Tag: microbiology

When was the last time I wrote about the outbreaks of Clostridium difficile (C. difficile) colitis in hospitals and nursing homes in Canada, U.S.A. and the U.K.? It was 20 months ago (see www.nbharwani.com January 26, 2010).

C. difficile colitis is not out of the news. It is also called antibiotic-associated colitis.

Recently, Southern Ontario and other parts of Canada have had outbreaks of C. difficile colitis. So, what is C. difficile colitis, and how can we prevent it?

C. difficile is a bacterium common in the environment. It is transmitted from person to person by fecal-oral route. That means we ingest food which is contaminated by somebody who handled that food. It comes down to poor hygiene.

The bacterium, in the form of a spore, settles down in the colon (large bowel) and waits there to create trouble. The normal colonic bacteria are resistant to these spors.  However, if the normal colonic bacterial flora is altered, for example, by taking antibiotics, resistance to colonization is lost. Then there is trouble and there is overgrowth of C. difficile.

What happens then? You may have no symptoms but become a carrier and spread it around if you do not maintain good hygiene. Or you may have symptoms like watery diarrhoea to life- threatening colitis.

How can we prevent it?

In a recent article in the Globe and Mail, Dr. Khursheed Jeejeebhoy, an emeritus professor of medicine and gastroenterology at the University of Toronto and Pierre-Jean Maziade, a microbiologist and infectious diseases specialist at Centre hospitalier Pierre-Le Gardeur said the following:

“While health authorities are mobilizing to enact stricter hygiene protocols, namely hand washing and hospital cleaning procedures, it’s clear that hygiene alone is not enough to prevent C. difficile colonization, particularly given that 20 per cent to 40 per cent of hospital patients are C. difficile carriers.”

According to Jeejeebhoy and his colleague, the logical solution is to fight bacteria with bacteria. That means use of high-dose probiotic formula to prevent C. difficile infection by repopulating the intestine with “friendly” bacteria.

There are many probiotics in the market. A recent randomized clinical trial published in the American Journal of Gastroenterology demonstrated that C. difficile infection can be reduced by 95 per cent in at-risk patients receiving antibiotics, with the use of a probiotic. (The study used a Canadian formula, Bio-K+.)

Jeejeebhoy and his colleague say that many hospitals have started using probiotics as a prophylactic measure to prevent C. difficile colitis. To date, 35,000 patients have received the probiotic formula, with no side effects. C. difficile infections were reduced by 73 per cent, and C. difficile-related death declined by 91 per cent. Probiotics are now considered standard protocol at Pierre-Le Gardeur Hospital, and it has among the lowest incidence of C. difficile in a hospital environment in Canada.

Finally, in a comment, Jeejeebhoy says, “I have myself used Bio-K prophylactically when I had to take a prolonged course of antibiotics.” Next time you are on antibiotics, make sure you take a probiotic like Bio-K.

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Quite often we talk about mold when we see a growth of minute fungi forming on vegetable or animal matter, commonly as a fluffy coating, and associated with decay or dampness. Sometimes you open the fridge and find mold spread over bread and cheese. Mold can be found on books and files as well.

Molds can be found in other places in the house. Painted walls and certain types of wallpapers can become overgrown by certain fungi, particularly in humid places such as showers.

You have just invested your life’s savings in a dream home. You have inspected the house thoroughly looking for possible problems. But you forget to check for mold.

It is said that virtually all buildings contain molds, but some are moldier than others. Molds love the interior of the buildings where they can adapt to dry conditions but molds cannot survive without some moisture. You wonder where the moisture comes from. The source could be a leaky basement, a dripping pipe or a roof in need of repair.

Usually it is hard to know if your house is moldy until somebody in the house complains of persistent allergies, headache, nausea or respiratory symptoms. A moldy building can be a serious health hazard.

This brings us to the subject of fungus. Mold is a kind of fungus. Fungi are all around us. Not all fungi are harmful. The American Heritage Science Dictionary defines fungi as any of a wide variety of organisms that reproduce by spores, including the mushrooms, molds, yeasts, and mildews. Spores can remain dormant for years.

Fungi can live in a wide variety of environments, fungal spores can survive extreme temperatures and fungi exist in over 100,000 species, nearly all of which live on land They can be extremely destructive, feeding on almost any kind of material and causing food spoilage and many plant diseases.

The fungus grows best in moist, damp, dark places with poor ventilation and on skin that is irritated, weakened or continuously moist. Most of the fungi are very helpful in the natural environment and only a few cause diseases in humans, plants and animals.

Candida is yeast like fungus which may cause athlete’s foot, vaginitis, thrush, or other infections. It can thrive in moist skin fold areas under the breasts, overhanging abdominal adipose tissues, groins, between fingers and toes, in the armpits and in the anus. Some of the fungi are dermatophytes which cause parasitic infections of the skin, hair, nails and adjacent mucous membranes.

Systemic fungal infections occur when spores are touched or inhaled by patients with chronic illnesses with poor immunity. Patients with systemic infection may have no symptoms or may have flu-like symptoms – coughing, fever, chest pain, chills, weight loss and difficulty with breathing.

Certain fungi, such as mushrooms, can produce poisonous toxins that may prove fatal if ingested.

Skin infection with fungus can be treated with antifungal skin ointment. Systemic fungal infection requires oral antifungal pills. Fungal infection can be prevented by keeping our body and the environment clean and healthy.

And make sure your leaky roof or foundation is fixed.

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“They’re back, and they’re bloodthirsty. Bedbugs, not too long ago little more than a riff in a nursery rhyme, have returned with a vengeance in the United States and around the world,” says an article in the Canadian Medical Association Journal (CMAJ).

And the problem only promises to get worse before it gets better, says the article. An expert on bedbugs from Virginia is quoted as saying, “Our ability to stop the spread is absolutely nonexistent.” No corner of the US has been spared, and the situation is similar in Canada.

The problem in big cities is worse than rural areas. It’s a pandemic – a disease prevalent throughout the entire country, continent or the whole world. It is an epidemic over a large area.

Why are the government policy-makers, local officials, businesses, landlords and private homeowners all struggling to respond to apple-seed-sized insects?

When we had DDT (dichlorodiphenyltrichloroethane) – now banned – bedbugs were largely eradicated. Now the bedbugs have become resistant to most of the insecticides we have in the market. They have demonstrated an extraordinary ability to multiply in spite of everything we have done to get rid of them.

Where would you find the bugs?

As the name implies, you will find them on your beds. You may find them in chairs, sofas, electrical outlets, baseboards and crevices at homes, apartments, hotels, hospitals, college dorms, offices, movie theatres, high-end stores and more, says the CMAJ article. Bedbugs hide during the day and they emerge at night to feed. Only in cases of severe infestation are they found crawling on individuals or in their clothing during the day.

How do they get around?

The common bedbug (Cimex lectularius) is a wingless, red-brown, blood-sucking insect that grows to an adult length of 5 – 6 mm. Bedbugs do not fly. They get around by crawling or hitching a ride on people’s clothing or shoes, bedding, luggage, handbags and furniture.

Are they dangerous?

No, they do not cause or transmit any disease. They feed on human blood with a painless bite, often delivered when people are asleep. The bites can leave itchy, bloody welts. They can cause skin rashes and allergic symptoms, as well as psychological effects like exasperation and irritation. Bedbug bites, however, should be considered a possible cause of chronic blood loss and iron-deficiency anemia in people who have signs of bedbug infestation.

Treatment of the bites typically involves symptomatic use of antihistamines and corticosteroids. Getting rid of bedbugs is hugely difficult. Methods include insecticides, heat, steam, freezing and vacuuming, but can take time and be very costly.

The Environmental Protection Agency held its first “bedbug summit” in 2009 and is participating in a US government task force trying to educate the public and develop better eradication options, says the CMAJ article.

Travellers should take steps like carefully inspecting their hotel room and checking clothing and luggage after a trip. Sleep well. Don’t let the bedbugs bite you.

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