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Cdiff and Other Infections (for CC)-SD

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So this is c. diff. So actually for the people with the chronic diarrhea c. diff infection is pretty high. About 10% up to 18% of the patient with chronic diarrhea in the pouch. Its very interesting is this could (?) especially male patient had high risk for developing c.diff infection of the pouch. Very interesting, we don't know why. And typically c. diff infection of the pouch we do not use metronidazole. Why? Because people with, with the c. diff infection of the pouch majority of them has been treated with flagyl or metronidazole or wasn't actually on flagyl. So we recommend them to see- to vancomycin. So we did have a few patient that we use a fecal transplant on. And a fecal transplant is very effective to eradicate the c. diff infection of the pouch. O.K. now there's FDA issues with IND you need a special license from the FDA. So we're applying for that. So, now this patient can have c. diff infection. Actually, this patient died from c. diff infection. It can be lethal. Can be lethal. Another thing is, another patient who already had ileostomy, had a stoma..Developed c. diff infection. So, we treat patient aggressively. We use vancomycin between two to four weeks to treat. Because those things you know,- "I didn't realize you could get it in your small intestine I thought c. diff was colostrium, colon." Crazy you read a lot of that actually, by definition it is uh, c. diff infection only occur in the patient with the colon but we realize that c. diff infection in the pouch can occur also in the small bowel can occur. And we also realize the prognosis, the disease course is much s-, maybe more severe in people with the pouch and with the stoma. "Than it is in the colon." Yes. I can tell you this is the story of this patient of mine. That time this is a Friday afternoon I did a pouch endoscopy, diffuse the inflamed. And in the meantime I saw this CT scan, I mean the c scan, th- what we call the KUB x-ray. Diffuse, dilated the small bowel, la-, small bowel. I already suspect he may have c.diff but I don't have lab result. Lab result at the time needed two or three days. This is a Friday afternoon. So we were lucky we already started vancomycin even before the stool come back. Two days later stool came back it was positive. m,kay? "So, why does that happen?" *sigh* c. diff happen is a long, long story. There's a lot of risk factor for example. And c. diff the bacteria is a spore. It's hard to kill. They're everywhere especially in a hospital setting, nursing home setting. And some of the patients use of some medicines may increase the risk for c. diff infection. Such as, we call acid suppress medicine. PPI, proton pump inhibitors may also increase it. And recent antibiotic exposure and if you shake hands and then go eat with somebody who already infected with c. diff you know or share the bathroom. There's multiple risk factor for that. So actually, go back actually. The patients with the c. diff infection has the spectrum. Some of the patients, actually 3% of the general population they're healthy. They carry the c. diff. Like this patient, one of my pouch patients, she was involved in one on one study. She's normal control. She's healthy but test positive. Now versus this patient is pouch so inflamed, so there's a spectrum of the disease. Some of the patients have c. diff and no symptoms. Some people have c. diff infection of the pouch have horrible symptoms, even die. Now, this patient actually if you're dealing,- love the chicken products, like chicken salads. These two patients have what's called the Campylobacter infection. The campylobacter typically have fever, dehydration, malaise. And actually this patient had the current campylobacter infection three years later. Now treatment is not ciprofloxacin or metronidazole. Actually its azithromycin. Treatment is different. And this patient has what's called CMV infection. Cytomegalovirus infection. CMV infection typically occur in immune compromised patient. Immune suppressed patient. But in the setting of the pouch disease those patients, a vast majority of them, they are immunocompetent. Their immune system's normal. They still have the c. diff- the CMV infection. CMV infection typically you diagnose by the biopsies. You can see the giant cells and you can do the immunihistal chemistry stain. You can see these cells and with this, and if the patient has systemic symptoms such as the fever, chills, night sweats, weight loss you treat them for the CMV. Now, yeast can occur in the patient. So that patient have a yeast infection around the anus and also have the yeast infection in the biopsies. So yeast infection you can ask the pathologist to do the yeast stain and you can see this yeast spore here. Then you treat it with antifungul medicine. Antifungul medicine. Oral antifungul medicine.

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Duration: 6 minutes and 28 seconds
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Language: English
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Posted by: ibdgirls on Mar 22, 2016

Cdiff and Other Infections (for CC)-SD

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