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impact of cefpodoxime proxetil and amoxicillin on the normal oral and intestinal microflora.ten healthy volunteers were given 200 mg cefpodoxime proxetil tablets every 12 h and ten volunteers received 500 mg amoxicillin tablets every 8 h for seven days and the impact of the agents on the oral and intestinal microflora was studied. in the oral microflora, only minor alterations were observed in both groups. in subjects receiving cefpodoxime proxetil, the numbers of streptococci, enterobacteria and clostridia were strongly reduced in the faecal flora, while there was an overgrowth of ent ...19938243490
an investigation of a nosocomial outbreak of clostridium difficile by pyrolysis mass spectrometry.isolates from a presumptive nosocomial outbreak of clostridium difficile infection at a large teaching hospital were typed by pyrolysis mass spectrometry (pms) and antibiograms. one isolate, from the putative index case, was dissimilar from the outbreak strain, but 24 isolates from 16 patients were indistinguishable by both methods. the outbreak centred on two wards for the acute care of the elderly, with a few cases elsewhere. transfer of patients appeared to be the route of transmission betwee ...19938246251
[antibiotic-induced diarrhea and pseudomembranous colitis].although not all antibiotic-induced diarrhoea is pseudomembranous, and not all pseudomembranous colitis is antibiotic-induced, by far the greater proportion of intestinal lesions and diarrhoea occurring in conjunction with clostridium difficile infection are attributed to previous antibiotic treatment. the article consists in a review of pathogenic, diagnostic, treatment and nosocomial aspects.19938247717
emerging problems in gram-positive infections in the postoperative patient.gram-positive bacteria are increasingly prevalent in the postoperative patient population and are important as pathogens. as increasingly ill and elderly patients undergo surgical treatment and as increased use is made of invasive or immunosuppressive treatment modalities, this trend is likely to accelerate. the increasing use of broad-spectrum antibiotics results in the emergence of resistant pathogens or superinfections that are increasingly difficult to treat. examples of such pathogens inclu ...19938256192
[an epidemic of clostridium difficile colitis in patients with cancer: role of cancer chemotherapy and nosocomial infection in the pathogenesis]. 19938259863
epidemiology of nosocomial clostridium difficile infection.c. difficile is a frequent cause of nosocomial diarrhea and is associated with substantial morbidity. c. difficile carriage may arise either from overgrowth of endogenous organisms or from exogenous acquisition. within hospitals, asymptomatically colonized patients typically outnumber symptomatic patients by a ratio of approximately 3:1. patient-to-patient transmission of c. difficile has been well documented in studies of nosocomial outbreaks, utilizing typing methods to supplement epidemiologi ...19938261769
antibiotic associated colitis.it is a prospective study based on 100 consecutive cases of diarrhea following antibiotic therapy admitted to the pediatric services of j.n. medical college, a.m.u., aligarh between january to december 1987. they had c. penicillin (50), chloramphenicol (34), ampicillin (34), gentamicin (34), cephalosporin (4) and cotrimoxazole (4) for 3 days to 3 weeks prior to the onset of diarrhea. apart from routine and special investigations, naked eye and microscopic examination of stool, its culture for pa ...19938262596
evaluation of four commercially available enzyme immunoassays for laboratory diagnosis of clostridium difficile-associated diseases.four commercial enzyme immunoassays (eias) for the detection of clostridium difficile toxin a have recently been developed and marketed (premier, meridian diagnostics, cincinnati, ohio; vidas, biomerierux vitek, inc., hazelwood, mo.; tox-a-test, techlab, blacksburg, va.; and bartels, baxter diagnostics, mcgaw park, ill.). the performances of these eias were compared with those of the tissue culture cytotoxicity assay and a definition of c. difficile-associated disease based on both laboratory an ...19938263168
clostridium difficile-related disease: evaluation and prevalence among inpatients with diarrhea in two freestanding rehabilitation hospitals.clostridium difficile has been associated with diarrhea in hospitalized patients receiving antibiotic therapy, and may be nosocomially acquired. rehabilitation hospital inpatients may require frequent antibiotic intervention and are thus at risk, though few reports of epidemics at such centers have been published. this study describes the evaluation and prevalence of c difficile-related disease, among rehabilitation hospital inpatients. a retrospective review was conducted of all diarrhea evalua ...19938267789
images in clinical medicine. clostridium difficile. 19948272087
epidemiology of community-acquired clostridium difficile-associated diarrhea.the epidemiology of clinically recognized community-acquired clostridium difficile-associated diarrhea was assessed in a retrospective cohort study of members of a health maintenance organization (hmo). potential cases were identified through positive toxin assay results and confirmed by review of automated full-text medical records. of 51 cases identified (7.7 per 100,000 person-years), 42 (82%) were diagnosed and treated exclusively in the ambulatory care setting; 33 cases occurred within 42 d ...19948277174
risk factors for clostridium difficile-associated diarrhoea in hiv-infected patients.to identify risk factors associated with a first episode of clostridium difficile-associated diarrhoea (cdad) in patients with hiv infection.19938280409
genomic fingerprinting of clostridium difficile isolates by using a random amplified polymorphic dna (rapd) assay.this study describes the use of a new and easy method called random amplified polymorphic dna (rapd) assay to distinguish strains of c. difficile. we used two single short primers (ap4 and ap5) with arbitrary nucleotide sequences in a polymerase chain reaction to amplify genomic dna. the profiles observed after electrophoretic separation were able to distinguish 20 reference c. difficile strains previously serotyped by delmée's method. the fingerprints of 11 epidemiologically unrelated c. diffic ...19938282184
case records of the massachusetts general hospital. weekly clinicopathological exercises. case 6-1993. a 31-month-old girl with fever, diarrhea, abdominal distention, and edema. 19948284009
nutritional aspects of cytotoxin production by clostridium difficile.arginine was the only amino acid used by clostridium difficile that permitted cytotoxin synthesis in a peptone-based medium. synthesis of cytotoxin was delayed when glucose was used as the substrate. addition of rifampin or puromycin to cultures prior to release of cytotoxin inhibited the release of cytotoxin, suggesting that a protein essential for cytotoxin release is synthesized after cytotoxin is synthesized.19938285703
diagnosis of enteritis and enterotoxemia due to clostridium difficile in captive ostriches (struthio camelus). 19938286467
[acute hemorrhagic colitis caused by pristinamycin: two cases with association of klebsiella oxytoca and clostridium difficile]. 19938288098
recurrent pseudomembranous colitis due to clostridium difficile in aids. 19948300102
human antibody response to clostridium difficile toxin a in relation to clinical course of infection.this study investigated whether differences in fecal and serum antitoxin a antibody levels may account for the duration of clostridium difficile-associated diarrhea (cdad) and the occurrence of relapses. by an enzyme linked-immunosorbent assay, we tested 40 patients with cdad including 25 patients without immunodeficiency and 15 patients receiving antineoplastic drugs. two hundred eighty serum samples and 80 normal stool samples were investigated as controls. in nonimmunocompromised patients, se ...19948300199
the effect of fce 22891, a new oral penem, on faecal flora anaerobes and their fermentation end products in patients with chronic obstructive pulmonary disease.the influence of fce 22891 on the faecal flora was investigated in 11 patients with an acute exacerbation of chronic obstructive pulmonary disease (copd). colony counts of faecal (an)aerobes and concentrations of their short-chain fatty acids and organic acids were determined simultaneously in fresh faeces before, during and after administration of the drug, and compared to those of healthy human volunteers. the mic of fce 22891 for the 142 isolated anaerobes was determined, and compared to the ...19938300248
postoperative clostridium difficile pseudomembranous colitis in idiopathic scoliosis. a brief clinical report.the authors report two healthy young patients with progressive idiopathic scoliosis, both without allergies or histories of gastrointestinal disorders, who received perioperative preventive cephalosporin antibiotics, and developed explosive diarrhea postoperatively, confirmed as clostridium difficile pseudomembranous colitis by stool toxin assay. both patients had initially recovered uneventfully after posterior fusion and cotrel-dubousset instrumentation. their youth, health, diagnosis, and lac ...19938303465
clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia. 19948304370
[yield of detection of clostridium difficile toxin versus stool culture in the study of nosocomial diarrhea].the aim of the study was to determine whether the detection of clostridium difficile toxin in stools may be more profitable than conventional stool cultures for the etiologic study of nosocomial diarrhea and to analyze what risk factors favor the development of nosocomial diarrhea by c. difficile.19938305554
use of the arbitrary primer polymerase chain reaction for investigating an outbreak of clostridium difficile-associated diarrhea in aids patients. 19938307056
putting back the bugs: bacterial treatment relieves chronic diarrhoea. 19948309401
saccharomyces boulardii for clostridium difficile-associated enteropathies in infants.based on experimental evidence in animals showing that the oral administration of saccharomyces boulardii is effective in reducing morbidity and mortality due to clostridium difficile-induced pseudomembranous colitis, we conducted an open trial to examine the effects of the living yeast, given as primary therapy, in a selected group of infants and children with persistent intestinal symptoms related to toxinogenic c. difficile overgrowth. over a period of 10 consecutive months, we studied 19 eli ...19938315551
[nosocomial infections. some aspects].nosocomial infection is not a recent problem. however, it presents nowadays as a serious issue, not only due to the associated morbidity and mortality but also due to the economic burden on hospitals. the increased susceptibility of patients and the increased resistance to antibiotics by bacterial agents are important factors in the present situation. among the different nosocomial pathogens, methicillin-resistant staphylococcus aureus and clostridium difficile are two of the most distressing fo ...19938317232
signal transduction pathways and cellular intoxication with clostridium difficile toxins.in cultured cells the cytopathic effects (cpe) of clostridium difficile toxins a and b are superficially similar. the irreversible cpes involve a reorganization of the cytoskeleton, but the molecular details of the mechanism(s) of action are unknown. as part of the work to elucidate the events leading to the cpe, cultured cells were preincubated with agents known to either stimulate or inhibit some major signal transduction pathways, whereupon toxin was added and the development of the cpe was f ...19938320269
activation of cellular phospholipase a2 by clostridium difficile toxin b.c. difficile toxin b is a potent cytotoxin known to disrupt the microfilaments of cultured cells. we have recently shown also increased phospholipase a2 activity in cells treated with toxin b. the activity was detected as a toxin-induced, dose-dependent release of 14c-arachidonic acid from prelabeled fibroblasts. here is shown that the toxin elicited a 14c-arachidonic acid release in a cell mutant resistant to the toxin b effect on the microfilaments. the toxin-induced release was further charac ...19938320270
the microecology of clostridium difficile.an understanding of the microecology of clostridium difficile provides for a better understanding of the disease that this organism causes. c. difficile is not a significant component of the microflora in the colon of healthy adult humans or animals; however, it can establish large populations in antibiotic-treated or gnotobiotic animals and in infants before they acquire a complete flora. major factors that determine whether or not disease develops are: (1) the size of the c. difficile populati ...19938324122
purification of a functional receptor for clostridium difficile toxin a from intestinal brush border membranes of infant hamsters.a receptor for clostridium difficile toxin a was purified from brush border membranes (bbms) from the small intestine of infant hamsters. the bbms were solubilized with triton x-114, and the solubilized receptor was purified with use of a toxin a immobilized affinity-chromatography column and differential temperature elution. sds-page and silver staining of the purified receptor revealed numerous high-molecular-weight bands. however, ligand blotting analysis with 125i-toxin a used as the probe i ...19938324123
role of the laboratory in investigations of clostridium difficile diarrhea.the laboratory diagnosis of acute diarrhea due to clostridium difficile can be based solely on the demonstration of either cytotoxin or enterotoxin in the stool. this and other noncultural methods, however, fail to provide isolates from which useful data can be obtained. outbreaks can be recognized only by comparison of isolated strains. a dual approach of toxin detection and isolation is therefore recommended.19938324124
elevated levels of serum immunoglobulins in asymptomatic carriers of clostridium difficile.serum levels of iga, igm, and polyvalent immunoglobulins reactive with clostridium difficile were determined by elisa for asymptomatic carriers (n = 5), symptomatic individuals (n = 21), and a pool of 30 "normal" individuals. mean iga concentrations expressed as optical density (od +/- sd) were significantly higher (p < .001) for asymptomatic carriers (1.252 +/- 0.516) than for symptomatic patients (0.374 +/- 0.145). mean serum igm levels also were significantly higher (p < .001) for carriers (1 ...19938324125
use of heat shock for culturing clostridium difficile from rectal swabs. 19938324126
antibacterial activity of meropenem and selected comparative agents against anaerobic bacteria at seven north american centers.the antibacterial activity of meropenem and comparative agents against approximately 1,000 anaerobes was determined using the disk dilution methods recommended by the national committee for clinical laboratory standards (nccls). the organisms represented 27 species of six genera and included the most common pathogens. meropenem and imipenem were the most active drugs and were comparable in overall activity, generally exhibiting an mic90 of < or = 1 micrograms/ml. in contrast, the mics of cefoxit ...19938324148
the friendly anaerobes.anaerobic bacteria include the most pathogenic of microorganisms. their primary function, however, is hardly to cause illness. they rarely are involved in epidemics or in clinically significant infections. some organisms, e.g. lactobacilli, control the normal vaginal ecosystem, and the intestinal anaerobes probably are instrumental in restraining the growth of clostridium difficile in human carriers. the main role of anaerobes appears to be the provision of catabolic enzymes for organic compound ...19938324162
optimal methods for identifying clostridium difficile infections.the major controversy in the diagnosis of symptomatic gastrointestinal infection due to clostridium difficile is whether laboratory evidence of the c. difficile organism in culture is sufficient or if evidence of one of the c. difficile toxins in stool should be required. cultures performed properly on selective media currently are the most sensitive method for detection of c. difficile, whereas the cell cytotoxin assay for detection of toxin b is the most specific. stool specimens from patients ...19938324164
clostridium difficile-associated reactive arthritis in an hla-b27 negative male. 19938331275
detection of clostridium difficile toxins in stools. comparison between a new enzyme immunoassay for toxin a and other routine tests.an enzyme-linked immunosorbent assay (elisa) for detection of clostridium difficile toxin a (enterotoxin) using a monoclonal antibody is described. no cross-reaction was observed with any of the clostridium species tested except for toxigenic clostridium difficile. one hundred and eight stool specimens from hospitalized patients harbouring c. difficile in their intestine and 43 samples negative for c. difficile isolation were studied to compare this test with a cytotoxicity assay, the isolation ...19938339887
reactive arthritis associated with clostridium difficile pseudomembranous colitis.reactive arthritis is associated with several gastrointestinal pathogens, particularly shigella, salmonella, campylobacter, and yersinia. another, less well recognized bowel infection leading to reactive arthritis is pseudomembranous colitis, caused by clostridium difficile. an illustrative case is presented, and the clinical features and characteristics of all reported patients with this association are reviewed. the pathogenesis of the reactive arthritis seems to be related to an immunological ...19938342048
intestinal carriage of clostridium difficile in neonate dogs.a total of 70 puppies and their dams, distributed in 14 litters, were submitted to weekly fecal examinations for c. difficile during the first 10 weeks after birth. during the study, 94.3% of the puppies and 42.9% of the dams harboured c. difficile at least once in their feces. we calculated that 58% of the puppies carried toxigenic c. difficile at least once during the survey. in the puppies, c. difficile carriage rates ranging from 3.1% to 67.1% were observed at different moments of the observ ...19938342371
the role of the clinical microbiology laboratory in the management of clostridium difficile-associated diarrhea.nosocomial diarrhea due to infection with c. difficile is a major health care problem, causing 20% to 30% of institutionally acquired diarrhea and affecting up to 8% of hospitalized patients. the clinical microbiology laboratory should be able to provide both diagnostic and epidemiologic services for institutions where this disease occurs. diagnostic testing includes culture for isolation of toxigenic c. difficile and detection of either toxin a or b from stool specimens. epidemiologic services ...19938345170
enterotoxigenic bacteria in the sudden infant death syndrome.faecal samples from 123 infants who died with sudden infant death syndrome (sids) and from a comparative group of 52 age-matched babies were analysed for toxigenic bacteria and their toxins. serum samples from the sids infants were also analysed for these toxins. a significantly higher proportion of toxigenic bacteria and their toxins were found in faecal samples of sids babies than in samples from the comparative group. these toxins were also found in serum from the sids babies. clostridium per ...19938345506
[diarrhea following antibiotic treatment, clostridium difficile, and quinolones]. 19938347715
the etiology and management of diarrhea in the gynecologic oncology patient.we determined the etiology and evaluated the usefulness of diagnostic tests in 42 gynecologic oncology patients with diarrhea.19938349164
characterization, cloning, and in vitro expression of the extremely thermostable glutamate dehydrogenase from the hyperthermophilic archaeon, es4.glutamate dehydrogenase (gdh) from the hyperthermophilic archaeon es4 (optimal growth temperature 98 degrees c and maximum growth temperature 110 degrees c) was purified to homogeneity. the purified native enzyme had an m(r) of 270,000 +/- 5,000 and was shown by gel filtration and sds-polyacrylamide gel electrophoresis to be a hexamer with identical subunits of m(r) = 46,000 +/- 3,000. the hexameric subunit composition was also evident from electron micrographs, which show a triangular antiprism ...19938349661
clostridium difficile infection associated with antineoplastic chemotherapy: a review.colitis and infection due to clostridium difficile have been reported in patients receiving antineoplastic chemotherapy for cancer without prior antibiotic treatment. chemotherapeutic agents can alter the normal bowel flora and cause extensive intestinal inflammatory changes, potentiating both the growth of c. difficile and its production of toxin. this review includes all 23 known reported cases of c. difficile infection associated with antineoplastic chemotherapy and examines the pathogenesis, ...19938353229
clostridia-associated enterocolitis in adult horses and foals.a review of the literature describing clostridia-associated enterocolitis is presented. the bacteria, their toxins, and possible factors that interact to contribute to the pathogenesis of enterocolitis are described. clinical signs associated with clostridia-associated enterocolitis, methods of diagnosis, treatments, and preventive strategies are discussed.19938358653
clostridium difficile: clinical disease and diagnosis.clostridium difficile is an opportunistic pathogen that causes a spectrum of disease ranging from antibiotic-associated diarrhea to pseudomembranous colitis. although the disease was first described in 1893, the etiologic agent was not isolated and identified until 1978. since clinical and pathological features of c. difficile-associated disease are not easily distinguished from those of other gastrointestinal diseases, including ulcerative colitis, chronic inflammatory bowel disease, and crohn' ...19938358706
comparison of vidas clostridium difficile toxin-a assay and premier c. difficile toxin-a assay to cytotoxin-b tissue culture assay for the detection of toxins of c. difficile.damage to the intestinal mucosa by clostridium difficile (cd) is toxin mediated. two enzyme immunoassays (eias) for toxin-a detection, the automated vitek immunodiagnostic assay system cda (vidas cda), and the premier toxin a (premier) were tested for their ability to detect toxin a in 301 stool samples and compared with an in-house tissue culture assay for toxin b (tca). of these 301 samples, 49 were tca positive and 252 were tca negative. agreement between vidas cda and tca on the initial run ...19938359010
detection of toxigenic clostridium difficile in fecal samples by colony blot hybridization.a hybridization assay for detection of toxigenic clostridium difficile in fecal samples was developed and compared with the classical tissue culture cytotoxicity assay. a dna fragment probe specific for the toxin b gene of clostridium difficile was synthesized by the polymerase chain reaction and labelled with digoxigenin. fecal samples were cultured for 24 hours, replica-plated and hybridized with the probe. the hybridization assay had a sensitivity of 100%, specificity of 96.7%, positive predi ...19938359169
clostridium difficile toxin a elicits ca(2+)-independent cytotoxic effects in cultured normal rat intestinal crypt cells.in rat intestinal crypt cells, clostridium difficile toxin a induces (i) early cytoskeletal alterations involving the whole population and (ii) late effects in 30 to 40% of the cells, consisting mainly of surface blebbing and nuclear fragmentation. all these effects were ca2+ independent and were not abolished by protein synthesis inhibitors.19938359922
shedding of clostridium difficile, fecal beta-lactamase activity, and gastrointestinal symptoms in 51 volunteers treated with oral cefixime.microbial changes including the shedding of clostridium difficile, fecal beta-lactamase activity, and gastrointestinal symptoms were assessed in 51 healthy volunteers given 200 mg of cefixime twice daily for 8 days. the number of organisms of the family enterobacteriaceae (means +/- standard deviations) dropped from 6.9 +/- 1.1 to 3.9 +/- 1.8 log cfu/g of feces (p < 0.01), whereas counts of enterococci rose from 7.0 +/- 1.5 to 9.0 +/- 1.0 log cfu/g of feces (p < 0.01). both counts returned to th ...19938363371
diagnostic tests for clostridium difficile diarrhoea and colitis: past, present and future. 19938374085
quantitative cultures of the mucosal-associated bacteria in the mechanically prepared colon and rectum.little is known about the mucosal microflora of the colon and rectum at the time of elective surgery. our objective was to determine the concentrations of anaerobic and aerobic bacteria associated with the mucosa of the mechanically prepared large bowel. ten patients were studied after a standard polyethylene glycol-electrolyte lavage preparation. no patient had taken antibiotics in the preceding four weeks. sterile wire brushes passed through the colonoscope during advancement were used to cult ...19938375226
pseudomembranous colitis.pseudomembranous colitis is an inflammatory disease of the colon and rectum characterized by the development of elevated mucosal plaques. it usually is associated with antibiotic therapy and is caused by elaboration of toxin from the anaerobic bacterium, clostridium difficile. the hallmark of treatment is orally administered vancomycin or metronidazole. the mortality rate is high in patients whose condition is not diagnosed and appropriately treated. emergency surgery occasionally is needed for ...19938378829
ischemic colitis in a patient with crohn's disease taking an oral contraceptive and an ergotamine alkaloid.a 22-year-old woman developed transient left-sided ischemic colitis with submucosal oedema and bleeding, six weeks after an uneventful right hemicolectomy for crohn's disease. the thrombogenic properties of the contraceptive pill and the concomitant use of an ergotamine alkaloid were thought to be the cause of this complication in a patient at risk. an increase of procoagulant activity and underlying vascular injury has been described in crohn's disease.19938388603
development of a rapid and efficient restriction endonuclease analysis typing system for clostridium difficile and correlation with other typing systems.a hindiii restriction endonuclease analysis (rea) typing system for total genomic clostridium difficile dna including a rapid and efficient method of dna extraction and a scheme for organizing unique electrophoretic dna band patterns was developed. rea typing was performed by two extraction methods for 1,965 c. difficile isolates obtained from patients with symptomatic c. difficile disease, asymptomatic patients who were c. difficile culture positive, and environmental surfaces. this isolate col ...19938394378
ketotifen inhibits clostridium difficile toxin a-induced enteritis in rat ileum.clostridium difficile toxin a is the principal mediator of inflammatory enterocolitis in experimental animals. the purpose of this study was to explore the effect of ketotifen, an anti-inflammatory drug, on toxin a-induced enterotoxicity in rat ileum.19938395445
clostridium difficile--the only important nosocomial gastrointestinal pathogen in developed countries. 19938400339
clostridium difficile enteritis in a canadian tertiary care hospital.nosocomial clostridium difficile enteritis causes epidemic and endemic infection. the authors report the incidence of c difficile enteritis in a tertiary care hospital. the overall incidence rate over two years in the authors' institution was 22.2 cases per 100,000 in-patient-days; this rate appeared to decline over the study period (from 30.0 cases per 100,000 in 1990 to 11.2 at study end in 1992). continued surveillance will determine whether this is a durable trend. an average of 5.25 cases p ...19938400341
clostridium difficile enteritis. a cause of intramural gas. 19938404420
improvement of clostridium difficile isolation by heat-shock and typing of the isolated strains by sds-page.clostridium difficile plays an essential role in causing pseudomembranous colitis. we looked for the presence of these bacteria in the stools of 169 hospitalized patients and 38 nurses from wards with cases of diarrhea (207 subjects). the study was divided into three parts. in the first part, we compared three methods for isolating clostridium difficile from stool samples: pre-selection with heat-shock, direct plating on cycloserine-cefotaxime-fructose agar (ccfa) and culturing in a selective br ...19938405320
approach to acute diarrhea in the elderly.diarrhea is a common problem among the elderly that can have catastrophic results. atherosclerosis predisposes older adults to morbid sequelae from dehydration resulting from diarrhea. deaths related to diarrheal illnesses are recognized among older adults living in the community as well as among those confined to nursing homes. outbreaks have most often been associated with excess deaths from diarrhea among nursing-home patients. although most cases of dehydration from diarrhea result from gast ...19938406728
clostridium difficile colitis and diarrhea.clostridium difficile is now regarded as the most prevalent nosocomial pathogen, infecting as many as a quarter of hospitalized patients. the pathophysiology of infection with this unusual enteric pathogen involves alteration of the normal enteric flora by antibiotics, ingestion of spores, and colonization by c. difficile. the organism then releases potent exotoxins that produce an inflammatory colitis and diarrhea. a spectrum of host responses occurs, ranging from the asymptomatic carrier state ...19938406734
use of an enzyme-linked immunoassay for clostridium difficile serogrouping.an enzyme-linked immunoassay (elisa) with 11 clostridium difficile serogroup-specific antisera was applied for serogrouping of c. difficile colonies from 314 consecutive positive fecal samples. two hundred forty-nine strains (79%) were correctly serogrouped, 57 (18%) belonged to serogroups other than the 11 which were evaluated and gave a negative reaction with all antisera, and 8 isolates (2.5%) did not react with their corresponding antisera. elisa is a rapid and reliable method for serogroupi ...19938408581
diagnosis and treatment of clostridium difficile colitis.pseudomembranous colitis associated with antibiotic therapy is almost always due to an overgrowth of clostridium difficile. if untreated, pseudomembranous colitis can lead to severe diarrhea, hypovolemic shock, toxic dilatation of the colon, cecal perforation, hemorrhage, and death. however, c difficile-associated colitis can mimic the more common "benign" antibiotic-associated diarrhea that is not caused by c difficile. an algorithm for diagnosis management of hospitalized patients with antibio ...19938416409
postoperative clostridium difficile gastroenteritis.clostridium difficile gastroenteritis can be the cause of an enigmatic postoperative syndrome of high temperature and marked leukocytosis, out of proportion to the initially mild constitutional symptoms. patients may suffer delayed onset of diarrhea, which will test positive for the c. difficile enterotoxin by latex agglutination. we report 5 cases of c. difficile gastroenteritis that occurred within a 2-year period. we believe that the combination of preoperative bowel preparation, and intraope ...19938417199
purification and characterisation of intracellular toxin a of clostridium difficile.after sonic disintegration of clostridium difficile cells, intracellular toxin a was purified to homogeneity by thyroglobulin affinity chromatography (tgac) followed by anion-exchange (mono q) by fast protein liquid chromatography (fplc). high haemagglutinating (ha) activity was detected in tgac-unbound fractions (2(9)/50 microliters), but not in tgac thermal eluates (2(0)/50 microliters). the low ha titre of the thermal eluates was markedly increased to 2(5)/50 microliters after dialysis agains ...19938418298
role of infectious agents in exacerbations of ulcerative colitis in india. a study of clostridium difficile.fifty patients with idiopathic ulcerative colitis--25 with acute exacerbation of the disease (group i) and 25 in quiescent phase (group ii)--were studied. none of the patients had a history of recent exposure to antimicrobial drugs or hospitalization. evidence of infection with protozoal and bacterial agents and/or presence of clostridium difficile toxin was demonstrated in eight (32%) patients in group i and one (4%) patient in group ii (group i vs. group ii, p < 0.05; chi 2 test with yate's co ...19938421140
detection of toxigenic clostridium difficile in stool specimens by the polymerase chain reaction.polymerase chain reaction (pcr) amplification of a segment of the toxin a gene was used to detect toxigenic clostridium difficile directly from stool specimens of patients with antibiotic-associated diarrhea. although pcr-inhibitory substances were recognized in dna prepared from stool specimens, the inhibitory substances were eliminated by using an ion-exchange column after phenol-chloroform extraction. eventually, 39 stool specimens were evaluated by pcr. pcr results for detection of toxigenic ...19938421180
comment to knoop et al. (1990) febs letters 267, 9-12, toxin b of clostridium difficile does not have enolase activity. 19938422931
purification and characterization of clostridium difficile glutamate dehydrogenase.recombinant clostridium difficile glutamate dehydrogenase (l-glutamate:nad oxidoreductase, ec 1.4.1.2) was purified 177-fold to electrophoretic homogeneity with a 62% recovery through a four-step procedure involving gel filtration and ion-exchange and dye affinity chromatography. the approximate molecular weights of the native enzyme by gel filtration and subunits by sodium dodecyl sulfate-polyacrylamide gel electrophoresis were consistent with a hexameric structure for the purified enzyme. the ...19938424683
in-vitro and in-vivo characterisation of resistance to colonisation with clostridium difficile.in hamsters, resistance to colonisation by clostridium difficile appears to be mediated by micro-organisms that are present in the gut in relatively low concentrations. small amounts of normal caecal contents inhibited the growth of c. difficile when added to cultures in vitro or given to animals which had been treated with clindamycin. filtrates of caecal contents, frozen and thawed contents and contents diluted to 0.1% wet weight lost their inhibitory properties. however, caecal contents retai ...19938429534
characterisation of clostridium difficile strains by polymerase chain reaction with toxin a- and b-specific primers.a total of 218 clostridium difficile strains was examined for production of toxin a by elisa, production of toxin b by a cytotoxin assay and the presence of toxin a and b gene-associated sequences by the polymerase chain reaction (pcr). after saturation amplification with toxin b-specific primers, the characteristic amplification product (591 bp) was detected in all 184 toxigenic strains examined. pcr with toxin a-specific primers gave positive results with all but one of the toxigenic strains. ...19938429535
surgical management and radiological characteristics of bronchogenic cysts.forty-two patients with bronchogenic cysts were treated over a 30-year period (1962 to 1991). the location was mediastinal in 37 and intrapulmonary in 5. cysts were symptomatic in 21 patients (50%) and complications occurred in 11 (26%). the complications included infection in 5 patients, hemorrhage into the cyst in 2 patients, dysphagia due to esophageal compression in 2, adenocarcinoma arising from a bronchogenic cyst in an 8 1/2-year-old girl, and an esophagobronchopleurocutaneous fistula as ...19938431062
effects of clostridium difficile toxin b on human monocytes and macrophages: possible relationship with cytoskeletal rearrangement.toxin b from clostridium difficile is cytopathic in vitro for various types of cells, including polymorphonuclear cells, lymphocytes, and monocytes. since intestine lamina propria is rich in macrophages, we studied the effect of toxin b on human monocytes and on human macrophages generated in vitro by long-term culture of purified circulating blood monocytes. upon addition of toxin b, human monocytes exhibited few modifications whereas macrophages adopted a stellate morphology, with rounding up ...19938432590
enzymatic reactions of clostridium difficile in aerobic and anaerobic environments with the rapid-ana ii identification system.the rapid-ana ii anaerobic identification system (innovative diagnostic systems, inc., atlanta, ga.) was used to determine whether the incubation environment affects enzyme detection. twenty strains of clostridium difficile were tested in aerobic, anaerobic, and low-co2 anaerobic incubation environments. the percentages of enzymes detected in reactions with the following substrates were noted in the three incubation environments: phenylalanine-beta-naphthylamide, aerobic, 0%; anaerobic, 35%; low ...19938432813
mammalian epithelial cell line kit for detection of clostridium difficile toxin.the performance characteristics of a mammalian epithelial (mep) cell line kit (cytotoxi test; advanced clinical diagnostics, toledo, ohio) for the detection of clostridium difficile toxin was compared with that of conventional tissue culture assays with human embryonic lung (hel) cells in shell vials and human foreskin fibroblasts (hffs) in test tubes. one hundred forty-nine stool samples were tested. the mep cells were at least as sensitive as the hel cells for use in c. difficile toxin detecti ...19938432817
typing of clostridium difficile by western immunoblotting with 10 different antisera.western blotting (immunoblotting) with antisera against each of 10 reference serogroups was evaluated as a means of typing clostridium difficile. a total of 164 clinical isolates of c. difficile were tested. variations in band profiles in each serogroup were used to type isolates into subserogroups. this technique was useful for an epidemiological investigation.19938432828
inactivation of clostridium difficile spores by disinfectants.the current study was designed to evaluate the activity of glutaraldehyde-based disinfectants against clostridium difficile using the association of official analytical chemists' (aoac) sporicidal test. this study was undertaken because gastrointestinal endoscopes that may be contaminated with c difficile spores are most commonly disinfected between patients using glutaraldehyde-based disinfectants.19938432966
[can antibiotic-associated diarrhea be prevented?].post-antibiotic diarrhea is common but rarely serious. the chief cause is changes in the normal intestinal flora. decrease in the number of bacteria leads to maldigestion of carbohydrates, resulting in osmotic diarrhea. disappearance of the flora encourages the emergence of resistant strains, e.g. clostridium difficile. general measures concern the prescription of antibiotics and the use of probiotics. the latter restore and replace the normal flora and prevent more than half of all cases of dia ...19938442650
the prevalence and nosocomial acquisition of clostridium difficile in elderly hospitalized patients.rectal swabs obtained from 10 of 49 chronic-care geriatric patients were positive for clostridium difficile, for a prevalence rate of 20.4%. simultaneous sampling of 29 patients in an acute geriatric ward revealed four colonized patients, for a prevalence rate of 13.7%. a prospective study of c. difficile colonization in 100 consecutive patients admitted to an acute geriatric ward was carried out. all patients were sampled upon admission and biweekly during hospitalization. two patients (2%) wer ...19938446550
trés difficile. 19938454879
production of monoclonal antibodies against clostridium difficile cytotoxin using immunosorbent binding bioassay procedure.in the following study, a novel screening approach was used to develop monoclonal antibodies specific for toxin b of clostridium difficile. the approach, which consisted of an immunosorbent binding bioassay (isbba), is based on antigen immunocapture by monoclonal antibodies and detection of biological activity. our results showed isbba, which uses unpurified antigen, to be more sensitive than the neutralization assay and elisa for the detection of toxin b antibody.19938456445
demonstration of toxin a and b by polymerase chain reaction and mccoy cell assay in clinical isolates of clostridium difficile from denmark.a polymerase chain reaction (pcr) for demonstration of gene fragments of clostridium difficile was established. one hundred and sixty-eight clinical isolates of c. difficile from three population groups were tested for production of cytotoxins by mccoy cell line assay (mca) and for fragments of toxin a and b genes by pcr. the fragments for pcr amplification were at the 5' end of the toxin genes, which was found to be specific for c. difficile. full agreement between the pcr and mca results was f ...19938457321
comparison of cefoxitin and ceftizoxime in a hospital therapeutic interchange program.to determine whether (a) ceftizoxime can replace cefoxitin in the prevention and treatment of various infections in a major teaching hospital, (b) a previously applied two-stage intervention program is an effective method of instituting a therapeutic interchange of ceftizoxime for cefoxitin and (c) the replacement of cefoxitin with ceftizoxime results in a more cost-effective therapy.19938457957
specific detection of toxigenic strains of clostridium difficile in stool specimens.clostridium difficile is the infectious agent responsible for antibiotic-associated colitis. we report the use of the polymerase chain reaction technique to identify toxigenic strains of c. difficile in human stool specimens. a set of primers based on the nucleotide sequence of the toxin b gene, which amplified a 399-bp fragment from isolates producing toxin b, was designed. we examined 28 known toxigenic strains, which were all positive by this assay. dnas from the nontoxigenic strains examined ...19938458943
comparison of enterotoxin production, cytotoxin production, serogrouping, and antimicrobial susceptibilities of clostridium difficile strains isolated from aids and human immunodeficiency virus-negative patients.we analyzed and compared clostridium difficile strains isolated from diarrheic stools of 49 human immunodeficiency virus (hiv)-negative and 50 aids patients. our results suggest that distribution patterns of serogroups are different in these two populations. serogroup c (which has been previously reported to be very resistant to antimicrobial agents) represents 66.0 and 18.4% of the isolates from aids and hiv-negative patients, respectively (p < 0.001); the selection of serogroup c could be expl ...19938458977
identification and characterization of adhesive factors of clostridium difficile involved in adhesion to human colonic enterocyte-like caco-2 and mucus-secreting ht29 cells in culture.experiments reported in this communication showed that the highly toxinogenic cd 79685, cd 4784, and wilkins clostridium difficile strains and the moderately toxinogenic fd strain grown in the presence of blood adhere to polarized monolayers of two cultured human intestinal cell lines: the human colonic epithelial caco-2 cells and the human mucus-secreting ht29-mtx cells. scanning electron microscopy revealed that the bacteria interacted with well-defined apical microvilli of differentiated caco ...19938459765
in vitro and in vivo antibacterial activities of t-3761, a new quinolone derivative.t-3761, a new quinolone derivative, showed broad and potent antibacterial activity. its mics for 90% of the strains tested were 0.20 to 100 micrograms/ml against gram-positive bacteria, including members of the genera staphylococcus, streptococcus, and enterococcus; 0.025 to 3.13 micrograms/ml against gram-negative bacteria, including members of the family enterobacteriaceae and the genus haemophilus; 0.05 to 50 micrograms/ml against glucose nonfermenters, including members of the genera pseudom ...19938460909
oral enoxacin for infection prevention in adults with acute nonlymphocytic leukemia. the enoxacin prophylaxis study group.a randomized, double-blind, placebo-controlled trial was conducted in eight hematologic units to determine the efficacy and safety of oral enoxacin for infection prevention in adult patients with acute nonlymphocytic leukemia. one hundred nineteen patients undergoing remission induction or consolidation chemotherapy were enrolled; 62 of them received enoxacin (400 mg orally every 12 h). patients received antifungal prophylaxis with oral mycostatin (1,000,000 u four times daily) or clotrimazole ( ...19938460916
saccharomyces boulardii inhibits clostridium difficile toxin a binding and enterotoxicity in rat ileum.saccharomyces boulardii is a nonpathogenic yeast used for the prevention and treatment of clostridium difficile-associated diarrhea and colitis. however, the mechanism by which s. boulardii exerts its protective effects remains unclear.19938462799
comparison of three enzyme immunoassays, a cytotoxicity assay, and toxigenic culture for diagnosis of clostridium difficile-associated diarrhea.enzyme immunoassays (eias) based on monoclonal antibodies for the detection of clostridium difficile toxins have recently been developed for clinical use. the aim of this study was to compare three commercially available eias, two for toxin a (premier c. difficile toxin a; meridian, osi, elancourt, france; and vidas c. difficile toxin a; biomérieux, marcy l'etoile, france) and one for toxins a and b (cytoclone a + b eia; cambridge biotech corp., codiapharm, evian, france), with a cytotoxicity as ...19938463404
[intestinal side effects of antibiotics]. 19938464389
clostridium difficile associated with typhlocolitis in an adult horse. 19938466991
clostridium difficile colitis: causes, cures. 19938468757
clostridium difficile colitis: causes, cures. 19938468759
clostridium difficile colitis: causes, cures. 19938468760
the treatment of clostridium difficile colitis. 19938468761
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