Clostridium difficile

So this first page is pathogens, and these are kind of the nasty things that your doctor would be testing you for and that they would wanna know about.

So stuff like C. diff, E. coli, Salmonella, Giardia, all those nasty things that nobody wants.

And she did not have any of that, so that was great.

And then we scroll down here, we look at H. pylori.

The spores themselves are not harmful until they encounter the right conditions and reactivate into vegetative cells.

You'll also probably recognize Clostridioides difficile or C. diff.

This is another spore forming bacteria, which means extensive isolation precautions and room cleaning.

The takeaway here is that spore forming bacteria require specialized cleaning to remove them from the environment.

And we're also going to talk about, and this one part I'm very excited about, the medication that doctors put us on and never take us off of that can actually create long-term years of of problems for ourselves.

So, um, including, uh, C. difficile, which I found that very fascinating when I was researching that.

I thought, wow, you have increased the C. diff and maybe this is one of the reasons why.

Um, so lots to cover today.

But for the organ transplant, again, um, a colonoscopy may be helpful, uh, especially if you have a, well, especially when you have a CM- negative CMV, but you, the patient is still at high risk.

So if D or D plus R minus has lots of diarrhea and the testing for things like C. diff and other GI infections are negative, then I think that one should consider doing a colonoscopy to get tissue to look for CMV.

Can I just make a comment about CMV from a biopsy? We do get, sometimes we get requests from clinicians, "Uh, can you do a CMV PCR from stool?" Which could be way easier, right, than doing a biopsy.

However, patients can shed CMV in the stool and a, and a positive result doesn't necessarily mean they have invasive disease.

But, uh, yeah, just the GI pathogen panel when it comes up with that norovirus, it makes me cringe a little bit.

Do you order a lot of GI pathogen panels or-

That's what originally when they come in with, they'll order C. diff and GI pathogen panel.

And then so, like, they're always popping up with random stuff.

For many patients that may mean symptoms are back or blood is back in the stool or their abdominal pain is back, right? So symptoms are starting to come back And so it's not necessarily one thing, right? It could be often when a patient is presenting with newer worsening symptoms, there's several things we always do.

We always check for infections like C. diff, which we know are very common in patients with IBD.

And so we have to rule that out because even if there haven't been, you know, if they haven't taken antibiotics or some of the more classic triggers that we know occur for C. diff, IBD patients can get C. diff regardless.

So we always check.

And ask questions like, have you been taking Motrin or Advil regularly? We know sometimes patients, you know, they have bad headaches or they had an injury and they're popping NSAIDs.