Vim & Vigor - Spring 2018 - University of Virginia - 52

LASTING
The gut infection C. diff finds a major foe

When Roberta "Berta" Hysell
first heard of fecal transplants, her reaction was not
surprising: "I went, 'Ew gross'-which is
the attitude for most people," she says.
Her dislike quickly turned to gratitude
after the procedure provided her with an
instant cure for a persistent and potentially deadly gastrointestinal infection
known as Clostridium difficile, commonly
called C. diff.
"It virtually is a lifesaver and really
not the least bit uncomfortable,"
Hysell shares.
Each year, almost half a million
Americans contract C. diff-and 30,000
die from C. diff-related causes. A course
of antibiotics is the first line of defense
for this bacterial infection. But when
this fails or C. diff comes back repeatedly, a fecal transplant can offer a
remarkable cure rate: "Ninety percent
of those who've been treated with a
fecal transplant have not had a recurrence for eight weeks, and that's considered to be a cure," says Ann Hays,
MD, a University of Virginia Health
System gastroenterologist.

A Cure Comes to UVA

Thanks largely to Dr. Hays, UVA became
one of the nation's first places to offer
fecal transplants. Several years ago, she
assembled a team of experts from gastroenterology, infectious disease, internal medicine and surgery to start the
UVA Complicated C. difficile Clinic. It
opened in 2013 and has since seen more
than 500 patients. About one-third of
these patients have needed a fecal transplant. Most find a cure with a one-time

SP RIN G 2 0 1 8

outpatient procedure. "On Friday
afternoons, our team has the entire
Infectious Disease clinic to ourselves.
We see three to five new patients each
week," Dr. Hays says. "These patients
are desperate and very anxious and fearful of having another episode. They're
not only worried about getting sicker or
dying, but because C. diff causes very
watery diarrhea (up to 15 times a day)
and there's a lot of incontinence with
it, it can be very isolating. They are also
worried about infecting their families."
The formal name for this procedure
is fecal microbiota transplantation
(FMT). It involves taking stool from a
healthy donor and putting it into the
colon of a person infected with C. diff,
with the aim of restoring a healthy
balance of bacteria. At UVA, FMT is
performed along with a colonoscopy.
It is typically covered by insurance.
Although considered to be an investigational drug by the Food and Drug
Administration, fecal transplant is
allowed to be used only for C. diff that
is recurrent or not responding to standard therapy. Because of its high cure
rate, FMT is becoming more accepted
as a treatment option for C. diff.

Female Seniors
Most Affected

Men and women who come to the UVA
clinic range in age from their 20s to 90s.
Hysell fits the typical patient profile:
"We see more Caucasian women over
age 65 than any other demographic.
Most of our young people either have
an immune deficiency or inflammatory
bowel disease," Dr. Hays notes.

BY KELLY CASEY

About 60 percent of C. diff cases are
hospital-acquired, but it can occur after
taking antibiotics and be exacerbated by
a diet high in sugar, steroid medication or
a zinc deficiency. Since many of Dr. Hays'
C. diff patients have type 2 diabetes, her
team plans to research that connection.

Avoiding Triggers

A diabetic herself, Hysell was hit with C.
diff during the holiday season three years
ago. She was in her late 70s at the time
and would wake up and have a dozen
or so bouts of diarrhea in the morning,
leaving her exhausted and sore.
"I remember when I first got C. diff, I
went up to Culpeper to watch a friend's
daughter dance in The Nutcracker. I
thought, 'How in the world do I make it
through this production?' Everything is
colored by this. Can I go to lunch? What
in the world can I eat?"
Her son was so worried that C. diff
might kill her that he encouraged her
to pursue a fecal transplant. Since having her treatment more than two years
ago at UVA, Hysell has been free of C.
diff. She learned from Dr. Hays and the
clinic's care coordinator, Melissa Buers,
RN, how to keep it from coming back:
She avoids antibiotics whenever possible
and no longer uses sugar or artificial
sweeteners in her tea. She uses a natural
sweetener from a plant (Stevia) that she
buys at a health food store. She avoids
the version available at regular grocery
stores, as it contains a form of alcohol
that is bad for gut health.
"I still live in a little bit of fear,"
Hysell says. "It is so horrendous. You
never want to have it back ever again." ■

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