Spores

[Suezer]

Do any C Diff spores hatch while being treated with antibiotics?

[Nancy1]

Here is my understanding about spores. Flagyl or vanco don't kill them, because they are very hardy and well-protected. Meds only kill the vegetative or growing forms. That is why some of us relapse after we stop taking Flagyl or vanco, because spores are still present and they hatch. Then there are no good bacteria in our guts to out-compete the cdiff bacteria, and these new growing forms give us cdiff again. I don't know the answer to your question for sure. So here is my thought. If any spores hatch while we are taking meds (and my guess is that they don't), these new growing forms will be killed by the meds.

FYI, pulsing works (and it worked for me) because it lets spores hatch on the days off of meds, and then they are killed on the days we take the meds. After a number of rounds of this, we run out of spores.

[cindym]

Doctor explained it to me this way:
Cdiff is spore forming bacteria and it is the toxin released by the bacteria once (hatched if you will) that cause us to get sick. The meds (vanco, flagyl) kill the bacteria that is causing the toxin and thus you get better. However, the spores lie dormant in your body waiting for the opportunity to come back to visit at the first sign of weakness in the gut flora.This is why so many of us continually relapse due to our good bacteria not being enough to overcome the new hatching spores. There are no known drugs to kill out the spores completely to date. Anyone that is lucky enough to get well must always be careful of taking any antibiotics in the future because be assured lurking somewhere in your gut are still spores that are just hoping for opportunity.

[Suezer]

Thanks for the replies.
My thinking was that- I am taking a medication that is most likely killing all the good stuff in my gut,as well as the C Diff toxin , why wouldn't any spore that might be lingering around , hatch-release the toxins at this time? I dont know how intelligent these things are, but one would think if my gut is a open field with little competition, these things would burst like mad, and in my favor be killed. -sigh-

I guess I am having a backward approach to thinking on this matter.Or I am just over thinking it all, which is probably very typical, its like trying to solve a twisted puzzle.

[Bobbie]

See Dr. Borody's article & FAQ-Transmission of C. diff. (Info. on "spores")

C. diff. isn't the only spore-producing bacteria. Botulism is another.

See http://www.webmd.com/search/search_resu ... =undefined.

Out of 7 "hits," 2 are about C. diff. Info. is from www.webmd.com.

[LindaSp]

My understanding is the spores are unable to turn into active, toxin-producing bacteria until the antibiotics (Flagyl/Vanco) are no longer present, and the antibiotics don't kill all spores that are stubborn/resistant. This increases the relapse probability once antibiotics are stopped in certain individuals. I believe these individuals, such as my daughter, don't produce their own antibodies to the C Diff bacteria. She has always had issues, asthma, environmental allergies, medicine allergies. She is my sensitive girl...All right, woman. She is 25!

Hope today is a good day for everyone!
Linda

[feelinghopeful]

Spores aren't smart, nor is bacteria. Both react to environmental conditions. Sometimes mutations occur that allow a few bacteria to survive a life threatening assault to the majority. These few survivors multiply. We now have a colony of bacteria that haven't reasoned their way out of a jam - they've adapted by way of a fortuitous mutation.

As was said, spores are produced when the vegetative bacteria is threatened, like when taking antibiotics or when the bacteria is thrown into a hostile environment - if there's enough time, I'm assuming (which sets my mind to working - can you somehow kill it so quickly it has no time to spore?). Again, as was stated, to insure survival, knowing it's going to die, the bacteria sort of lay practically indestructable eggs (the spore) that contains all the genetic information needed to become a full blown bacteria when conditions are favorable. So, I wonder if a spore would 'hatch' in intestines that had a low enough pH. C-Diff reportedly does not favor highly acidic conditions. What keeps the intestinal pH acidic is byproducts of the good bacteria's metabolism. This is what I'm working with at the moment. I try to eat a diet that feeds the good bacteria in an attempt to maintain and environment hostile to the C-Diff bacteria.

Here's a crazy thought I'm throwing out there just for fun - this is not science but speculation. Don't hesitate to shoot me down if you have something to add. I like trying to work these things through.

So, if a person is lactose intollerant, the lactose doesn't get broken down by enzymes into sugars that would be digestible by C-Diff bacteria. It makes its way in tact to the large intestines where bacteria that can ferment lactose reside. C-Diff doesn't eat lactose while it does eat many other sugars.

This is some old research that has interesting info on the sugars C-Diff can utilize under the heading "Results".

http://jcm.asm.org/cgi/reprint/16/4/659.pdf

The fermentation of that lactose creates an acidic environment, at least it does in children, according to MedicineNet. Look under "stool acidity test" below. I'm not sure why it would be any different in adults but it very well could be.

http://www.medicinenet.com/lactose_into ... /page6.htm

I've wondered if a touch of lactose intollerance isn't actually beneficial in some way with respect to C-Diff. Nobody wants more than a touch of lactose intollerance but you see what I'm getting at.

Anyway, back to spores (I'll spare you my other half baked thoughts for another post). I'm hoping that the spores eventually all get eliminated in time by a number of means. They cannot reproduce in a spore state. They do get shed. There are so many variables with this disease it's mind boggling, precisely because of these stupid spores. However, the approach I've been taking is to foster the healthy bacteria, thereby keeping up the acidity in my colon (which does a few good things), hoping the good bacteria dissuade and/or crowd out the residual C-Diff or even kill it and the spores outright and if not, maybe the spores eventually get eliminated.

Did I really just spend that long writing this? I'm now late for a very important date.

[trob25]

Fascinating information feelinghopeful, you should become a doctor in this field! lol.

Anyway, I've been wondering about the spores a lot more in recent weeks. I'm 5 months post C-Diff, dealing with periodic PI-IBS, which is slowly getting less severe with each bout. However, I wonder what causes it sometimes?

My GI indicated, as have many of you, that when the intestines suffer any kind of massive irritation, like infection or surgery, they simply take 6 months - year or longer to recover. But with C-Diff, I wonder if it's caused by small amounts of the residual bacteria? A kink is thrown into that theory however, by my three negative lab tests over the course of two months of on and off PI-IBS episodes. My lab is damn good too, they always caught it when I had it, they did the three tests on three seperate days thing (so I was really tested 9 times) and they know to bring samples in within 3 hours etc.

So if I were shedding bacteria there, I think it would have shown up. Regardless, another doc I had informed me I could have picked up a C-Diff spore 10 years ago and it just waited to come out at an opportune moment. He was a bad doctor though, so not sure if he was right.

Another thing I wonder, is if our good bacteria is strong enough, if it will eventually remove the leftover spores given enough time? I always had excellent intestinal bacterial, how do I know? My entire life (till about 19 or so) I suffered with sinus infections and bronchitis. I was on antibiotics at least 2 entire months, every year from the time I was 7-19. Never had even one bout of antibiotic associated D. Second, sometimes we'd eat out and everyone would get mildly sick from bad food, everyone except me, I never had a problem.

And getting C-Diff took a long time. I was on 5 rounds of antibiotics over the course of a year for Lyme Disease, everything from Cipro for a month to Doxy and Amoxicilian, and was fine. The following year, when I went on Cipro again for a month for a Lyme side effect, is when I got C-Diff again, but it wasn't until 3 months after the Cipro!

In the words of my good GI, "Your body put up one hell of a fight after all that, it just couldn't survive that last round of Cipro."

So I wonder if my good bacteria will return one day, even ridding me of these spores? Or is my old bacterial makeup gone forever, washed away with the Flagyl?

[Nancy1]

trob25,
I think that the answer to your question, unfortunately, is that no one knows. Some folks have been able to take antibiotics after cdiff without problems, while others have gotten cdiff again. So my guess is that some folks eventually get rid of their spores, while other don't. But we don't know which group we belong to.

[Bobbie]

trob25.
Some can take antibiotics again without a problem. Some cannnot. I had C.diff from l993-l997 & was C. diff. free (did have IBS) until l999 when I had to take an antibiotic for pneuimonia. Even though I took Vanco. immediately (doc. prescribed it) & brought probiotics to the hospital, I developed C. diff. again.

About four years ago, I had pneumonia again & survived a Z-pak. (Zithromycin). No one was more surprised than I was. Several others on this siite have taken antibiotics again without a problem. Others have developed C. diff. again. Most doccs. prescribe Vanco. or Flagyl with the other antibiotic. It didn't keep me of getting C. diff., but it has for others.

Short version: You won't know until you have to take an antibiotic again.
Make sure you need an antibiotic & take one with a lower chance of C. diff. (see FAQ-Antibiotics). Usually, the broader spectrum ones are the biggest culprints. Any antibiotic can cause C. diff., however -- somtimes (rarely) even Flagyl.

[feelinghopeful]

Great question, Trob. I'm not feeling very alert today from lack of sleep, nutrition, and from stress. Just got back from a wake, too, but here's my two cents anyway.

C-Diff only produces toxins when its hungry. When there's a lot of C-Diff competing for the same food (all bacteria eat different things), there's limited available nutrition so the C-Diff will produce toxins so it can literally turn you into food. I believe that's why you can have some C-Diff held in check by other bacteria and there's enough food to go around so it doesn't often have to wage an attack. You can probably have a percentage of C-Diff living happily with enough to eat, tralala. When factors throw the balance of your bacteria momentarily out of whack, you have a flair up. Stress effects your intestines, hormones, what you eat, the water you drink, cosmic rays for all we know. So it's possible that amounts of toxin too small to detect is produced now and then and this creates a disturbance. Small percentages of toxin make testing incredibly unreliable. I provided a link about that somewhere. So that's one reasonable possibility.

As your good bacteria becomes a greater and greater percentage of your flora, the PI-IBS gradually diminishes. I read it can take five years to fully recover from PI-IBS. The reason I don't think most PI-IS is caused by damage to a colon that has to heal is, when I went back on antibiotics no matter how damaged my colon was, the symptoms disappeared. If it was a damaged colon that had to heal, antibiotics wouldn't make it feel great in two days.

Another possibible explanation for your IBS is that we can have an immune response to the presence of C-Diff bacteria that isn't necessarily C-Diff disease and not caused by the toxins but by the presence of the bacteria. Possibly until your intestines cross a certain point where the good stuff is firmly back in order, the presence of too much C-Diff bacteria causes your body to react to it now and then. I think there are intestinal diseases out there that are the body's respondse to bacteria that are not causing obvious manifestations of disease. Swelling is an immune resonse. Mucus is one, too. So, there's another possibility. It could be both or neither, of course but if I have to put my thinking cap on I think they're both viable explanations.

I can't remember your other questions but here's my take on the spores. They are not infinite if vegetative bacteria isn't present. We need to make the environment inhospitable to the bacteria and then hope that the spores, which cannot duplicate if they don't 'hatch' will be eliminated in time.

We can also hope for the discovery of a benign bacteria that eats them!

I can't read this back, my mind is spinning now. I hope something here gives you some hope or ideas on how to approach your situation. My very best to you.

[feelinghopeful]

Trob,

You set my mind to thinking and wanted to add that any number of things could be going on simultaneously. Once you wipe out so much bacteria, not everything is going to grow back evenly or possibly at all - unless it gets introduce with a transplant or enteric pill. You flora is in constant flux so I doubt minor alterations would cause major problems. However, after C-Diff treatment, some beneficial bacteria could become opportunistic once other strains have been wiped out and real estate is up for grabs. So, you could wind up with an extremely out of whack intestinal tract - not damaged in and of itself but damaged in terms of the balance of bacteria (which you mention). That's possibly why it often takes a while to get IBS once off antibiotics and why it can take so long to recover from. So, how to foster repopulation and balance of the bacteria your body has known all its life, or close to it or even better (if that's possible). I guess this is what we all want to know.

Studies have been conducted to determine if it's possible for your body to accept new strains of bacteria after you've developed a profile. It appears that for the most part, if your body has never known a bacteria, if you never had it from youth, your body won't ever let it move in. I've given the ramifications of this idea a lot of thought in terms how absolute this might be. If you never had strain A1 you can never have strain A1? What if you had it's near identical twin A2, can you slip A1 by? How absolute is this exclusive club? Could you genetically alter A1 to fool the body into accepting it. I think people are going to be paying much closer attention to intestinal bacteria in the future - they already are, actually.

I bet some people aren't predisposed to C-Diff because they have a high percentage of bacteria that's hostile to coexistence with C-Diff. My body also had to take mulitple hits to finally get full blown C-Diff after exposure to it. I had a great set of bacteria! I hope a few survived all those antibiotics to repopulate.

They did small pox studies on monkeys who were naturally resistant to it. They could not get the monkeys to develop small pox. Finally, they overwhelmed their immune systems with far greater amounts of the virus and the monkeys did develop manifestations of the disease much like that of humans. It's a virus, not a bacteria - huge difference, as is the scenario, but the idea of absolute immunity, rejection or whatever is called into question. Can you sneak a close relative in? The small pox vaccine is made with cow pox, not small pox... it's all so curious...

Rant over :)

I MUST stop thinking about this stuff!

[trob25]

I know you need to get away from the C-Diff boards feelinghopeful, but you know so much and are both incredibly helpful and an incredible resource of information!

Thanks to you and everyone who replied. I've been thinking about this more lately because I think I'm far enough removed from the C-Diff to not be constantly worried about that and these PI-IBS bouts aren't even as bad as they originally were, but still happening every few weeks, or once a month for a week.

Anyway, bacteria profiles are an interesting concept. I wondered if our intestines naturally draw a certain kind of bacteria, that even if wiped out, would repopulate with the same type. But the fact that it was wiped out, makes me wonder how it could or would bring back the same types? Unless our genetic makeup is partial to specific types, that would explain a lot.

Also interesting that while it could be small amounts of C-Diff toxins causing PI IBS, it may simply be a bacteria imbalance war zone in there as things try to naturally re balance. Perhaps this is why eating certain foods sets us of while others don't. Maybe some of the bacteria we need has come back, but others, that processed red meats etc., aren't full there yet or strong enough?

I know from reading bacteria for breakfast and the probiotics revolution that intestinal bacteria are responsible for a good deal of our overall health or lack thereof. I was really fascinated with some of the concepts in those books and about how studies have looked and are looking at good intestinal bacteria in regards to preventing other previously thought unrelated major diseases.

[Allison]

...and don't forget that PI-IBS is not exclusive to cdiff. It is prevalent in 3 - 30% of patients after any infectious gastrointestional illness, regardless of the causal agent -be it a virus, parasite, or bacteria. It happens after infection with non toxin-producing bacterias as well.

One thing I've noticed... the severtity and duration of PI-IBS does not correlate to the severity and duration of the original cdiff infection among forum users over the last eight years.
This is strictly observational, and a build up of anecdotes is still not evidence in any way, but it's interesting. We've had folks with galloping PMC and near megacolon who recovered from cdiff with little to no PI-IBS, and others who had a mild cdiff infection of very short duration, no inflammation on colonoscopy, but were left with fairly moderate PI-IBS for a year or more. There are alot of other factors involved, some well known and others not so much.

I always liked my GI's summary (and I think Fire's GI told him the same):
I'm paraphrasing..."The colon is THE stupidest organ in the human body. Once it's out of whack, it forgets everything. It has no memory of how and when it's supposed to work like other organs do. It doesn't respond properly to the usual stimuli anymore, and over-responds to stimuli it isn't supposed to. It retrains at it's own pace and of it's own volition".

[klt03301]

Thanks for that, Allison...especially the last two sentences. It should give all of us hope!

Karen