Many years ago I took care of an elderly woman in the nursing home who suffered from Clostridium difficile, or C. diff. for short. She had come to us from a local hospital suffering from C.diff., a strain of bacteria that is normally found in the environment, including our own stools. She had watery stools, so many that her buttocks were completely excoriated – red and raw – the superficial layer of skin having been burned off by the constant exposure of fecal material on her skin. It was the worst case of skin breakdown caused by C. diff that I had ever seen.

Treating her was a real challenge. She was elderly and very debilitated as a result. Anything she ate passed right through her. Protecting her skin from further breakdown was paramount. If we couldn’t stop the diarrhea and prevent further skin breakdown, she would die.

I can’t remember now how we were able to stop the diarrhea – presumably we used stool bulking agents as well as metronidazole to stop the infection. I called a friend who worked in wound care, and she proposed a unique regimen of a thick layer of a zinc based cream (the white cream you used to see life guards use on their noses) topped off with an equally thick layer of vaseline. Whenever she stooled, the aides were instructed to clean her by gently wiping away the layer of vaseline but not the underlying layer of zinc. In this way we managed to protect her skin from the burning effects of the stool.

She eventually healed but I never forgot how potentially deadly C diff can be. C diff is a bacteria that is found in the environment – in stool, soil, air, or water. Healthy people don’t normally get the disease because our gut has many more colonies of good bacteria that keep C. diff. in check. When we take antibiotics however, the medication indiscriminately kills the good and the bad bacteria and in some people, especially the elderly, C. diff. out numbers the good bacteria causing inflammation of the colon, which leads to chronic watery stools. There are some particularly vicious strains of C. diff. that can kill.

Treating C. diff. by taking antibiotics (yes, antibiotics do cause C. diff. but it’s also treated by taking antibiotics) can take many weeks but there are new treatments being used in dire circumstances: fecal transplantation.

Since the colon is lined with healthy bacteria, some specialists are now treating difficult cases of C. diff. with stool specimens given by family members and mixing it with normal saline. In one particularly horrendous case, a patient had lost 60 pounds in 8 months until one gastroenterologist mixed a small amount of her husband’s stool with normal saline and delivered it in her colon. Within 1 day, her diarrhea had stopped. Within 2 weeks, her gut was populated with normal bacteria.

The procedure is known as bacteriotherapy or fecal transplantation, and involves using bacteria normally found in the body to combat certain bacterial overgrowth that is detrimental to the body. In fact, scientists have calculated that there are more than 10x more microbes in our bodies than human cells and a new field of treatment is developing around this.

To read more about the fascinating use of microbes to treat illness, read the NY Times article entitled, “How Microbes Defend and Define Us“.

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