Tag: diarrhea

Dear Dr. B: I am concerned about the recent reports of outbreak of diarrhea in Calgary and Montreal hospitals. Can you please explain the cause and effect of this kind of colitis?

“More people have died after contracting a virulent infection that has broken out in hospitals in Montreal and Calgary than were killed by SARS – yet neither public health nor hospital officials warned the public until CMAJ broke the news,” says an article in the recent issue of the Canadian Medical Association Journal (CMAJ).

The bacterium responsible for the outbreak of diarrhea is called Clostridium difficile (C. difficile). The condition is known as Clostridium difficile-associated diarrhea (CDAD).

In the last 18 months, at least 12 hospitals in Montreal have been fighting CDAD. More than 1400 patients have tested positive to this organism in that city. At least 79 people have died in Montreal and four in Calgary from C. difficile infection.

The organism was first described in 1935. In the last 25 years, it has been recognized that C. difficile can cause mild to life threatening diarrhea – also called psuedomembranous colitis.

The C. difficile infection is most commonly associated with antibiotic use. The antibiotics cause disruption of normal bacterial flora in the gut and allow C. difficile to thrive and produce toxins which causes diarrhea. C. difficile is resistant to most common antibiotics. Hence, the difficulty of controlling the infection.

July 16th issue of the CMAJ has several articles on the subject. One of the articles written by Dr. Thomas Louie from Foothills Medical Centre, Calgary says, “The root cause of outbreaks of C. difficile diarrhea in our hospitals relates to the difficulty of practicing and maintaining good infection control measures in hospitals.” This is because of high occupancy rate in hospitals, intensive antibiotic use and increasingly complex care of patients.

Many hospitals are old, there are few single or isolation rooms, many patients have to share toilet facilities and there is rapid turn over of patients. All these factors make it difficult to control or contain infection.

What’s the situation in Medicine Hat? I spoke with Dr. Wai Chow, Regional Medical Director of Laboratory Services in the Palliser Health Region. He said that there is no evidence of any outbreak of CDAD in our region. The laboratory continues to get sporadic cases of CDAD which is not unusual. Most cases are due to antibiotic use.

Hospitals in Canada are acutely aware of the situation and continue to implement infection control measures. But there is no guarantee that there won’t be another outbreak of CDAD. Changing behavior of bacteria and viruses will continue to challenge our survival, our resources and our skills. SARS and avian flu are good examples.

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Diarrhea is a worldwide problem. It causes significant ill health and many people die. The situation is worse in poor countries. Even in developed countries diarrhea causes significant illness and death.

Diarrheal diseases have been a scourge to humanity throughout recorded history all over the world. “Infections are estimated to account for three to four billion cases of diarrhea each year, and up to 4.3 million deaths in children under the age of five years,” says an article in the Canadian Journal of Gastroenterology.

Diarrhea means loose, watery stools and abdominal cramps. Frequency of bowel movements may vary in each case.

Management of diarrhea depends on whether it is acute or chronic.

Acute diarrhea is unpleasant and almost everyone experiences at one time or another. The loose stools usually last a few days.

Most common causes of acute diarrhea are due to infections:

-Viruses: Rotavirus and adenovirus are common examples in young children. Direct contact easily spreads viral diarrhea.

-Bacteria and parasites: Parasites such as Giardia and cryptosporidium can cause diarrhea. Certain bacteria like campylobacter, salmonella, shigella and E. coli can cause diarrhea. The source of infection is contaminated food or water.

-Diarrhea can also be side effect of many medications, particularly antibiotics.

-Traveler’s diarrhea can occur in 20 to 50 percent of travelers to tropical countries. Eighty percent of traveler’s diarrhea is due to bacterial infection.

Chronic diarrhea lasts much longer than acute diarrhea. Diarrhea lasting four weeks would probably be considered chronic but six to eight weeks would provide a better distinction.

The prevalence of chronic diarrhea in the United States seems to be approximately five percent.

It can be a sign of a serious disorder like chronic infection, inflammatory bowel disease or poor absorption of nutrients (malabsorption). It may be due to a less serious condition such as irritable bowel syndrome.

Other causes of diarrhea are: Lactose, a sugar found in milk and milk products, artificial sweeteners, sorbitol and mannitol, found in chewing gum and other sugar-free products can cause diarrhea.

There are many more causes of chronic diarrhea. They cannot all be mentioned here. To name few more: dumping syndrome, celiac disease, chronic pancreatitis, antacids, alcohol use and diabetes.

In one study, 30 percent of the patients a definite cause of diarrhea was found. In 20 percent of the patients the cause was found to be in laxative and diuretic abuse. In 50 percent of the patients – no specific diagnoses was made. They were given the diagnoses of “functional” or “idiopathic” diarrhea.

Most significant complication of diarrhea is dehydration – as suggested by excessive thirst, dry mouth, little or no urination, severe weakness, dizziness or lightheadedness. This can be dangerous especially in children and the elderly. One should seek immediate medical help.

Viral diarrhea can be prevented by washing hands and encouraging your children to wash their hands. One must also guard against diarrhea caused by contaminated food and water.

Several precautions should be undertaken when one is traveling in tropical countries.

Investigation of diarrhea includes history and physical examination. Blood and stool tests. If no cause is found then examination of the colon, stomach and duodenum with an endoscope should be undertaken.

Sometimes diarrhea is only an inconvenience. Sometimes it can be life threatening. Sometimes it can be prevented by good preventive measures like washing hands and avoiding potentially contaminated food and water. Sometimes there is not much you can do to avoid it – especially in cases like ulcerative colitis, Crohn’s disease and other medical conditions.

So, if you have diarrhea then see your doctor before it runs you down!

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