Tuesday, May 5, 2009


The intestinal flora in human beings are diverse and billions of microbial cells inhabit the GI tract, most of them beneficial to the host. Over 500 species of microorganisms have been identified and some of them are pathogenic in nature. However the pathogenicity does not find expression under normal conditions due to the overwhelming presence of friendly microbes. Helicobacter pyloris is a classical example of a pathogenic organism that resides in the stomach which can flare up under favorable conditions causing chronic ulcers and other problems. Clostridium difficile, also referred to as CDF or cdf or simply as C.diff is another example of a pathogen that has been found in 2-5% of the population in the world. The enterotoxin, cytotoxin and binary toxin produced by C.difficile can cause severe diarrhea and other complications in the large intestine when the general population of harmless bacteria declines due to repeated use of antibiotics through the oral route or cross infection from patients harboring high population of this bacteria in their body. Old age population, residents of hospitals and nursing homes and people coming in direct contact with infected persons can contract this disease.

Emergence of CDF as a major causative agent in intestine related disorders is of a recent origin. With hardly 1000 case reported 5 years ago, to day more than 50000 incidences involving this pathogen are being recorded, some of them proving to be fatal. Large intestine where there is very little oxygen, is the thriving ground for CDF as it is an anaerobic microorganism. Its proliferation can cause serious ulcers, bleeding from the colon and even perforations of the intestine which can be fatal. There are about 100 variants of CDF and the most virulent is Type 027 which has been detected in most of the infections occurring in recent times. As they are spore forming microbes, their destruction is not easy once they start growing as many normal antibiotics are ineffective against it. Oral administration of special antibiotics like metronidazole, vancomycin, fusidic acid or bacitracin can control the infection to a great extent. Psuedomembranous colitis caused by CDF results in bloating of stomach region, constipation, severe diarrhea and abdominal pain. In India there is no credible report of occurrence of CDF infection, probably due to insufficient diagnostic tools available to detect CDF and all diarrhea being clubbed together under one category.

With indiscriminate use of a wide range of antibiotics, even for minor fever and ailments, CDF infection is likely to rise in the coming years unless some restriction is put in place on supply of these antibiotics with out accurately diagnosing the reason for every ailment. Some hospitals do type out the microbial profile of the faeces to determine the causative agent but this is more an exception than the rule. Though antibiotics sale is covered under physician prescription regulations, the ground reality is that any one in India can get them from small pharmacies without such prescriptions and there is a tendency amongst many citizens to rush to a drug shop rather than an hospital or a physician when ever they have fever and similar symptoms. Administration of freeze dried lactobacillus culture containing live cells, is practiced by many physicians to restore the the intestinal flora every time antibiotics are used to treat serious infections. Consumption of yogurt or butter milk in abundant quantities will also serve the purpose. It is no wonder that yogurt finds a prominent place in almost all lists of "top ten" healthy foods recommended by health experts world over and its regular consumption can preempt infections from pathogens like CDF in the long run.


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