After my last post about poop, a few people were wondering about the last question in the poop quiz:
True or False: Doctors can transplant stool from one person to another to help with unhealthy bowels.
If you haven’t heard about this before, WebMD is correct. Fecal transplants are, in fact, a thing.
I first learned about them in Microbiology, because we did a case study on Clostridium dificile, or C. dif. I also knew someone who died of C. dif, so even before class, I knew how deadly it could be.
C. dif is often contracted as a nosocomial infection (a fancy word for an infection you pick up in the hospital – i.e. you’re there for another reason, but contract C. dif as a not-so-pleasant surprise). C. dif preys on people whose gut flora are already compromised. We all have bacteria that live in our bodies, which you probably know because of Jamie Lee Curtis. They’re called our natural gut flora, and they require certain things in order to live, like food and water. Things like acid reflux medications and antibiotics kill some of our gut flora (the former by changing the environment they live in, and the latter because they kill a ton of stuff in the gut, including good stuff), so people who are on these types of medications are especially susceptible to contracting C. dif; so are people whose immune systems are already suffering. This is why it’s so easy to pick up in the hospital.
The reason this particular infection is so nasty is that it cannot be treated with regular means. C. dif isn’t killed by antibiotics or other medications. The reason for this is that it can form endospores.
Endospores are a type of virulence factor (traits that allow bacteria to cause disease) that allow bacteria to live under extremely harsh conditions. A shortened, simplified explanation is that, when a threat is eminent, the bacterial cell takes all it’s most vital components – such as DNA – and sort of rolls it up into a ball that then pinches off from the main cell. The rest of the main cell that’s left behind dies, and the new spore develops an extremely tough outer membrane. The newly formed endospore can survive just about anything – antibiotics, heat (i.e. from a fever), even time. Scientists have found endospores from hundreds and thousands of years ago (for example, this is how bacteria survived in King Tut’s tomb to infect the people who opened it). This is because it isn’t really, technically alive, so therefore it can’t die. It’s just a ball of DNA protected by an extremely tough membrane.
Then, when conditions are once again suitable for life, the endospore disintegrates while the DNA and other components inside rebuild the bacterial cell. It’s sort of like dying and coming back to life.
So, if you’re treated with antibiotics, you might seem like you got better – but then once you’re off the meds, the endospores will repopulate and infect you again.
This is pretty damn terrifying. It was one of the scariest (and simultaneously coolest) things I learned in Microbiology. It’s also why doctors are cutting back on prescribing antibiotics – the more bacteria are exposed to them and not killed off (i.e. if someone stops taking their medication before all the bacteria are dead), the more the bacteria learn to adapt to them. Someday, there may not be antibiotics strong enough to kill any bacteria at all, unless new medications are developed.
However, it isn’t just the endospores that make C. dif dangerous. The cells are also able to stick to the cell walls of the structures around them. This means that they attach themselves to your intestinal wall and hold on for dear life. Even worse, they have the ability to eat through, or digest, the wall to which they’re attached.
As they start digesting the intestinal wall, they eventually create a hole. This, obviously, is a horrible problem all on its own. Waste in the intestine can then leak through the hole, getting into all kinds of parts of the body where waste should never be. This is called sepsis, and it basically means you’re screwed. Even if doctors manage to close the hole, all that waste is still out there.
These three virulence factors combined make C. dif a complete nightmare to treat. Luckily, doctors have discovered a new plan: fecal transplants.
Healthy poop from a non-infected person is either flushed up into the patient’s colon, or else condensed into a pill that the patient swallows (they’re still working on methods). While the healthy poop can’t actually kill the C. dif first hand, it is full of all that healthy, natural gut flora that the infected patient no longer has enough of (either due to the meds they were on before, or because the C. dif has killed them). These good bacteria then start using up the food and water sources in the gut, effectively starving the C. dif to death.
It’s better than the little bastards deserve!