Sandbox Sickness: Diarrhea-Causing Bacteria Found on Playgrounds

A small study by researchers in Spain finds that dangerous germs are lurking on playgrounds. [1]

For the study, a team of scientists tested sandboxes and searched for Clostridium difficile, or C. diff. They found it alright, and it was the drug-resistant variety.

C. diff is usually considered a hospital-acquired infection; but the rates of infection outside of hospitals are increasing, the authors of the study write.

One possible source of C. diff exposure is sandboxes, the researchers found. The bacterium may wind up there from the feces of humans and other animals. (Cats + sand = litter box.) The bug can survive for weeks or months outside of the body.

C. diff in sandboxes is especially dangerous for young children, the primary group at risk of catching the bug from playgrounds. Why? Because kids have high rates of geophagia. In other words, they eat sand and dirt.

Studying the Nitty-Gritty of C. Diff in Sandboxes

For the study, researchers tested sand from 40 sandboxes in public parks in Madrid, Spain, including 20 that were designated for children and 20 that were for dogs. C. diff was found in 9 of the sandboxes intended for kids, and 12 of the sandboxes intended for dogs.

An analysis of the different C. diff strains revealed that 2 of the samples from the kids’ sandboxes and 6 samples from the dogs’ sandboxes had “toxigenic” strains, meaning that they produced toxins. These toxins can lead to a damaged colon lining and diarrhea. Some strains of C. diff produce more toxins than others.

Every sample that the researchers tested was resistant to at least 2 antibiotics, making the infection more difficult to treat.

Read: Dutch “Poop Bank” Will Offer Treatment, Research of C. Diff as Antibiotics Fail

The researchers wrote that because of the risks posed by C. diff, tests for the bacterium should be included in future environmental-risk assessments.

Lead researcher Dr. Jose Blanco, from the Department of Animal Health at Complutense University of Madrid, said:

“This study shows the wide distribution of [these] bacteria in the environment, and the need for more studies to elucidate its presence in our communities.” [2]

Past studies in the U.S. have found other pathogens in sandboxes, including Toxoplasma gondii, which can cause flu-like symptoms, and parasitic Ascaris (nematode worm) eggs that can cause abdominal discomfort.

If you’re not totally disgusted yet, this should do it: Different types of roundworms have been found in playgrounds. Baylisascaris procyonis, spread by raccoons, can cause neurological damage and death. Thankfully, it’s extremely rare. Then there’s Toxocara roundworms – these stomach-turning creatures cause about 70 cases of blindness in U.S. children each year.

About Clostridium Difficile

Source: Medical News Today

C. diff infection can be hard to treat. The bacteria cause an intestinal infection that can lead to severe diarrhea which, in turn, can lead to dangerous dehydration. The symptoms of mild to moderate C. diff infection typically include:

  • Watery diarrhea 3 or more times a day
  • Mild abdominal cramping and tenderness [3]

Serious infections can cause:

  • Watery diarrhea 10 to 15 times a day
  • Abdominal cramping and pain, which may be severe
  • Rapid heart rate
  • Fever
  • Blood or pus in the stool
  • Nausea
  • Dehydration
  • Loss of appetite
  • Weight loss
  • Swollen abdomen
  • Kidney failure
  • Increased white blood cell count [3]

Severe complications can arise from C. diff infection, including:

  • Toxic megacolon, a condition in which the colon is unable to expel gas and stool, causing it to become greatly distended (megacolon). If not treated in time, the colon can rupture, causing bacteria from the colon to enter the abdominal cavity, requiring emergency surgery. Toxic megacolon is sometimes fatal.
  • Bowel perforation, a rare condition caused by extensive damage to the lining of the large intestine or after toxic megacolon.
  • Death [3]

A single course of antibiotics can cause C. diff. infection.

How to Prevent C. Diff Infection

To help prevent your little ones from getting sick from sandboxes, the American Academy of Pediatrics recommends:

  • Keeping sandboxes covered when not in use to keep insects and animals out.
  • Letting sand dry before covering the sandbox, as wet sand is an ideal place for bacteria to grow.
  • Raking the sand regularly to remove debris, clumps, and other foreign material.
  • Not allowing pets to play in the sandbox… for the obvious reasons. [2]


[1] Live Science

[2] CBS News

[3] Mayo Clinic

Medical News Today

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Superbugs may be More Widespread than Previously Thought

The potentially deadly, drug-resistant “superbug,” carbapenem-resistant Enterobacteriaceae (CRE), is more widespread in U.S. hospitals than previously thought, an earlier-released study has found. [1]

Researchers looked for cases of infections caused by CRE in a sample of 4 U.S. hospitals – 3 in the Boston area and 1 in California – and identified numerous varieties of the bacterium. [2]

Each year, CRE bacteria sicken about 9,300 people and claim the lives of 600 people in the United States, according to the CDC. Those numbers are climbing. CRE bacteria, in particular, have been called “nightmare bacteria” by CDC Director Tom Frieden because they often continue to thrive even in the face of “last-resort” antibiotics – drugs reserved for the toughest infections. [1]

Read: It’s Here – Bacteria Resistant to ALL Antibiotics Shows up in the U.S.

In the study, the researchers also found that CRE has a plethora of genetic traits that make it resistant to antibiotics, and these traits can be easily transferred between the many CRE species.

The study documented the identical gene in different species. William Hanage, associate professor of epidemiology at Harvard Chan School and senior author of the study, says that “the extent to which this has happened is really quite surprising,” He added that the team “found 2 cases of high-level resistance we could not explain.”

He compared it to dark matter: 

“We know it’s there because we can see its effects, but what’s actually making it happen at the moment is unknown. If I were to criticize my own work, I would say it is a shame that we weren’t able to get more hospitals and more samples from elsewhere within the health care systems.”

Based on the findings, the researchers believe that CRE is more common than previously thought, and that it may be transmitted from person to person without causing symptoms.

Source: CBC News

In fact, Dr. Alex Kallen, a medical officer in the CDC’s Division of Healthcare Quality Promotion, said “the most common source of transmission with CRE is asymptomatic.” For that reason, the team writes in Proceedings of the National Academy of Sciencesthere needs to be increased surveillance of CRE. [2]

A healthy person might be able to carry CRE (it resides in the gastrointestinal tract) without developing an infection. However, if the bacterium is transferred to someone with a compromised immune system, it can be deadly. [1] [2]

Hanage said:

“We often talk about the rising tide of antibiotic resistance in apocalyptic terms. But we should always remember that the people who are most at risk of these things would be at risk for any infection, because they are often among the frailer people in the health care system. [2]

While the typical focus has been on treating sick patients with CRE-related infections, our new findings suggest that CRE is spreading beyond the obvious cases of disease. We need to look harder for this unobserved transmission within our communities and health care facilities if we want to stamp it out. [1]

The best way to stop CRE making people sick is to prevent transmission in the first place. If it is right that we are missing a lot of transmission, then only focusing on cases of disease is like playing whack-a-mole; we can be sure the bacteria will pop up again somewhere else.”

On a related front, it has come to light that a Nevada woman in her 70’s died months ago from a CRE infection that none of the 26 antibiotics available in the United States would touch. Dr. James Johnson, a professor of infectious diseases at the University of Minnesota, said of the case:

“I think this is the harbinger of future badness to come.” [3]

Read: Antimicrobial Resistance Could be a “Bigger Threat Than Cancer by 2050”

Johnson added that it’s hard to believe nobody else in the country is carrying the same strain. He said that when people ask him “How close are we to the edge of the cliff?,” he tells them: “We’re already falling off the cliff.”

Last fall, a Reuters investigation revealed that thousands of U.S. deaths due to superbugs go unreported each year, because in many cases it is not indicated on death certificates.


[1] HealthDay

[2] CNN

[3] USA Today

CBC News

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