for pseudomembranous colitis (which includes some support group links) - a practice generally approved by WP:EL.

-- MarcoTolo (talk) 19:35, 5 December 2008 (UTC)

Oral metronidazole dose

Metronidazole (500 mg orally three times daily) is the drug of choice

In practice here in the UK, I have only ever seen 400mg TDS orally. Is this the same elsewhere in the world? The intravenous dose however is 500mg TDS. Possibly due to the bio-equivalence between the IV and oral routes?!? Or is it simply because the tablets come in a 400mg strength? Panthro (talk) 01:11, 2 January 2009 (UTC)

Just had a look at the BNF online. A 21-pack of 400mg tablets of metronidazole is 94p. A 21-pack of 500mg tablets is £23.13! 2360% increase!!! Is this simply a cost-cutting measure? How can the price difference be so huge in a non-propietary medication which is only 100mg more? Confused :S So my last statement is probably void as it would appear it is simply due to cost rather than bioequivalence! Panthro (talk) 01:18, 2 January 2009 (UTC)

As far as i am aware the oral dose for metronidazole is 400mg tds p.o daily in the UK. The 500mg tablets that appear in the online BNF are actually suppositories (the online version is a bit confusing) hence the vast price difference. Can anyone confirm that 500mg tds p.o is a recognised dose elsewhere? Otherwise i think the article should be altered. SYSTem050 —Preceding unsigned comment added by SYSTem050 (talk • contribs) 14:14, 22 July 2009 (UTC)

Proposed text for new treatments in development section

I’d like to propose a new section on the Clostridium difficile page for treatments in development since there are several currently. You’ll find my suggested text in full here: kdrichards. Following yesterday’s TIME article on the desperate need for new antibiotics, more clarity on the progress that’s taking place would be helpful for Wikipedia users. KDR 22:06, 1 October 2009 (UTC)

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)

Toxin A (TcdA) and Toxin B (TcdB) are two entirely separate entities. Both have a large degree of amino acid homology, but have slightly different mechanisms of action. Indeed, both are cytotoxic. TcdA is referred to as an an 'enterotoxin' because it causes fluid accumulation in the gut, and this is its predominant mode of action. However, it also causes cytopathic effects (CPE) in certain cell lines (like Chinese Hamster Ovary cells) and this is a result of its cytotoxicity. TcdB is primarily a cytotoxin and can be up to 1000 times more cytotoxic than TcdA. For this reason, it is referred to as a cytotoxin. The same concentration of TcdB can be titrated out much farther in cells than TcdA and still induce 100% CPE. The toxins are classified by their most predominant mode of action. Jlizer (talk) 00:35, 22 March 2010 (UTC)

Probiotics notes

Clostridium difficile

http://en.wikipedia.org/wiki/Clostridium_difficile

(Wikipedia)

Prophylaxis with competing, nonpathogenic organisms such as Lactobacillus spp. or Saccharomyces boulardii has been found to be helpful in preventing relapse in small numbers of patients (see, for example, Florastor, or Lactinex). It is thought that these organisms, also known as probiotics, help to restore the natural flora in the gut and make patients more resistant to colonization by C. difficile.[33]

... one of the most troublesome aspects of the disease is it's high rate of recurrence. But studies show that adding the yeast-based probiotic Saccharomyces boulardii (sold under the brand name Florastor®), can cut the rate of recurrence by about half.

---

Lactobacillus reuteri is a natural inhabitant of the gastrointestinal tract and is an excellent probiotic. The organism was originally derived from breast milk and is available in capsule form at pharmacies and health food stores and on the Internet. Early studies indicate that this organism can speed a child's recovery from diarrheal disease and is safe for use in patients with H.I.V., Dr. Reid said.

---

Dr. Reid holds a patent on one probiotic product not yet available in North America but licensed to Chr. Hansen, a Danish company. That company sells another product, ProbioTek, that is encapsulated to survive oral ingestion and reach the intestinal tract, where its potential protective action can be released. It contains four microencapsulated probiotic organisms and is currently sold in American pharmacies as Flora-Q by Bradley Pharmaceuticals.

---

Complementary and Alternative Medicine Therapies for Cold and Flu Season: What Is the Science?

http://www.medscape.com/viewarticle/711485_2

... Probiotics in food (eg, yogurt and kefir) or supplements are generally safe and well tolerated in adults, children, pregnant women, and even premature infants.[74,75] Sepsis-like illnesses have been described in case reports when probiotics were administered to severely immune-compromised patients.[76]

76. Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, Shetty AK. Lactobacillus sepsis associated with probiotic therapy. Pediatrics. 2005;115:178-181.

—Preceding unsigned comment added by 68.165.11.210 (talk) 20:52, 21 April 2010 (UTC)

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)

Some of those now mentioned in Treatment and Research sections. Could reorg. Rod57 (talk) 14:33, 18 August 2010 (UTC)

This article is a disservice

So who wrote a paper for their high school science project and then posted it to Wikipedia? This article deserves much lower than a B rating. The grammar is horrible, spelling is inconsistent, and the information is unreliable at best. Given the magnitude of this disease in both humans and animals today, this article is a disservice. It's too far gone to even attempt to fix it at this point without making an entire weekend of it.

Regarding other things: unless you have research experience with this organism or disease in an academic setting and have justifiable and reliable data or information to share, check your anecdotes at the door. This is legitimate science, not tea time. Jlizer (talk) 01:04, 22 March 2010 (UTC)

I agree, this article that hops around and contains some completely irrelevant points. The recent evidence reviews from SHEA in ICHE 2010 and Hsu 2010 are worth reviewing and referencing. The latter paper includes reference to most of the antibiotic intervention trials that have reduced C. difficile infection. Mdjkf (talk) 11:01, 29 August 2010 (UTC)

If you would like to improve the article adding content sourced to those recent reviews that would be great.--Literaturegeek | T@1k? 10:29, 8 September 2010 (UTC)

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.

First, cephalexin is actually not that broad spectrum of an agent. It is used mainly for SSTI's(non-MRSA), surgical prophylaxis, and occasionally for S. viridans prophylaxis in valve patients undergoing dental procedures. But it is a straight G(+) agent which definitely limits its use to certain organ systems. Secondly, C diff can range from colonization with minimal infection (hence the discovery in hospital fecal screens) to full blown colitis. The point is that there is no universal presentation in the severity of the infection. Finally, the combination z antibiotic mentioned previously was probably zosyn (piperacillin/tazobactam). Though this beta lactamase inhibitor may have the broadest spectrum of coverage outside of the carbapenems, I have never seen it used for C. diff treatment. —Preceding unsigned comment added by 72.128.72.33 (talk) 05:52, 9 December 2010 (UTC)

Treatment section appears to contain an advertisement.

Saccharomyces boulardii Lyo is the only probiotic worldwide known to diminish levels of Clostridium difficile in the body. S. boulardii Lyo can be found under the brand name Florastor; clinically proven as effective treatment alongside traditional medications.[24]

This reads more as an advertisement than an informative block of text. In addition, the source cited appears to be from a company selling this supplement. —Preceding unsigned comment added by 64.79.177.254 (talk) 19:43, 3 February 2010 (UTC)

Agreed. It's been scrapped now. Rhode Island Red (talk) 01:13, 17 April 2011 (UTC)

Diagnosis

The diagnosis section is currently incomprehensible to a non-specialist, for example it says "By the end of 2009, 3 different Real-Time PCR tests had achieved 510(k) clearance from the FDA". This contains many acronyms such as (510)k which may have meaning to professional microbiologists working in the USA but are not immediatly obvious to others. Unfortunately, as I don't know what this section is saying, I can't effectively edit it. I will try to add a tag to ask for clarification.AlexsandraSmart (talk) 14:39, 19 September 2011 (UTC)

SciAm resource - stool transplants

Swapping Germs "A potentially beneficial but unusual treatment for serious intestinal ailments may fall victim to regulatory difficulties" by Maryn McKenna Scientific American December 8, 2011; excerpt "... by inserting into her colon a diluted sample of stool from someone whose intestinal health was good."

See chronic diarrhea, antibiotics, diverticulitis, Brown University, Fecal bacteriotherapy,

97.87.29.188 (talk) 00:05, 22 November 2011 (UTC)

Organization

This article is more about the infection than the bacteria. I propose we move the content here to Clostridium difficile (infection) and than we could have an article on Clostridium difficile (bacteria) Doc James (talk · contribs · email) 13:10, 19 March 2012 (UTC)

Statiistics needed

Stats on incidence and prevalence would be useful. -- Beland (talk) 01:38, 15 April 2012 (UTC)

The Treatment section may require "Cleanup"?

This cannot be taken seriously.

Yes it can. It's a part of the treatment to get rid of the host so one doesn't catch it again. — Preceding unsigned comment added by 89.160.137.185 (talk) 00:51, 8 July 2012 (UTC)

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.

Yes, my brother got it from a hospital, he broke his ankle in 2 or 3 different places, they treated him, but he unfortunately picked up this infection from somewhere... he had all of the symptoms stated and he became lactose intolerant. We don't know when or if he will ever not be lactose intolerant. 24.98.70.246 (talk) 14:29, 28 October 2009 (UTC)

Using sources like CNN or any other newspaper or websites is why Wikipedia articles are not reliable for science entries. The is a reason that only reputable academic journals are taken seriously by the scientific community. Web sites like that have science or scientific in their dot com name is the equivalent to a daily newspaper. If you want accurate info you need to get it from an academic journal database

             Dirtclustit (talk) 05:09, 29 January 2013 (UTC)

Remove primary article added

Per discussion here, there is a wide consensus among established medical editors that the addition of the primary study violates multiple policies and guidelines, including WP:MEDRS, WP:UNDUE, with concerns about WP:CITESPAM and WP:CITEKILL. The use of multiple IPs to edit war is likely a WP:MEAT problem as well. Please remove the primary study. Yobol (talk) 15:04, 4 April 2013 (UTC)

• Request - revert this edit. This is the contentious edit for which page-protection was granted. Anonymous users added it without going to the talk page to answer the community as Yobol suggested above. I assert that removing this is noncontroversial and that adding it is controversial. Blue Rasberry (talk) 15:55, 4 April 2013 (UTC)

Done --Redrose64 (talk) 19:07, 4 April 2013 (UTC)

Classical Latin pronunciation

The Classical Latin pronunciation is currently written /dɨˈffɪkɨle/ when it should be [dɪf.ˈfɪk.ɪl.eː] (the English approximation is /dɪ.ˈfɪk.ɪl.eɪ/). --Mahmudmasri (talk) 15:01, 8 April 2013 (UTC)

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)

Most if not all bacterial infections are treated with antibiotics and what causes resistance is misuse. When the pathogen is diagnosed as bacteria, which entails detection of specific Genus and species known to be pathogenic for the location it resides, and the correct antibiotics are prescribed for that pathogen, taken as directed for the entire duration of days prescribed it plays no part in development of resistance.Dirtclustit (talk) 01:16, 12 April 2013 (UTC)

Former external links

• Clostridium difficile: Is your family at risk? AboutKidsHealth
• Schroeder MS (2005). "Clostridium difficile--associated diarrhea". Am Fam Physician. 71 (5): 921–8. PMID 15768622. {{cite journal}}: Unknown parameter |month= ignored (help)
• Wins Story (The risks of C Diff infection and hospital neglect)
• {{dmoz|Health/Conditions_and_Diseases/Infectious_Diseases/Bacterial/Clostridial/Pseudomembranous_Colitis/|Pseudomembranous colitis}}
• "From hand to mouth". The Economist. 2006-05-25. discussing C. difficile
• Pathema — Clostridium genomics resource
• Centers for Disease Control and Prevention (CDC) (2005). "evere Clostridium difficile-associated disease in populations previously at low risk--four states, 2005" (PDF). MMWR Morb. Mortal. Wkly. Rep. 54 (47): 1201–5. PMID 16319813. {{cite journal}}: Unknown parameter |month= ignored (help)
• Abrahamian FM, Talan DA, Moran GJ, Pinner R (2006). "Update on emerging infections from the Centers for Disease Control and Prevention. Severe Clostridium difficile-associated disease in populations previously at low risk—four states, 2005". Ann Emerg Med. 48 (1): 55–9. doi:10.1016/j.annemergmed.2006.04.005. PMID 16791928. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• from the UK Clostridium difficile Support Group (UK)
• MedscapeCME Healthcare-associated infections
• "Sea Change Anticipated in the Management of C. difficile Infection" July 2009
• Clostridium difficile genomes and related information at PATRIC, a Bioinformatics Resource Center funded by NIAID
• CDI Toolkit from the Provincial Infection Control Network of British Columbia (PICNet)
• Provincial CDI Surveillance Reports from the Provincial Infection Control Network of British Columbia (PICNet)
• C. difficile TcdA — information from the Consortium for Functional Glycomics on one of the major virulence factors from C. difficile

If anyone thinks any of these meet WP:EL then say so. Best. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 12:01, 6 October 2013 (UTC)

Some may be suitable refs. Others people can add to DMOZ as DMOZ is still in the article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:05, 6 October 2013 (UTC)

I prefer a curated and edited list over DMOZ, personally, as I've done over at DVT. It takes some managment time, but if someone wants to invest the time I think readers are served much better than they are with the DMOZ. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 14:12, 6 October 2013 (UTC)

DMOZ is a curated and edit list. DMOZ is open to anyone and those who are interested in that sort of thing are more than welcome to join them. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:35, 6 October 2013 (UTC)

Rollback

Not wishing to draw out the de facto owner of the page, I've removed all my changes and his revisions to said.

These items remain for someone to work on:

1. A reference uses Google Books.

2. Saccharomyces boulardii Protease Inhibits the Effects of C. difficile Toxins A and B in Human Colonic Mucosa (Castagiliuolo 1999, Infection and Immunity)

3. Patients treated with S boulardii and standard antibiotics have lower risk of recurrence of CDD (McFarland JAMA 1994:271(24):1913-1918)

4. A robot fixed a reference. Perhaps it will find it and fix it again.

5. Generic Vancomycin Products fail "in Vivo" despite Being Pharmaceutical Equivalents of the Innovator (Vesga 2010 Antimicrob Agents Chemother Aug 2010; 54(8) 3271-3279).

HiTechHiTouch (talk) 18:17, 24 April 2014 (UTC)

Organizations of topic

I propose we move the content here to "Clostridium difficile infection"

Than split out the content on Clostridium difficile as "Clostridium difficule (bacteria)"

Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:11, 30 August 2014 (UTC)

• According to 2010 Emerging Infections Series, Chapter 16 on C diff disease (Musher, Aslam), the best term is Clostridium difficile colitis :-/ I was hoping to move contents to that page. Brian Gilcrease (talk) 05:36, 30 August 2014 (UTC)

It was a bit of a balance between common words and the most prefered technical name.

We have the ICD 9 here [6] and the ICD 10 here [7]

And MESH is here [8]

Am not opposed to using Clostridium difficile colitis Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:47, 30 August 2014 (UTC)

Moved

As this article is about the infection I have been bold and moved to Clostridium difficile diarrhea. Let me know if there are concerns. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:04, 21 April 2014 (UTC)

• I fail to see how this is an improvement. The articles on many disease-causing organisms talk mostly about the diseases. Furthermore, all species are expected to have a Wikipedia article. If the emphasis on the disease bugs you, you should WP:split the article. Abductive (reasoning) 20:18, 21 April 2014 (UTC)

• Hum yes I guess we need to create an article that is more just focused on the organism. Will work on doing this in a bit. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:23, 21 April 2014 (UTC)

• In the meantime this article must be moved back. Then the disease parts can be split off it. Abductive (reasoning) 03:19, 22 April 2014 (UTC)

Okay done. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:27, 30 August 2014 (UTC)

Stool transplant

There is a debate at WP:EAR regarding some suggested additions to the stool transplantations section regarding the "ick/yuck factor" associated with this procedure. IMO the suggested changes (which were reverted as vandalism) were made in constructive spirit, even if not very encyclopedic in wording and without citation of proper sources, and should be reintroduced in some form. I'm happy to attempt that but will wait a day or two for the dust to settle ;-) mman444 (talk) 13:09, 1 July 2011 (UTC)

There was a recent unsigned addition to Stool Transplant treatment section of article, stating: "Due to the epidemic in North America and Europe, fecal microbiota transplantation (FMT) has gained increasing prominence, with some experts calling for it to become first-line therapy for CDI." The article cited an editorial in the Journal of Clinical Gastro. This is certainly an area of controversy, and the 2013 NEJM paper certainly makes fecal transplant seem quite promising, but I think there is not enough evidence or consensus right now to put this is a 'first line therapy.' At least, this statement should be couched in some more context. Thoughts? Dr G (talk) 18:11, 23 September 2014 (UTC)

Review

JAMA doi:10.1001/jama.2014.17103 JFW | T@lk 20:26, 27 January 2015 (UTC)

NEJM also doi: 10.1056/NEJMra1403772 JFW | T@lk 21:32, 16 April 2015 (UTC)

QJM about faecal microbiome transplantation doi:10.1093/qjmed/hcu182 JFW | T@lk 09:44, 3 May 2015 (UTC)

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Trehalose

″According to some laboratory studies published in Nature in January 2018, trehalose stimulates the growth of certain strains of Clostridium difficile bacteria. These bacteria can cause severe inflammation of the colon, especially in the patients treated in hospitals. In one study in mice, dietary trehalose increased the severity of the infection caused by C. difficile. More studies are needed to find out if trehalose increases the risk and severity of the infection in humans.″ [9] Not sure this is a reliable source.

The point is that the large increase of c.diff infections may have coincided with the approval of this synthetic sugar as a food additive. Shtove (talk) 13:17, 18 January 2018 (UTC)

Moved here

A clinical practice guidelines by the Infectious Diseases Society of America and a systematic review by the Cochrane Collaboration address treatment.Doc James (talk · contribs · email) 16:33, 27 December 2011 (UTC)

We should add conclusions rather than just listing that reviews exist.--Doc James (talk · contribs · email) 16:47, 27 December 2011 (UTC)

References

Just adding reflist-talk. Umimmak (talk) 02:11, 15 December 2018 (UTC)

Risk Factors

"The majority of C. difficile cases occur in health care settings, where germs spread easily, antibiotic use is common and people are especially vulnerable to infection. In hospitals and nursing homes, C. difficile spreads mainly on hands from person to person, but also on cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers — even telephones and remote controls."

"Although people — including children — with no known risk factors have gotten sick from C. difficile, your risk is greatest if you: Are now taking or have recently taken antibiotics. The risk goes up if you take broad-spectrum drugs that target a wide range of bacteria, use multiple antibiotics or take antibiotics for a prolonged period. Are 65 years of age or older. The risk of becoming infected with C. difficile is 10 times greater for people age 65 and older compared with younger people. Are now or have recently been hospitalized, especially for an extended period. Live in a nursing home or long term care facility. Have a serious underlying illness or a weakened immune system as a result of a medical condition or treatment (such as chemotherapy). Have had abdominal surgery or a gastrointestinal procedure. Have a colon disease such as inflammatory bowel disease or colorectal cancer. Have had a previous C. difficile infection."

Recently at least one study has shown that not having an appendix may increase your risk for Clostridium difficile infection.

99.122.126.252 (talk) 13:57, 5 January 2012 (UTC)

References

Adding reflist-talk. Umimmak (talk) 02:12, 15 December 2018 (UTC)

Imodium (loperamide)

Reference 47, used to support the statement that Loperamide should not be used, is inappropriate. It points to a clinical study due 2009 which never got off the ground and reported no results.

To the extent that dehydration is more immediately dangerous, I should expect that loperamide would be most useful in getting the fluid balance under control.

Does anyone know of a specific contraindication?

The prescribing information says that is it not a PRIMARY treatment, but may be used (and discontinued per indications).

In general, Loperamide hydrochloride should not be used when inhibition of peristalsis is to be avoided due to the possible risk of significant sequelae including ileus, megacolon and toxic megacolon. Loperamide hydrochloride must be discontinued promptly when constipation, abdominal distention or ileus develop.

Treatment of diarrhea with Loperamide hydrochloride is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate (or when indicated).

HiTechHiTouch (talk) 09:18, 12 April 2014 (UTC) I should have copied reference 47 information, so I could find it again.

At this point, I can't argue against the reference. However, "Cunha, Burke A. (2013). Antibiotic Essentials 2013 (12 ed.). p. 133. ISBN 9781284036787." is a pointer to google books (http://books.google.ca/books?id=3sL3RlLMKtEC&pg=PT133) and google books won't display it for me. What's the wiki way to handle this? HiTechHiTouch (talk) 13:28, 24 April 2014 (UTC)

Google book says should not be used. The drug.com ref does not mention C. dif. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:53, 24 April 2014 (UTC)

References

Adding reflist-talk. Umimmak (talk) 02:13, 15 December 2018 (UTC)

Association with antibiotics

I removed association with "broad spectrum antibiotics such as clindamycin" from opening paragraph and I furthermore move that we move away from associating CDI with clindamycin so specifically. Although it is of historical interest that CDI was first discovered in association pts treated with clindamycin, the fact is that it is well-known that CDI is associated with almost every antibiotic. There are too many instances in medicine where "buzzwords" and classic associations are perpetuated (probably due to medical education practices) when subsequent research has later corrected or disproven the understanding. Brian Gilcrease (talk) 17:03, 30 August 2014 (UTC)

Sounds reasonable to me. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:57, 31 August 2014 (UTC)

References

Adding reflist-talk. Umimmak (talk) 02:13, 15 December 2018 (UTC)

Recurrent Infection - differentiating relpase from reinfection

The following statement has been added to the recurrent infection section without any citation "In clinical settings, it is virtually impossible to distinguish a recurrence that develops as a relapse of CDI with the same strain of C. difficile versus reinfection that is the result of a new strain". This is somewhat of a troubling statement in my opinion. Sure it is virtually impossible for a treating Physician to differentiate relapse vs. reinfection at onset. But most centres send cdiff stool samples to local laboratories for typing. At which point its possible to differentiate strains using a modified MLVA method. Instantwatym (talk) 17:11, 18 October 2023 (UTC)