Describing a Clostridioides difficile Infection and the 6-Month Journey to a Diagnosis

At the end of September 2021, Freda Pyles, a resident of rural Pennsylvania, began an antibiotic for a dental infection. That set off a 6-month battle with Clostridioides difficile, which was misdiagnosed a few times before she was treated at Yale-New Haven Hospital by Paul Feuerstadt, MD, FACG, AGAF, of Yale School of Medicine and Yale-New Haven Hospital. Here, she describes how she contracted the infection and what happened afterwards.

Transcript

How did you contract Clostridioides difficile?

I was heading out on vacation to Kansas, and I had a toothache. So I went to the dentist, and she found an infection in the base of my tooth, so she put me on antibiotics. And probably 2 days into the drive to Kansas, I started getting diarrhea. And my husband, who's an emergency room doctor, said, you might want to stop taking the antibiotics because it could be causing the diarrhea. But I mean, what does the doctor know? I didn't want to have a toothache in Kansas, and I knew the protocol is to finish the whole course of antibiotics, so I stayed on them. And it just got worse and worse and worse. By the time we got to Wichita, Kansas, I could barely leave the hotel room.

Was it problematic getting a diagnosis, once you were in Kansas?

Yes, I got so weak and so sick. My husband said I had a—what do you call it—a firm abdomen, and he was worried. So we went to an emergency room in Wichita and he couldn't come in with me because of COVID, so he couldn't ask them what they were doing or anything. And they did a CT scan and found out that I had diverticulitis, which I've had before, but I've never had serious diarrhea. And because I'd had the diarrhea for so long, they should have done a stool specimen. They did not. And they released me the next day. They said, well, I didn't stay overnight. I said we were leaving the next day to come home because I was so sick. And so they said, well, here's some antibiotics you should take. And so my husband talked to the doctor by phone and he said to the doctor, is there any sign of C diff? And he said no, we didn't find any. But they never did a stool specimen. They never did it, so how could he say that they didn't find it? So the next day we got on the road to come back home, and it's a 2-day drive or more, and I was getting sicker and sicker.

Luckily, my husband got some Depends because there were so few restrooms along the area that I couldn't make it from one rest area to the next, and we were stopping at truck stops. And I was getting so sick. I just, I couldn't even help him drive. I was just leaning against the door in the passenger seat. Just miserable, trying to drink water, because he kept saying you've got to drink water. So I was trying to drink enough water. But by the time we got probably 30 miles west of Columbus, Ohio, I couldn't walk. He tried to help me out of the car to go to the bathroom. And I could not walk. And he said, what's wrong with you? I said, I don't know. I just can't walk.So he said, OK, we've got to get to a hospital. And so we called my nephew who lives in Columbus and said, which is the best hospital to go to? And he said, Riverside Methodist, right off the highway. So, by the time we got there, I couldn't even get out of the car. He went and got a wheelchair, and they got me right in. My kidneys were shutting down. My blood pressure had dropped out from under me. And I was dehydrated. So they admitted me right away for 5 days. And they were even doing surgery consults—they were thinking that they had to take out part of my colon. And my husband kept saying, no, no, we're not going to do that. And so, 5 days later, I still had it, but they let me head home, and so I was still sick when I got home.

About 5 days later, it suddenly stopped. And I had a break, and I was able to go and do things. I went to the grocery store with him. I was up and around. And 2 days later, bam, it came back again. I was just heartbroken. And this happened 4 times. The fourth time, after I got better, I said to my husband, if I get it again, I'm not going to survive. I'm just not going to survive. I’d lost 45 pounds. I fell twice in the house because I was so weak. I couldn't get out of my chair. I just was so sick.

My husband and our friends who are doctors in New Haven at Yale were doing all this research on what they could do. And my husband found the C diff clinic down in Florida, and she suggested there was a C diff clinic in Pittsburgh that was doing fecal transplants, and she said it sounded like that's what I needed. And just then our friends read in the New England Journal of [Medicine] an article by Dr [Paul] Feuerstadt, and our friend in New Haven called his office and said, listen, we have a friend that is so sick with this, he said, I just don't know if she can make it. And Dr Feuerstadt set up a telemedicine appointment. And he said, OK, you need to get up here right away. But they had to put me on Difficid [fidaxomicin], the antibiotic to get it cleared up so I can travel. But that stuff is $5000, that medicine, so we paid out of pocket $1500. But it stopped that long enough for us to drive to Connecticut and get in to see Dr Feuerstadt and get the treatment.