In three reports released recently by the Centers for Disease Control (CDC)and The New England Journal of Medicine, researchers have determined that a particularly virulent strain of the bacterium Clostridium difficile is causing widespread and sometimes severe outbreaks of dangerous diarrhea in the United States.

Long known to cause problems for hospital patients on antibiotics, this strain of C. difficile appears to be the same germ responsible for the deaths of hundreds of hospital patients in Quebec in 2003.

Researchers and physicians are especially alarmed because the infection is appearing in healthy individuals who had not been admitted to hospitals, a possible harbinger of a larger public health problem. Previously, C. difficile infection was limited to hospital patients, specifically those undergoing treatments with antibiotics.

C. difficile is a normal inhabitant of the colon that is now resistant to antibiotics that are effective against other intestinal bacteria. In a patient undergoing treatment with antibiotics, competition from other bacteria is eliminated, allowing populations of C. difficile to grow rapidly.

In addition to causing severe diarrhea, C. difficile can also cause colitis, a dangerous intestinal condition.

"There is a new strain of Clostridium difficile that is causing epidemics in many hospitals in the United States," said John G. Bartlett, M.D., of The Johns Hopkins University School of Medicine in Baltimore, who co-wrote an editorial in the journal.

In the first of the three papers recently released, Dr. Vivian Loo of the McGill University Health Centre identified the bacterium culpable in the Quebec infections as a form of C. difficile resistant to fluoroquinolones - a class of antibiotics. In the second paper, L. Clifford McDonald, M.D. of the CDC reported findings of the same bacterium in samples collected from eight health-care facilities from around the U.S.

In another report, McDonald and colleagues detailed the 33 cases of C. difficile infection reported in the U.S. since 2003, 23 of which appeared in otherwise healthy individuals. Ten of these healthy individuals were pregnant women. One of the pregnant women was the only fatality among the 33 cases.

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