New Hampshire medical experts and state officials are taking notice of a potentially deadly bacterium that has developed a more virulent strain and may be spreading beyond medical facilities, where it once was thought to be concentrated.

As reported by the Fosters Daily Democrat (Deadly Germ Getting Worse by Nate Pardue 1/15/06), the bacterium, Clostridium difficile, or C. diff, was historically found in nursing homes and hospitals. Some recent reports show that people who only have visited medical facilities briefly, or not at all, are also acquiring the bug. One CDC study, published in the Dec. 2 CDC Morbidity and Mortality Weekly Report, highlighted 33 cases of C. diff infections in Pennsylvania, New Hampshire, New Jersey, and Ohio. A New Hampshire mother acquired the more dangerous strain after only a brief stay at a hospital to give birth.

C. diff causes diarrhea and other serious intestinal maladies like colitis. Over the past two years, several states have reported the more dangerous strain, which is more severe and has higher mortality rates, according to the CDC. The cases involved 23 people from Philadelphia and four surrounding counties who hadn't been hospitalized. The other 10 cases involved women who, as in New Hampshire's case, were hospitalized only briefly to give birth One of the 33 people died. The results were surprising because the areas affected were thought to have been low risk, especially outside of medical facilities.

Gastric acid protects the stomach from C-diff. Suppress gastric acid, and the stage is set for C-diff to flourish. A recent issue of the Journal of the American Medical Association carries a study from Montreal's McGill University. Using information from the United Kingdom General Practice Research Database, The McGill team identified more than 1,600 cases of C-diff and matched each case against ten control subjects.

Results showed that people who used a class of drugs known as H2 receptor antagonists (such as Zantac and Pepcid) had twice the risk of C-diff infection compared to nonusers. And the results were even more worrying for users of proton pump inhibitor drugs (such as Prevacid and Prilosec): They were three times more likely to experience a C-diff infection compared to those who used no heartburn medication.

Use of non steroidal anti-inflammatory drugs (NSAIDs) was also associated with an increased risk of C-diff infection. Overuse of antibiotics is already a known factor in the alarming rise in the number of C-diff cases.

New Hampshire health officials say they've seen signs that cases of C. diff are on the rise locally, but since medical facilities are not required to report positive findings to the state, most of the evidence is anecdotal. Still state health officials have taken notice since the CDC warned that the newer strain is resistant to antibiotics that once weakened it. "We are aware. It appears the spectrum of the illness, C. diff, may be more severe than in the past," said Elizabeth Talbot, New Hampshire's deputy state epidemiologist.

Unlike Eastern Equine Encephalitis, AIDS, or influenza, the severity of the impact of C. diff in New Hampshire only can be measured through word-of-mouth accounts, as there are no statewide figures available to measure the number of C. diff cases. State health officials do mandate that "all unusual occurrence or clusters that may be of danger to public health" be reported, but Talbot said the presence of C. diff has not seemed to reach that threshold.

Some hospitals in the United States and Canada have seen a spike in C. diff-related deaths. A New England Journal of Medicine article published Dec. 8 examined the occurrence of C. diff in 12 hospitals in Quebec, Canada, where researchers counted 1,703 patients with C. diff illnesses. The research found that 422 patients died within 30 days.

The bacterium was blamed last year for 100 deaths over 18 months at one hospital in Quebec, and there were reportedly 21 deaths related to C. diff in the Cleveland area, most in 2005, The Associated Press reported. Ohio health care facilities now must make weekly C. diff reports to their local health department.

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