How could my sister get Clostridium botulinum while having surgery in the hospital? She didn't get sick until she had been home for one week. She has had diarrhea constantly for three weeks now. Her doctor cannot explain it. Thank you for any information on the subject.

K.K.

Clostridium botulinum is the bacterium that causes botulism. Botulism is a severe disease that usually occurs after consuming contaminated canned foods. The patient develops various symptoms, including blurred vision, vomiting, abdominal pain and, most importantly, paralysis. If the breathing muscles become paralyzed, the patient may die. Botulism is now uncommon in the United States, though it occurs occasionally when people eat food that was canned improperly in the home. Rare cases due to commercially prepared food are occasionally reported as well. Another type of infection, called wound botulism, can occur if Clostridium botulinum contaminates a wound. It would be very unusual for botulism to occur in a hospital. Also, while diarrhea can occur with botulism, it would not be the only symptom.

What your sister may have had is Clostridium difficile infection. This organism is related to Clostridium botulinum, but it causes a completely different illness: diarrhea. Clostridium difficile infection can range from mild, watery diarrhea to a more serious illness with fever, abdominal pain and even rupture of the colon. What is unusual about this infection is that it almost always follows the use of antibiotics. For more information, please see my column on C. difficile & Antibiotics.

What your sister should do is find out if she has Clostridium difficile infection. If she does, she should probably be given an antibiotic called metronidazole (trade name Flagyl), which is now considered the treatment of first choice for this infection.