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By Zach Giordano | video by Taylor de Lench
| October 15, 2019
Late October is notoriously frightening. It’s a time of early dusk, harvest moons, and winds that drag dried leaves across empty streets. However, for Philly-resident Dayle Skelly, the end of October in 2005 was frightening not because of the usual seasonal spooks, but because of a phone call that alerted her that something was very wrong—one that only hinted at the tragedies to come.
C. difficile: A stealthy, dangerous illness
On the phone 14 years ago was Skelly’s father, bearing the news that her grandmother—recently discharged from the hospital after being treated for emphysema—had been readmitted for an unknown infection. But that wasn’t the only news: Skelly’s mother, caregiver to her grandmother in the weeks prior, was laid up in bed with what appeared to be a worsening case of the flu.
Skelly and her sister wasted no time making the drive from Philly to their parents’ home in Edison, New Jersey. “My mom was someone who always had her face made up, her hair done up, and the house in top shape for guests,” Skelly says, “but when we arrived, she was laying in bed with no makeup on, her stomach had swollen, and she was sweating through her pajamas.”
The Skelly family immediately brought their matriarch to the hospital, where she was diagnosed with something Skelly had never heard of before: Clostridioides difficile, or C. difficile, a bacterial infection that manifests in the colon when the healthy balance of gut bacteria is disrupted, resulting in symptoms like diarrhea, abdominal pain, and fever. Soon after, they were alerted that the mysterious infection that brought their grandmother back to the hospital was also C. difficile.
As Skelly soon learned, the spores that cause the debilitating C. difficile infection can be found everywhere. They can live on surfaces for months and are hard to kill—even alcohol-based hand sanitizers are ineffective in preventing the spread of the bacteria. An opportunistic and highly contagious disease, C. difficile poses a greater risk to older patients, who are at greater risk of developing it.
It also often affects the colons of patients recently treated with antibiotics, like Skelly’s grandmother, who had been taking them following her emphysema diagnosis. Knowing her mother had been in close contact with her grandmother for the past few weeks, Skelly realized where her mother’s illness most likely came from.
The next day, after leaving her mother and grandmother under the watchful care of doctors and hospital staff, Skelly received another phone call: Her grandmother had passed away in the night, succumbing to the complications of her C. difficile infection. “All of us were absolutely devastated,” Skelly says. “But when we visited our mother, she did look better. She had color back in her face and was talking a bit more, but her stomach was still distended.”
Following this, her mother’s stomach distention only got worse, eventually pushing so hard on her diaphragm that more drastic measures needed to be taken. “She was literally gasping for air, so doctors felt it was best to move her to the ICU, where she was placed on a ventilator,” Skelly says.
Skelly’s mother was in the ICU for six weeks, where her condition continued to deteriorate. By the end of December, hospice was called in, and preparations were made. On December 23, 2005, Skelly’s mother passed away.
In the span of seven weeks, Skelly lost her grandmother and her mother to a disease she had known existed for just as long.
Researching how to outsmart C. difficile
Skelly finishes recounting her story—which she’s told many times in the past few years since joining the C. Diff Foundation as an advocate—to Dr. Nicholas Kitchin, a scientist and researcher of a C. difficile vaccine candidate at Pfizer who is studying the disease that claimed Skelly’s mother and grandmother. The two sit in the morning glow streaming through the windows of Pfizer’s campus in Pearl River, NY, an outpost just 45 minutes from Skelly’s father’s home in New Jersey.
“I want to commend you, first of all, on your commitment to raising awareness through the Foundation,” Dr. Kitchin says. “It’s amazing to me that something the CDC calls a public health threat requiring urgent attention—something that affects approximately 450,000 people per year and kills 29,000 just in the U.S.—is also something that so few people know about.”
Skelly agrees, following up with a question about research goals that leads Kitchin into an overview of C. difficile’s life cycle in the body. Essentially, he says, everyone’s colon has a calibrated balance of bugs that keep the gut healthy. However, if certain good bugs are killed off—by antibiotics, for example—this balance becomes disrupted, leaving a gap for C. difficile to proliferate and start producing toxins that can kill the cell lining in the gut, leading to diarrhea, abdominal pain, and fever.
“Those toxins are the bad guys, so what we’re researching with a vaccine is to get the body ready—before it’s ever been exposed to C. difficile—to produce antibodies to those toxins,” Kitchin says. “If the vaccine works, these antibodies would essentially identify the toxins, bind onto them, and neutralize them so they can’t then cause the disease.”
The potential future of prevention
From a preventative perspective, the C. difficile battleground is vast, with a number of biopharmaceutical companies and research organizations conducting research in this space. At Pfizer, Kitchin has been a member of the team of scientists developing a pipeline vaccine for the potential prevention of C. difficile infections since the first human study began in 2012. The research developed in the last seven years has led to a vaccine currently being tested in a worldwide clinical study. Across 23 countries, 17,000 people are involved in testing whether this vaccine can successfully prevent C. difficile infections. Skelly’s follow-up to this is an important one: How long until this vaccine is seen in the market? But that’s a question Kitchin doesn’t have an answer to just yet.
“To get the vaccine licensed, we need enough information to prove that it’s safe and effective, and that requires proving its efficacy in a well-controlled trial setting,” says Kitchin. “It’s difficult to predict when that will be, but we’ll continue to focus our efforts on the research that we hope will one day benefit patients.”
And this is what Skelly appreciates above all. The fact that this much effort is being put into fighting a disease so significant to her means a lot; she shares that she doesn’t want what happened to her family to happen to anyone else’s.
“I learned about C. difficile 14 years ago,” Skelly says, “and ever since joining the C. Diff Foundation, I’ve seen all the strides being made by people on the ground, myself included, to change the future of this disease. But to hear how it’s become a focus of research is astounding, and exciting, and so, so important to so many people.”
With this, both Skelly and Kitchin offer each other heartfelt thank yous, each recognizing the other as an important figure in the battle against an invisible enemy.
Sponsored by Pfizer
Dayle’s letter: “Before this, my mother was a relatively healthy woman…”
Dear Scientist, I wasn’t aware I was sick until I almost needed a new liver. Are strides being made to diagnose my disease earlier?
A young woman’s devastating diagnosis becomes the catalyst for her to reclaim her health—and her story becomes vital feedback for the specialist working to prevent future cases like hers.
Dear Scientist, my baby went to the ER with a potentially life-threatening illness. Is a vaccine on the way to help future infants?
The Harris family was home with their newborn for only 10 days before she contracted a severe illness caused by respiratory syncytial virus (RSV). Scientist Kena Swanson and her team are developing a vaccine that could prevent RSV disease.