Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

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Flusted
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Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby Flusted » Thu Aug 17, 2017 12:46 pm

Hi, I am a Male 72 yrs in reasonably good health, 250 lbs. I am a recently hired land surveyor and have come down with C DIFF after measurement of elevations and sizes of pipes in sanitary sewers needed for highway work. There is no direct contact with sewage fluids but secondary contact with tools used to get the measurements and possibly contact with pathogens from the air and fluids released on the surface. I was tested positive for C DIFF on August 9th, 2017 after working for about a month on the job.
My questions are:

(1) (I've searched topics for "sewer" and haven't found good answers to my first question.) Can C DIFF be acquired from sanitary sewer manholes while contact is made with fluids, possibly airborne spores, and tools while measuring. The metal manhole cover is removed with a special crowbar. Usually there is an inner plastic/vinyl cover below the metal manhole cover containing years old rainwater. When inner cover is removed with crowbar, the old water splashes everywhere, most going into the MH. The manhole opening tools are exposed. Most MHs are filled with hundreds of cockroaches. They scurry around and hide as well as they can. Then measurements are made with a rod which gets filled with fluids which later drain out of it. All these tools are stored in truck. We now wear rubber gloves while opening the manholes but didn't always at first. The metal of the manhole covers can have rusted filaments that can puncture skin. We try not to touch these MH fixtures, but I in my ignorance did touch some even with bare hands.

My Internet search has come up with two items of information: (1) C DIFF spores are found in both sanitary sewer input and output to sewage treatment facilities in at least one test that I could find. (2) C DIFF spores can be airborne in clinical settings apparently during normal treatment of patients with C DIFF as the spores get disturbed. There was no mention of how these airborne spores can cause C DIFF so one does not know if from breathing or from subsequent contact.

(2) If C DIFF spores are airborne near open sanitary sewer manholes how does a human get C DIFF from the airborne spores?

(3) Is it most likely that my recent C DIFF came from some other source or from the sanitary sewer exposure?

Just as background, my symptoms were atypical. Constipation and mucus, not diarrhea. Now taking the antibiotic Flagyl (Metronidazole) 500 mg 3 times daily started 8/9/17. Bowel function was restored but now 3 days of constipation again. Is this a relapse? I called my doctor, waiting for result.

So, I have more questions having to do with prognosis, prevention and treatment but this is enough for a start ... thanks so much for this forum. The medical industry just does not give one enough info for complicated illnesses like this. How do you live with it while you have it? You can't stay at home all the time. best approaches to try to get rid of it?, etc. Here is a final question for this post.

(4) One person I know had the following to say, and I'm wondering if there is any experience with this or "You may have already googled it, but the name of the specific organism for you to look for in a probiotic is: S. boulardii (Saccharomyces boulardii). I found it in certain probiotics with "soil-based" organisms (ha - maybe we should just eat more dirt!). Anyway, my kept having recurrent infections until I introduced the correct probiotic to help." ?

roy
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby roy » Thu Aug 17, 2017 2:19 pm

It's very possible you are colonised with c.diff, that's not unusual and a lot of people are colonised.
That's normal.
Working with sewage would increase the likleyhood that you are.
That does not mean it's causing your illness though.
C.diff typically causes watery D if it overgrows.
That's when it becomes a disease, symptoms indicate the disease and the test confirms it.

Lisa33
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby Lisa33 » Thu Aug 17, 2017 3:23 pm

Hi Flusted - Welcome to the site. Please read the first forum for all new users on rules of posting, standard intro, etc.

So sorry that you are experiencing these GI issues and have been diagnosed with c-diff. Although constipation is not usual with c-diff, we have had some posters who experienced it. The usual symptoms are persistent watery D with the urgency to go, as Roy said. I'm sure that being around sewage would expose you to all kinds of bacteria, including c-diff. However, in order to have an active infection, unless you are immunocompromised, something would have had to wipe out your good gut bacteria, such as recent antibiotic use. The good gut bacteria is what keeps the bad bacteria in check. When you say that you tested positive for c-diff, was it with a toxin test. I'm just curious because like Roy said, maybe you are colonized.

Many posters on this site, including myself take sacchromyces boulardii for a probiotic. It is a yeast probiotic and is not killed off by the c-diff meds as live bacteria probiotics are. If you take a live bacteria probiotic, make sure to space them out from the meds. Many, including myself have found sacch boulardii to be beneficial in restoring good gut bacteria to ward off the c-diff. I also took VSL-3 while fighting c-diff and for a couple of years after. It was recommended by my GI. It's a live lactic acid probiotic. However, some people cannot tolerate probiotics, so start off slowly to see how you do. Many also find Kefir (a probiotic drink) to be beneficial as well.

Some of us never know where we actually ingested the c-diff spore. It's usually contacted in hospitals or nursing homes. And most, get c-diff after being on antibiotics. I got it after taking an antibiotic for a so-called sinus infection, but I was not in a hospital or medical facility around that time at all. It's becoming more and more acquired just out in the community.

Hopefully you feel better soon, but I would question the test results further with your doctor as you are not presenting with the classic symptoms. Although like I said. there are some posters who did experience constipation and mucous, so anything is possible.

Feel better,
Lisa

Flusted
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby Flusted » Thu Aug 17, 2017 3:42 pm

Hi Roy. Thanks for your reply. I have a question though. From what you are saying, it is perhaps okay and semi-normal to be "colonized with C DIFF". Is that correct? But if you are either colonized or catch it and it gets "overgrown", then it is a problem? That makes it pretty confusing. What is the level of C DIFF from a test to determine whether you are "overgrown" if the test is positive? Or are there other signs? What questions should I ask my doctor? Is it okay to have a colonoscopy done?

roy
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby roy » Thu Aug 17, 2017 3:56 pm

Being colonised is not a disease, it can be and often is a normal part of the gut flora.
At least 1 in 20 people carry c.diff.
The rest of the flora keep it under control as nature intended.
If the flora is disturbed by antibiotics (or another reason) the c.diff can then overgrow and cause a disease (colitis) usually resulting in watery D.
Tests do not differentiate between colonisation and disease, both give a positive result.
Drs are supposed to look at symptoms and if they indicate c.diff test to confirm it.
Labs are instructed NOT to ever test formed stool for c.diff to protect the patient from a Dr that treats just because of the test result.

Flusted
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby Flusted » Thu Aug 17, 2017 4:18 pm

Lisa33 wrote:
> Hi Flusted - Welcome to the site. Please read the first forum for all new
> users on rules of posting, standard intro, etc.
"Yes, I did read the rules"
> So sorry that you are experiencing these GI issues and have been diagnosed
> with c-diff. Although constipation is not usual with c-diff, we have had
> some posters who experienced it. The usual symptoms are persistent watery
> D with the urgency to go, as Roy said. I'm sure that being around sewage
> would expose you to all kinds of bacteria, including c-diff. However, in
> order to have an active infection, unless you are immunocompromised,
> something would have had to wipe out your good gut bacteria, such as recent
> antibiotic use. The good gut bacteria is what keeps the bad bacteria in
> check. When you say that you tested positive for c-diff, was it with a
> toxin test. I'm just curious because like Roy said, maybe you are
> colonized.
" I have a call into the doctor today. Not replied yet. Didn't reply to last call either. He is my colonoscopy doctor. I've never seen him. I have a test scheduled for 8/28 that came up before this. I called because I had this constipation and was wondering if it would affect my colonoscopy test. Nurse called and told me to come in for a test. Test gave c-diff result."
>
> Many posters on this site, including myself take sacchromyces boulardii for
> a probiotic. It is a yeast probiotic and is not killed off by the c-diff
> meds as live bacteria probiotics are. If you take a live bacteria
> probiotic, make sure to space them out from the meds. Many, including
> myself have found sacch boulardii to be beneficial in restoring good gut
> bacteria to ward off the c-diff. I also took VSL-3 while fighting c-diff
> and for a couple of years after. It was recommended by my GI. It's a live
> lactic acid probiotic. However, some people cannot tolerate probiotics, so
> start off slowly to see how you do. Many also find Kefir (a probiotic
> drink) to be beneficial as well.
"Thank you for this tip. I have ordered this probiotic. It is interesting that my problem seem to start when I started taking a probiotic that I normally take that I had been off of for a while.
>
> Some of us never know where we actually ingested the c-diff spore. It's
> usually contacted in hospitals or nursing homes. And most, get c-diff
> after being on antibiotics. I got it after taking an antibiotic for a
> so-called sinus infection, but I was not in a hospital or medical facility
> around that time at all. It's becoming more and more acquired just out in
> the community.
>
> Hopefully you feel better soon, but I would question the test results
> further with your doctor as you are not presenting with the classic
> symptoms. Although like I said. there are some posters who did experience
> constipation and mucous, so anything is possible.
>
> Feel better,
> Lisa

Thanks Lisa, I'm feeling fine. Most bothersome is the disease if it is a disease. Crazy disease. If you don't test positive for c-diff you are okay. If you do test positive for c-diff you may be ok too, or maybe not. Only way to tell if you are okay is if you have normal bowel function, correct? So today I have correct bowel function, no pain, no symptoms. Constipation finally broke. I'm staying home from work so nobody at work will catch this strange disease from me. Maybe I am really well and should be at work. Or maybe the spores are all over me and I will spread it like crazy since I have it but I'm well. The only way to be sure I won't spread it is if I get a negative c-diff test. If I have a positive c-diff test maybe it's okay to go to work but not okay to go out dinner. Maybe I shouldn't kiss anybody because they might get it. Maybe it's spread by air so everybody around me will be get. Maybe it's not spread at all if I'm having normal bowel function. Maybe everybody has it and they don't know it. Babies apparently are born with it.

Any ideas how to handle this infection problem?

amg
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby amg » Thu Aug 17, 2017 4:34 pm

If you are having normal bowel movements and no other symptoms, then it seems safe to conclude you don't meet the clinical criteria for having an active infection that needs treating. If you are practicing good hygiene and not incontinent or messy with your stools, then you are not going to spread this around. It's the people who have diarrhea and are at risk of contaminating their surroundings with stool, who are contagious.

The danger of treating c diff when you are only colonized and don't have an active infection is that the c diff meds themselves like Flagyl and Vancomycin (and most all antibiotics used for any reason) kill other bacteria in your gut along with the c diff, including beneficial bacteria that we all need to be healthy and to keep c diff in check. So you can actually give yourself an active c diff infection by treating it when it's not active.

roy
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby roy » Thu Aug 17, 2017 4:40 pm

You stop worrying!
C.diff is a common soil borne bacteria.
Your not spreading it around like typhoid Mary.
A golden rule is you NEVER test to see if its gone, your Dr shoukd know that fact. (Many do not).
C.diff is spread by getting the spores that might be in your faeces into someone's mouth, not in the air.
If your bowels are normal it's not a disease.

beth22
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby beth22 » Thu Aug 17, 2017 4:42 pm

I worked during my c diff infections, but I was not having D either. When I was first diagnosed, I was like you, constipated, but I was having a lot of mucus and felt like I had to go all the time from the M. My doctor had me treat with vancomycin and I think in hindsight it was probably not a good idea, although I will never know for sure. You are on mediation and if you are not having D, there is no reason not to go to work In your work, do you use those portable outhouse toilets? You are more likely to catch something there in my opinion. As long as you practice good hygiene after using the toilet by washing your hands well, you should not be contagious. I got c diff from visiting my mother at a nursing home and as you mentioned, in those types of surroundings, airborne spores can be a cause for concern because they land on surfaces and people touch those surfaces with their hands. I don't think you can get it just by breathing the spores, unless somehow you swallow them. Maybe if some get in your mouth if you are talking while changing a patient perhaps. I don't think there have been many, if any, studies on that.

If you feel well, go about your normal activities. I have tested positive for over a year now after I was on antibiotics last year in the hospital. When I first relapsed, I had D, but by the time the test came back, I was not having D any longer and have not treated the infection. Supposedly, I too, am colonized. I do have IBS symptoms and I also have some other issues like chronic pancreatitis as a result of my c diff history though.

I was not able to tolerate the probiotic you mentioned, so whichever one you try, just take a small amount at first and see how you feel. I got a lot of gas and bloating, D, and even a rash. I had to try several different probiotics before finding one that halfway agreed with me.

Hope that answers some of your questions. When you post, no need to use the quote feature, as it takes up a lot of space and we lock the thread after two or three pages, so without the quotes, you can get a lot more responses.

Flusted
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Re: Cdiff from Sanitary Sewer Manholes? How to Treat/Prevent

Postby Flusted » Thu Aug 17, 2017 9:29 pm

amg wrote:
> If you are having normal bowel movements and no other symptoms, then it
> seems safe to conclude you don't meet the clinical criteria for having an
> active infection that needs treating. If you are practicing good hygiene
> and not incontinent or messy with your stools, then you are not going to
> spread this around. It's the people who have diarrhea and are at risk of
> contaminating their surroundings with stool, who are contagious.
>
> The danger of treating c diff when you are only colonized and don't have an
> active infection is that the c diff meds themselves like Flagyl and
> Vancomycin (and most all antibiotics used for any reason) kill other
> bacteria in your gut along with the c diff, including beneficial bacteria
> that we all need to be healthy and to keep c diff in check. So you can
> actually give yourself an active c diff infection by treating it when it's
> not active.

Thanks AMD ... I'm getting a better picture of what this is and isn't.


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