Allison,
I thought the posts under animal transmission were most interesting. Could you please clarify the difference between relapsing and recurrent cdiff? When we talk about relapses after finishing a round of Flagyl or vanco, are these really recurrences, if a few days elapse between the meds and the "relapse"? Thanks for your help.
relapsing vs. recurrent cdiff
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Allison
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Nancy,
That would be considered relapsing disease if you can't stay off the meds for a reasonable amount of time before symptoms restart. It prolly was never really "gone" in the first place, but just hanging out and gathering steam. It's then usually labeled refractory, or resistant to treatment.
We know relapses can and do occur immediately on up to several months after meds are completed. (Ive read that 90% of relapses occur within 2 weeks, the other 10% after that).
But once an individual has been treated successfully, meaning off all meds for (current thinking is what, 90 days?) then another "relapse" should be labeled recurrent, because the infection cleared initially with no sign of return within that window.
Some people suffer with relapsing disease, but aren't susceptible to recurrent disease down the road. For others, the opposite seems to occur...
I know a cancer patient who "gets" cdiff every round of chemo he receives, takes 7 days of flagyl, (that's right - seven) becomes completely asymptomatic, forgets about it, and then starts all over again with the next round of chemo. He's been through this eight times over forty weeks - gets on the flagyl immediately, doesn't get very sick, and then there's no sign of it until next time. It would be very interesting to see if he's being infected with same or different strains each time, but regardless, his bouts of cdiff are considered recurrent.
In my experience, those who really like to make the distinction and think it's significant are the Infectious Disease docs, which makes sense to me.
That would be considered relapsing disease if you can't stay off the meds for a reasonable amount of time before symptoms restart. It prolly was never really "gone" in the first place, but just hanging out and gathering steam. It's then usually labeled refractory, or resistant to treatment.
We know relapses can and do occur immediately on up to several months after meds are completed. (Ive read that 90% of relapses occur within 2 weeks, the other 10% after that).
But once an individual has been treated successfully, meaning off all meds for (current thinking is what, 90 days?) then another "relapse" should be labeled recurrent, because the infection cleared initially with no sign of return within that window.
Some people suffer with relapsing disease, but aren't susceptible to recurrent disease down the road. For others, the opposite seems to occur...
I know a cancer patient who "gets" cdiff every round of chemo he receives, takes 7 days of flagyl, (that's right - seven) becomes completely asymptomatic, forgets about it, and then starts all over again with the next round of chemo. He's been through this eight times over forty weeks - gets on the flagyl immediately, doesn't get very sick, and then there's no sign of it until next time. It would be very interesting to see if he's being infected with same or different strains each time, but regardless, his bouts of cdiff are considered recurrent.
In my experience, those who really like to make the distinction and think it's significant are the Infectious Disease docs, which makes sense to me.
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