Getting C-Diff spores without getting C-Diff illness?

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MarkF
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Getting C-Diff spores without getting C-Diff illness?

Postby MarkF » Sun Nov 12, 2017 11:10 am

My 92-year old father-in-law contracted C-Diff about three weeks ago. The first few days of it none of the family members new what it was (would be nice if nursing homes warned of potential C-Diff when leaving!) and we took care of him. Maybe 5 days later we realized what it was and took extreme precautions with gloves and bleach. My father-in-law has since been back in the hospital and now back in nursing home where he's got maybe another week before he passes in Hospice due to his C-Diff complication of Ileus.

The caretakers were his 88 year old wife, my 58 year old wife and my 29 year old daughter, and myself, a 62 year old male. His 88 year old wife is pretty healthy given her age, and the rest of us are fit, very healthy and take probiotics, an not generally prone to being sick. None of us are on antibiotics or had taken them recently.

Thankfully, none of us have caught C-Diff, so far. Seems like since we made it at least a couple weeks since we started with gloves and C-Diff, we (knock on wood) are okay. Of course, we all live in fear of it still.

Here's my question: Even though we have not caught C-Diff, since we spent every day with him, long hours, for a few weeks, as careful as we were, would we have likely acquired the C-Diff spores into our gut somehow, and they are sitting there now making us more likely to develop C-Diff in the future, should we have to take antibiotics or otherwise compromise our immune system in some way? Are we more vulnerable now?

If anyone knows the answer to the above questions, I'd really appreciate it some insight.

And some say that "everyone has C-Diff in their gut" to begin with, and that it's there waiting to strike when conditions are right. Is this true, and if so, what would make this different from someone catching some spores from an infected patient, yet lying dormant, unexpressed? It doesn't sound right because then why would people mostly get C-Diff when during a hospital/nursing home stay where the bug is being passed around?

amg
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby amg » Sun Nov 12, 2017 2:30 pm

I am so sorry about your father-in-law.

Those are all very good questions you are asking. Here are a few thoughts:

Yes, c diff spores are out in the community. But there are different strains of c diff. Some are not toxigenic (meaning they do not produce toxin and cannot make you sick with c diff diarrheal illness). Others are toxigenic. And of the toxigenic ones, some are particularly virulent. (Make you more sick, higher relapse rate, more difficult to eradicate).

People are more susceptible to c diff while in the hospital or just after a hospital stay. This makes sense if you consider that hospitalized or recently hospitalized patients are not as healthy, likely have weakened immune systems, may have just had intestinal surgery or something that compromises the gut, could be older or more frail, and could potentially have been exposed to hardier strains of c diff because the people who are sicker from c diff go to the hospital for treatment.

I don't know if there is a scientifically proven/known answer to your question about you all being more susceptible in the future because of your exposure. And there must be individual variation in immunity even among healthy people - perhaps it's the mix of an individual's natural intestinal flora? My 85 year old mom was recently put on clindamycin TWICE by her dentist (and didn't tell me!). And this was after my dad had spent 29 days in the hospital. I was convinced she would get c diff. But she didn't. However, I consider myself, who works in a hospital every day, probably at higher risk of contracting c diff illness if I'm exposed to antibiotics or if my immune system becomes compromised, than someone who is not in a hospital environment every day.

So yes, be vigilant about practicing good hygiene, cleaning/bleaching the surfaces that may have been contaminated, and avoid antibiotics if they are not truly necessary.

Again, I'm so sorry about what your family has recently gone through.

MarkF
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby MarkF » Sun Nov 12, 2017 3:28 pm

Thank you for your thoughts, amg. I appreciate all the great information.

It's very interesting that there are multiple strains. Makes sense to me. Interestingly, one morning at the hospital where he was getting his C-Diff treatment, we went to visit and there was, out of nowhere, a second patient, a C-Diff patient, in his "private room." We had a fit and had them move the other patient right away, with them apologizing that this should not have happened. I expressed concern to the doctor that introducing another strain to the room could be troublesome (to both my father-in-law and us as visitors who stay in the room most of the day), and guess what he said: there is only one strain. But then I've learned to no really trust everything doctors say.

amg
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby amg » Sun Nov 12, 2017 4:06 pm

You could show that doctor this paper:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122689/

:)

MarkF
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby MarkF » Mon Nov 13, 2017 3:45 pm

Since posting I have learned that 1-3% of the population has C.diff in their intestines and, even then, C. diff is present in teen-tiny numbers (relative to all the other gut bacterium) and usually harmless. [CDC, Harvard Med, et al].

I'd like to restate the question I'd still like to find an answer to: I still am trying to understand if people who are caretakers, as careful as they are, are likely additions to that 1-3%. In my case, I and my wife and her mother have spent hundreds of hours caring for my father-in-law, in his home, the hospital and now at the nursing home where he is passing away very soon. We've been very careful (gloves, bleach, handwashing, etc) and show no signs of any problems. But are we now potentially part of that 1-3% of carriers because at some rare slip up in our care of him, it could have transferred to us, even though we show no signs of having it?

roy
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby roy » Tue Nov 14, 2017 11:53 am

C.diff is a transient bacteria, you can carry it for a while and not become sick.
It's possible you could have picked it up while careing for him but it's VERY unlikely to become a disease in a healthy person.
In fact you probably pick it up several times a year from items like supermarket trolleys handles and even from money.
Its very common in processed foods as well.
You mention the small% of people that carry it, that increases to over 25% if someone spends 2 weeks or more in a hospital or care home.
If you have picked it up it's not time to panic because it's just another species of normal gut flora.
Did you know that your almost certainly carrying staph, strep and E.coli?
Along with clostridium species they are all normal unless they cause symptoms.

MarkF
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby MarkF » Tue Nov 14, 2017 1:22 pm

Thanks for your input Roy!

MarkF
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby MarkF » Tue Nov 14, 2017 2:43 pm

Oh, one thing I should ask for clarification on just to be clear: when you say " that increases to over 25% if someone spends 2 weeks or more in a hospital or care home," do you mean if a patient spends that time in hospital or home care, or do you mean if like family spends all that time in a hospital and home care with the patient?

Thanks!

roy
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby roy » Tue Nov 14, 2017 4:33 pm

A patient, mostly because they are already sick and highly likely to be on antibiotics.
Hospital staff carrier rates are around the same as community carrier rates.
No doubt hospital staff do pick up the bugs but their immune system just deals with it as nature intended and they do not become sick.
Same will apply to you and your family.
My mother died of this so I have been in exactly this situation and can assure you with almost 100% certainty that you are not at any serious risk.

MarkF
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby MarkF » Tue Nov 14, 2017 5:00 pm

Thanks Roy, that's makes it very clear. I'm sorry about your mother, we are waiting for my father-in-law to pass at any literally moment now due to an ileus thanks to C-Diff.

roy
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby roy » Tue Nov 14, 2017 5:40 pm

If you need to know anything send me a message.
Make the most of what time you have.
I hope they are still treating him.
Withdrawing treatment just because of age is not acceptable.
Good luck.

beth22
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby beth22 » Wed Nov 15, 2017 2:27 am

MarkF - Are they not treating the ileus? My dad had an ileus and they made an incision and he had to wear a bag for about a month and then they reversed it. He was in his 80s at the time.

MarkF
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Re: Getting C-Diff spores without getting C-Diff illness?

Postby MarkF » Wed Nov 15, 2017 8:41 am

Beth, They are not treating the Ileus, as he has multiple other problems (COPD, failing kidney, and other things) that don't give him a long time anyway. And he's gotten too frail and old (92) where none of us, doctors and family, think it's worth doing to him at end of life.


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