Publications

identification and molecular cloning of a 70 kda species-specific antigen common to clostridium difficile.	three common antigens (cb 1, 2 and 3), characteristic of clostridium difficile species were identified by immunoblot analysis using homologous and heterologous rabbit antisera, raised against whole cells from 9 distinct strains of c. difficile. a gene library of c. difficile genomic dna was constructed in escherichia coli by cloning in sau 3a-cleaved clostridial dna fragments into the bacteriophage vector lambda embl3. out of 3000 plaques screened using the whole cell antisera, 27 clones were po ...	1988	3273466
prospective study comparing imipenem-cilastatin with clindamycin and gentamicin for the treatment of serious surgical infections.	surgical infection remains a leading cause of hospital morbidity and mortality. we compared the efficacy and toxicity of imipenem-cilastatin sodium in 32 patients with that of clindamycin phosphate and gentamicin sulfate in 25 patients. in the imipenem-cilastatin group, 87.5% had a favorable outcome, with a 12.5% failure rate and 13 adverse reactions. in the clindamycin-gentamicin group, 80% had a favorable outcome, with a 20% failure rate and ten adverse reactions. two significant superinfectio ...	1988	3277587
comparison of api zym system with api an-ident, api 20a, minitek anaerobe ii, and rapid-ana systems for identification of clostridium difficile.	the api zym system was compared with four anaerobe identification systems for the definitive identification of clostridium difficile by using 88 cultures of c. difficile grown on mueller-hinton blood agar medium. the api zym system yielded a distinct and consistent enzyme profile for all test strains, whereas the sensitivities of the other systems in identifying c. difficile ranged from 78 to 96% (an-ident, 77.9%; rapid-ana, 88.6%; minitek anaerobe ii, 90.9%; and api 20a, 95.5%). the api zym sys ...	1988	3277989
effect of inoculum size on detection and recovery of clostridium difficile in selective broth cultures.		1988	3278014
infections after experimental cadaver bone marrow transplantation in beagle dogs. transplantations with and without selective gastrointestinal decontamination.	experimental transplantations of cadaver bone marrow (bmt) in beagle dogs were performed to evaluate the problems and potentials in a preclinical setting. the effectiveness of selective decontamination of the gut (sd) and gnotobiotic surveillance in preventing infections during longer aplastic periods was investigated. three groups of dogs were compared. group a: controls. group b: dogs with bmt, without sd and irregular gnotobiotic surveillance. group c: dogs with bmt, with sd and regular gnoto ...	1988	3283036
cloning and expression of secreted antigens of clostridium difficile in escherichia coli.	the feasibility of the cloning and expression of clostridium difficile antigens in escherichia coli was investigated. the expression of a limited number of cloned clostridial antigens under the control of clostridial promoter elements in e. coli was observed.	1988	3286505
gastrointestinal carriage rate of clostridium difficile in elderly, chronic care hospital patients.	the carriage rate of clostridium difficile in patients at a chronic care hospital was determined by two point prevalence surveys at 6-monthly intervals. in the first survey c. difficile or its toxin was present in stool samples from five symptomless patients on three of the four wards studied. all of these colonized patients had been in hospital for at least 2 months, but there was no relationship between carriage of the organism and antibiotic use. when the survey was repeated 6 months later, n ...	1988	2899585
hybridization analysis of the class p tetracycline resistance determinant from the clostridium perfringens r-plasmid, pcw3.	the tetracycline resistance determinant from pcw3, a conjugative plasmid from clostridium perfringens, has been identified and the structural gene localized to within a 1.4-kb region. hybridization analysis, which utilized an internal 0.8-kb specific gene probe, showed that eight nonconjugative tetracycline resistant c. perfringens strains all carried homologous resistance determinants. no homology was detected in dna prepared from tetracycline resistant isolates of clostridium difficile or clos ...	1988	2901767
clostridium difficile as a nosocomial pathogen.	patients admitted to a 19-bed floor with intermediate nursing care were studied for the onset of clostridium difficile-associated diarrhoea during a six-month period (181 calendar days) in 1986-87. all admitted patients were reviewed weekly and followed after discharge from the study unit to other inpatient services. multiple items in the environment of five patients' rooms were sampled bacteriologically for the presence of c. difficile weekly during the study period. three of the rooms were sel ...	1988	2896737
isolation of shiga toxin-resistant vero cells and their use for easy identification of the toxin.	shiga toxin-resistant vero cells were isolated by treatment of the cells with nitrosoguanidine. these mutant cells were not affected by shiga toxin at more than 1 microgram/ml, although the parent vero cells were sensitive to 25 pg of the toxin per ml. immunofluorescence studies showed that all the mutant cells had lost toxin-binding capacity. the cytotoxic activities of various bacterial cultures against the parent and mutant cells were compared. all samples from 10 strains of shigella dysenter ...	1988	3045003
the histopathology of the hemolytic uremic syndrome associated with verocytotoxin-producing escherichia coli infections.	verocytotoxin-producing escherichia coli (vtec) infection was present in three cases of hemolytic uremic syndrome (hus), two fatal and one non-fatal, in which detailed histopathologic investigations were conducted. two patients had a prodrome of bloody diarrhea, one of whom required a hemicolectomy for severe bleeding. the renal histopathology was characterized primarily by glomerular thrombotic microangiopathy (tma) with greater than 95% of glomeruli showing changes of capillary wall thickening ...	1988	3047052
[domestic animals as excreters of clostridium difficile].		1988	3048969
advances in ulcerative colitis.	ulcerative colitis is one of the two common chronic inflammatory bowel diseases which affect the colon of children. the disease can occur at any time during infancy and childhood and is far commoner than crohn's disease of the colon in children less than 6 years old. the jewish population outside of israel is at far greater risk of developing the condition than any other ethnic group. the reason for this is unknown. the chances of a family member developing the condition is 2-3 times as great as ...	1988	3050919
correlation between serogroup and susceptibility to chloramphenicol, clindamycin, erythromycin, rifampicin and tetracycline among 308 isolates of clostridium difficile.	the susceptibility to chloramphenicol, clindamycin, erythromycin, rifampicin and tetracycline of 308 isolates of clostridium difficile from various origins was determined by a disc diffusion susceptibility testing and the results were compared with the serogroup of the strains. for the five antimicrobials, there was a clear-cut separation between susceptible and resistant strains. some correlation between resistance and serogroup was found. almost all of the 161 isolates of serogroups a, f, g, h ...	1988	3053559
[bacteriologic and serologic diagnosis of enteral infections].	infections of the gastrointestinal tract still are numerous, ranging on the second place after infections of the respiratory tract. some of them show quite severe or prolonged course. in contrast to other infections, especially those of the urinary tract, laboratory diagnostic of enteritis is only scarcely ordered. during the last ten years new methods and knowledge of etiologic germs like campylobacter, yersinia, various types of e. coli, clostridium difficile, rotavirus, adenovirus, giardia, b ...	1988	3054377
[in vitro activity of a combination of amoxicillin-clavulanic acid on anaerobic bacteria].	one hundred and one anaerobes isolated from clinical specimen were examined for their susceptibility to amoxicillin, alone or in combination with clavulanic acid, cefoxitin, cefotetan, cefotaxime, piperacillin and metronidazole. tested strains were as follow: 90 bacteroides fragilis group, 16 bacteroides bivius and 5 clostridium difficile. for 54 strains combination amoxicillin-sulbactam were also studied. minimal inhibitory concentrations (mics) were determined by agar dilution method on wilkin ...	1988	3054746
[in vitro activity of beta-lactams, clindamycin and metronidazole on clostridium difficile].	in one year and a half period 47 clostridium difficile were isolated from stool samples. isolates with questionable morphologic features were identified using sugars fermentation, gaz liquid chromatography (glc). cytotoxin assay was performed on mac coy cells. the comparative susceptibilities to amoxicillin-clavulanic acid (amc), cefotetan (ctt), cefoxitin (fox), cefotaxime (ctx), latamoxef (mox), mezlocillin (mez), piperacillin (pip), clindamycin (clin) and metronidazole was tested using minima ...	1988	3054747
[clostridium difficile in children and adolescents undergoing anticancer and antimicrobial chemotherapy. the possibility of nosocomial acquisition].	we looked for c. difficile and its cytotoxin among children and adolescents treated with diverse kinds of cancer chemotherapy in an oncologic ward of a pediatric hospital. most of them were also given multiple antibiotic treatments, susceptible of making c. difficile colonization easier due to the modification of the intestinal ecosystem. as the colonization may have an external origin, we also looked for c. difficile in the environment. 14 patients have been studied and we found cytotoxic strai ...	1988	3054763
evaluation of a computer-assisted method of analysing sds-page protein profiles in tracing a hospital outbreak of serratia marcescens.	sodium dodecyl sulphate-polyacrylamide gel electrophoresis (sds-page) profiles of bacterial proteins have been successfully used for taxonomical purposes. more recently this technique has been applied to epidemiological investigations in respect of various micro-organisms including neisseria meningitidis, staphylococcus aureus and clostridium difficile. the main limitations of the methods so far described are lack of standardisation in extraction and separation as well as in the analysis of resu ...	1988	3060541
results of a prospective, 18-month clinical evaluation of culture, cytotoxin testing, and culturette brand (cdt) latex testing in the diagnosis of clostridium difficile-associated diarrhea.	an 18-mo evaluation of culture, cytotoxin, and latex testing for clostridium difficile was performed between july 1, 1985, and december 31, 1986, on 1,536 specimens from 1,406 patients during evaluation of diarrhea. all cases with at least one test positive were investigated for clinical status. there were 144 clostridium difficile-associated diarrhea (cad) patients; 139 (97%) were positive by culture, 96 (67%) by cytotoxin, and 98 (68%) by latex testing. in the 1,262 non-cad patients with diarr ...	1988	3066571
management and prevention of bacterial diarrhea.	the etiology, pathogenesis, transmission and communicability, diagnosis, and management of infectious diarrhea are reviewed. infectious diarrhea is common in both industrialized and unindustrialized areas of the world. better understanding of the etiology and pathogenesis and identification of "new" enteric pathogens has resulted in the use of a variety of drugs to relieve symptoms or to effect a clinical cure. both host and microbial virulence factors are key in the acquisition of diarrheal ill ...	1988	3069286
bacterial-induced diarrhoea.	in diverse parts of the world, many bacterial strains have been recognised as the causative agents of diarrhoea. great achievements have been made in perceiving the varied mechanisms which explain their intestinal pathogenicity. these achievements include the elucidation of the 5 mechanisms of disease production by escherichia coli, the mechanisms of action of shigella, salmonella, campylobacter and yersinia, new information about antimicrobial-associated colitis caused by clostridium difficile ...	1988	3069445
[nosocomial nature of antibiotic-induced intestinal clostridium infections caused by clostridium difficile].		1988	3069610
diagnosis of infectious diarrheal diseases.	for many years, microbiologic examination of feces was focused on the isolation of two members of the family enterobacteriaceae--salmonellae and shigellae. over the past two decades, other enteric pathogens such as the various classes of diarrheagenic e. coli, campylobacter, vibrio spp., yersinia enterocolitica, and clostridium difficile have gained prominence. a newly recognized protozoan parasite, cryptosporidium is now known to infect both immunocompetent and immunodeficient individuals. adde ...	1988	3074126
pseudomembranous colitis induced by clostridium difficile.		1988	3077615
clostridium difficile toxin b induces reorganization of actin, vinculin, and talin in cultured cells.	clostridium difficile toxin b is a powerful cytopathic agent which causes animal cells in culture to become rounded and arborized, an effect similar to that induced by the cytochalasins. in this study, we demonstrated that the morphological effects of the toxin are directed specifically against the actin and related components of the cytoskeleton. dramatic disruption and reorganization of the actin stress fibers were detectable prior to significant changes in cell shape and alterations in the mi ...	1988	3121372
partial characterization of the enzymatic activity associated with the binary toxin (type c2) produced by clostridium botulinum.	clostridium botulinum produces a binary toxin that possesses a heavy chain (approximately 100,000 daltons) and a light chain (approximately 50,000 daltons). the heavy chain is a binding component that directs the toxin to vulnerable cells, and the light chain is an enzyme that has mono(adp-ribosyl)ating activity. a number of experiments have been done to help characterize the enzymatic activity of the toxin. the data reveal that the enzyme has a ph optimum within the range of 7.0 to 8.0. it is n ...	1988	3121511
prevalence of enteric pathogens in homosexual men with and without acquired immunodeficiency syndrome.	we studied 388 homosexual or bisexual men from the baltimore-washington area to define the spectrum of enteric pathogen carriage in a population at high risk for "gay bowel syndrome" in association with human immunodeficiency virus infection. seventy-seven patients with acquired immunodeficiency syndrome, 68 gay men with symptoms of acute diarrhea or proctitis, and 243 gay men without gastrointestinal symptoms and participating in a natural history study of human immunodeficiency virus infection ...	1988	2831107
serotyping of clostridium difficile.	a total of 246 live clostridium difficile cultures were serotyped by a slide agglutination technique. fifteen grouping antisera were produced which serotyped 98% of the cultures (241 of 246). our results indicated that certain serogroups may have specific pathogenicity. strains of serogroups a, g, h, k, s1, and s4 were cytotoxigenic and were isolated mainly from adult patients with pseudomembranous colitis or antibiotic-associated diarrhea. nontoxigenic strains of serogroups d and cd-5 were isol ...	1988	2833528
acquisition of clostridium difficile from the hospital environment.	an outbreak of antibiotic-associated colitis that occurred on a ward of a michigan hospital during february-april, 1984, was studied by bacteriophage-bacteriocin typing. stools from the seven involved patients yielded clostridium difficile isolates of types b1537 or cld7;b1537. c. difficile was recovered from 31.4% of environmental cultures obtained on the ward, and the majority of isolates were types b1537 or cld7;b1537. when the ward was disinfected with unbuffered hypochlorite (500 parts per ...	1988	2835900
in vivo profiles of eicosanoids in ulcerative colitis, crohn's colitis, and clostridium difficile colitis.	to compare the local release of arachidonic acid metabolites in inflammatory diarrheal disease, in vivo equilibrium dialysis of the rectum was done in consecutive untreated patients with ulcerative colitis (n = 20), crohn's colitis (n = 10), and clostridium difficile colitis (n = 7). all patients had endoscopically proven rectal inflammation. eicosanoid profiles were determined in rectal dialysates by radioimmunoassay after preliminary purification. concentrations of prostaglandin e2, prostaglan ...	1988	2836256
in vitro activity of ly146032 against gram-positive bacteria.	the activity of ly146032 (ly) was evaluated against 269 clinical isolates: 150 staphylococcus spp. (staph), 45 enterococci, 51 clostridium spp., and 23 peptostreptococci. ly was compared to penicillin, metronidazole, imipenem, clindamycin, oxacillin, ciprofloxacin, vancomycin, and ampicillin. ly and oxacillin were tested against staph by microdilution in cation-supplemented mueller-hinton broth (csmhb), and in unsupplemented mueller-hinton broth (mhb). for ly, the mic 90s in csmhb were 16-32 dil ...	1988	2838217
clostridium difficile toxin a stimulates intracellular calcium release and chemotactic response in human granulocytes.	clostridium difficile, a common enteric pathogen, mediates tissue damage and intestinal fluid secretion by release of two protein exotoxins: toxin a, an enterotoxin, and toxin b, a cytotoxin. because toxin a elicits an intense inflammatory reaction in vivo, we studied the effects of highly purified c. difficile toxins on activation of human granulocytes. toxin a at concentrations of 10(-7) to 10(-6) m, but not toxin b, elicited a significant chemotactic and chemokinetic response by granulocytes ...	1988	2838520
in vitro activities of daptomycin (ly146032) and paldimycin (u-70,138f) against anaerobic gram-positive bacteria.	the in vitro activities of daptomycin (ly146032), paldimycin (u-70,138f), vancomycin, and penicillin g against 344 clinical isolates of anaerobic gram-positive bacteria were determined by an agar dilution method in calcium-supplemented (50 micrograms/ml) wilkins-chalgren medium, using an inoculum of 10(5) cfu. daptomycin demonstrated excellent activity against a broad range of anaerobic gram-positive cocci and bacilli, including peptostreptococcus, eubacterium, bifidobacterium, actinomyces, prop ...	1988	2840019
characterization of a nosocomial clostridium difficile outbreak by using plasmid profile typing and clindamycin susceptibility testing.	the mean number of cases of clostridium difficile diarrhea at the minneapolis veterans administration medical center increased to 17.3 per month in june-august 1985, compared with 7.1 per month in the previous 17 mo. plasmid profiles and clindamycin susceptibility were used as markers to evaluate the increase in cases. ninety clindamycin-resistant and 22 clindamycin-susceptible isolates of c. difficile from 1985 were examined for plasmids. a clindamycin-resistant organism contained a cryptic pla ...	1988	2844914
molecular cloning and genetic analysis of a chloramphenicol acetyltransferase determinant from clostridium difficile.	a gene bank from a clinical isolate of clostridium difficile expressing high chloramphenicol acetyltransferase activity was constructed by cloning sau3a-cleaved clostridial dna fragments into the plasmid vector puc13. among 1,020 clones tested, 11 were resistant to chloramphenicol; 1 of these, with an insert size of 1.9 kilobases (pppm9), was studied further. the clone pppm9 was mapped using a variety of restriction enzymes, and a 0.27-kilobase ecorv-taqi restriction fragment was shown to be wit ...	1988	2847649
in vitro activity of azithromycin (cp-62,993), a novel macrolide, against enteric pathogens.	azithromycin (cp-62,993 [9-deoxy-9a-methyl-9a-aza-9a-homoerythromycin]) is a novel macrolide antimicrobial. in this study the in vitro activity of cp-62,993 has been determined against selected enteropathogens, including clostridium difficile, and compared with that of erythromycin. mics were determined using an agar incorporation technique in mueller-hinton medium, containing saponin-lysed horse blood at a final concentration of 10% v/v, with an inoculum of 10(4) cfu. cp-62,993 was considerably ...	1988	2854515
immunochemical and structural similarities in toxin a and toxin b of clostridium difficile shown by binding to monoclonal antibodies.	clostridium difficile toxins a and b were shown to share immunochemical and structural features, including shared sequential epitopes. nineteen hybridomas generated after immunization of mice with a mixture of toxoids produced monoclonal antibodies, all igm(x), which bound to toxin a and toxin b in a solid-phase radioimmunoassay (ria). none of the antibodies neutralized the cytotoxicity of either toxin, alone or in pairs, nor did they neutralize mouse lethality. the antibodies did not inhibit he ...	1988	2459808
identification and characterization of clostridium difficile promoter element that is functional in escherichia coli.	the promoter element involved in the expression of a previously characterized cloned clostridial antigen was isolated and characterized. a restriction fragment containing the promoter element of the clostridium difficile insert was cloned using the promoter probe vector, pga46. subclones of the clostridial dna insert in pga46 were then analyzed by nucleotide sequencing and by s1 nuclease experiments. the clostridial promoter element exhibits a high degree of homology with typical escherichia col ...	1988	2463955
[clostridium difficile in the colon of patient with pseudomembranous colitis and contamination of environment].		1988	3150408
haemolytic uraemic syndrome and pseudomembranous colitis.	two cases of haemolytic uraemic syndrome (hus) associated with pseudomembranous colitis (pmc) are described. the toxin of clostridium difficile was detected post mortem in the stool of one patient and the other patient showed a good therapeutic response to oral vancomycin, an antibiotic with established efficacy in the management of pmc. when associated with hus, pmc is probably an independent specific disease that, in common with many other infections, may activate hus.	1988	3153053
clostridium difficile infection in patients with haematological malignant disease. risk factors, faecal toxins and pathogenic strains.	two hundred and forty-eight patients from shared oncology and general medical wards were prospectively studied over a 6-month period for carriage of clostridium difficile during an outbreak of clinical disease with an epidemic strain of the organism. risk factors for infection were assessed. acute leukaemia and/or its treatment were identified as significantly increasing the risk of infection. the relationship between the type of c. difficile isolated (as defined by a typing system based on the ...	1988	3123260
[laboratory methods of diagnosing pseudomembranous colitis and diarrhea caused by clostridium difficile (review of the literature)].		1989	2469839
clostridium difficile toxin b: characterization and sequence of three peptides.	the cytotoxin, also named toxin b, was isolated from a toxigenic strain of clostridium difficile, purified to homogeneity and partially characterized. the purification procedure included ultrafiltration followed by anion-exchange chromatography. we noticed that a non-specific nucleic material eluted with the protein during the purification. the presence of these nucleic acids appeared to be important for the toxic activity of the protein. some characteristics of the cytotoxin were examined, espe ...	1989	2474559
diagnostic procedures for isolation and characterization of clostridium difficile associated with enterocolitis in foals.		1989	2488656
[enumeration and identification of clostridium from stools treated with the thioglycollate-lysozyme method].	we have used spore isolation by the sodium thioglycolate-lysozyme technique on collected stools. of the 51 stools studied, we found 41% of clostridium perfringens with an average ratio of 10(4) germs/gr. 15 strains were typical double hemolysis and trehalose positive-5 presented only one hemolysis and were trehalose negative. we only found a single strain of clostridium difficile with a rate of 10(4) germs/gr in the stools of a 10 months infant.	1989	2489405
[2 cases of arthralgia associated with infection by clostridium difficile].	the clostridium difficile is the etiologic agent most often isolated in patients with antibiotic-associated colitis. rarely this symptomatology is complicated by postinfection arthritis. the following describes 2 cases of acute colitis by clostridium difficile associated with acute polyarthritis.	1989	2491298
clostridium difficile settles in a nursing home.		1989	2493005
prevention of antibiotic-associated diarrhea by saccharomyces boulardii: a prospective study.	saccharomyces boulardii, a nonpathogenic yeast, has been widely used in europe to prevent antibiotic-associated diarrhea (aad). we performed a prospective double-blind controlled study to investigate aad in hospitalized patients and to evaluate the effect of s. boulardii, a living yeast, given in capsule form concurrently with antibiotics. over 23 mo, 180 patients completed the study. of the patients receiving placebo, 22% experienced diarrhea compared with 9.5% of patients receiving s. boulardi ...	1989	2494098
occurrence and significance of clostridium difficile in faecal specimens of hospitalized children.	stool specimens from 766 hospitalized children, 418 with diarrhoea and 348 controls, were investigated for c. difficile. in both groups the rate of isolation was highest (about 30%) during the first year of life, dropping to nearly 5% in older children. there was no significant difference in the frequency of c. difficile in children with diarrhoea and the controls nor was there a significant influence of previous antibiotic therapy on the rate of isolation. 111/135 strains (82.2%) produced toxin ...	1989	2494813
effect of purified clostridium difficile toxins on intestinal smooth muscle. i. toxin a.	in these studies we determined the effects of purified clostridium difficile toxin a, an enterotoxin, on the electrophysiological and contractile properties of rabbit intestinal circular smooth muscle and correlated these effects with changes of smooth muscle morphology. simultaneous measurements of intracellular membrane potential and contractility were determined in excised ileal muscle strips after administration of toxin a in vivo (60 micrograms/ml) into an isolated rabbit ileal loop or dire ...	1989	2495733
effect of purified clostridium difficile toxins on intestinal smooth muscle. ii. toxin b.	in the companion paper [am. j. physiol. 256 (gastrointest. liver physiol. 19): g759-g766, 1989] we showed that highly purified clostridium difficile toxin a had a profound effect on intestinal smooth muscle after in vivo but not in vitro exposure. in this study we assessed the effects of in vivo and in vitro exposure to c. difficile toxin b on simultaneous measurements of intracellular membrane potential and contractility in rabbit ileal smooth muscle. direct exposure of ileal smooth muscle to t ...	1989	2495734
focal ulcerative ileocolitis with terminal thrombocytopenic purpura in juvenile cotton top tamarins (saguinus oedipus).	a newly recognized syndrome characterized by an acute focal ulcerative ileocolitis, anemia and thrombocytopenic purpura in five juvenile cotton-top tamarins is described. the presentation and morphology of this syndrome is distinct from any other reported gastrointestinal disease reported in tamarins. traditional etiologies such as viruses, ingested toxins, campylobacter, salmonella and yersinia and clostridium difficile are not considered likely etiologic agents. nontraditional etiologies such ...	1989	2496272
multiple relapses of clostridium difficile-associated diarrhea responding to an extended course of cholestyramine.		1989	2496393
polymicrobial septicemia with clostridium difficile in acute diverticulitis.	a case is reported of a patient without previous gastrointestinal symptoms, who presented with polymicrobial septicemia caused by escherichia coli, enterococcus faecalis, clostridium difficile and bacteroides vulgatus. septicemia occurred during acute diverticulitis. a strain of clostridium difficile, which was of the same serogroup c as the blood culture isolate and also produced toxin, was recovered from the stools, but the pathogenic role of this organism in the gastrointestinal symptomatolog ...	1989	2497002
relationship between levels of clostridium difficile toxin a and toxin b and cecal lesions in gnotobiotic mice.	various clostridium difficile strains were studied with respect to their pathogenicity in monoassociated mice in relation to levels of toxin a and toxin b in vivo and in vitro. two strains which were the most potent toxin producers in vitro induced mortality (100%); mice monoassociated with these strains were found to have high levels of both toxins in their ceca and an intense cecal epithelial ulceration together with a severe inflammatory process. no mortality was observed with the other strai ...	1989	2499546
intestinal colonization with clostridium difficile in infants up to 18 months of age.	the faecal colonization with clostridium difficile was investigated among 343 infants during their first 18 months of life. rectal swabs were taken at the ages of 6 days, 6 weeks, 6 months, 11 months and 18 months. about 25% of the children were colonized with clostridium difficile between 6 days and 6 months of age. the colonization rate decreased to 3% at 18 months of age. the rate of strains producing cytotoxin was low in infants less than 6 months of age, but at that age about half of the st ...	1989	2502403
evolution of the caecal epithelial barrier during clostridium difficile infection in the mouse.	the most striking effect of clostridium difficile infection is its degrading of the intestinal barrier. the aim of this study is to establish whether the cellular or paracellular constituent of the barrier is the initial target of the toxins produced by c difficile. accordingly, the caecal epithelium of c3h/he mice was challenged under three experimental conditions with the c difficile strain vpi 10463: (1) by in vivo inoculation of axenic mice, (2) by adding the toxins to ligated caeca in vivo, ...	1989	2504650
cloning and characterization of overlapping dna fragments of the toxin a gene of clostridium difficile.	clostridium difficile, a human pathogen, produces two very large protein toxins, a and b (250-600 kda), which resist dissociation into subunits. to clone the toxin a gene, a genomic library of 3-8 kb chromosomal dna fragments of c. difficile strain vpi 10463 established in puc12 was screened with a rabbit polyclonal toxin a antiserum. thirty-five clones were isolated which carried 2.5-7.0 kb inserts representing a 10 kb region of the c. difficile genome. all the inserts were oriented in the same ...	1989	2506313
production, purification and characterization of clostridium difficile toxic proteins different from toxin a and from toxin b.	the purification and characterization of three new proteins called c1, c2, and c3 from clostridium difficile are described. their estimated molecular mass were about 350 (c1), 270 (c2) and 140 (c3) kda, consisting of subunits of 39 (c1), 43 (c2) and 41 (c3) kda, respectively. immunodiffusion revealed that the three proteins contained similar but not identical antigenic determinants to toxin a. each protein induced a cytotonic effect on hamster ovaric cells; the combined proteins, had a specific ...	1989	2506935
clostridium difficile toxin a. interactions with mucus and early sequential histopathologic effects in rabbit small intestine.	clostridium difficile produces two toxins, a (enterotoxic) and b (cytopathic), that are implicated in the pathogenesis of pseudomembranous colitis. however, the relationship of the secretory effect and the early histopathologic events is still unclear. we examined the early histopathologic effect of purified c. difficile toxin a in rabbit ileal loops and correlated the mucosal damage with the secretory response. as early as 2 hours after inoculation, toxin a at 1.0 micrograms caused cytolysis of ...	1989	2507823
comparative in vitro activity of the new oral penem alp-201 against aerobic and anaerobic bacteria.	the in vitro activity of the new penem derivative alp-201 against 226 aerobic and 350 anaerobic clinical bacterial isolates was determined using agar dilution techniques. for comparison amoxicillin, cefaclor, ceftazidime, doxycycline, erythromycin, imipenem and trimethoprim/sulfamethoxazole were also tested with aerobic bacteria, and cefoxitin, chloramphenicol, clindamycin, imipenem, metronidazole and piperacillin with anaerobic bacteria. alp-201 was found to be highly active against escherichia ...	1989	2512142
polymicrobial septicaemia and clostridium difficile.		1989	2512153
molecular studies on the epidemiology and pathogenicity of clostridium difficile.		1989	2514126
effects of clostridium difficile toxins a and b on cytoskeleton organization in hep-2 cells: a comparative morphological study.	a comparative study on the effects of toxin a and toxin b from clostridium difficile on hep-2 cells was carried out. both toxins caused cell retraction and rounding and seemed to exert their effect on cell morphology via a rearrangement of actin and alpha-actinin microfilaments. such a rearrangement occurred at an early stage, when no change in microtubular and cytokeratin systems was detectable. nevertheless, several structural modifications accompanying the cytopathological process induced by ...	1989	2515619
teicoplanin in the treatment of infections by staphylococci, clostridium difficile and other gram-positive bacteria.	eighty-three episodes of gram-positive infection in 82 patients were treated with teicoplanin in an open study. infectious episodes included endocarditis (6 cases), bacteraemia (7), osteomyelitis (8), pseudomembranous colitis (13), cellulitis (11), urinary tract infection (5), pneumonia (1), wound and post-surgical infections (9) and erysipelas (23). four patients affected by an overwhelming gram-positive infection as well as eight cases of gram-positive-gram-negative mixed infections received t ...	1989	2526109
clostridium difficile-associated typhlitis in specific pathogen free guineapigs in the absence of antimicrobial treatment.	clostridium difficile (toxin) associated typhlitis was diagnosed in untreated barrier-maintained specific pathogen free guineapigs. it resembled the pathological lesions of antibiotic induced enterocolitis. the possible role of limited colonization resistance to c. difficile provided by mouse enteric microflora in the pathogenesis of the disease is discussed.	1989	2527322
treatment of clostridium difficile-associated disease with teicoplanin.	forty-seven patients affected by clostridium difficile-associated disease were treated orally with either vancomycin (patients hospitalized from february 1984 to february 1987) or teicoplanin (from march 1987 to december 1988). all patients given teicoplanin remained asymptomatic after discontinuation of treatment, and all but one were also cleared of c. difficile. in the vancomycin group, clinical symptoms recurred in 3 of 23 evaluable patients, and follow-up cultures were positive in another a ...	1989	2528941
observations on phage-typing of clostridium difficile: preliminary evaluation of a phage panel.	of the various methods now employed to type clostridium difficile, the performance of the phage-typing, as proposed by sell et al., was investigated on a large collection of isolates from various local epidemiological settings. because those isolates appeared in preliminary trials mostly resistant to the reference phages, the panel was enlarged by including newly isolated phages. the new set was redundant but better suited to the purpose: out of 287 phage sensitivity patterns 8.4% only were resi ...	1989	2529136
mechanism of action of clostridium difficile toxin b: role of external medium and cytoskeletal organization in intoxicated cells.	toxin b, an exotoxin produced by clostridium difficile, induces the rounding-up and arborization of cultured mammalian cells, a typical effect which resembles that provoked by cytochalasins. in this study, the effect of toxin b was examined on astroglial cells grown in primary culture. a specific antiserum to toxin b was used to investigate its mechanisms of action. we found that the toxin exerts its effects on cell morphology after its incorporation into cells. the internalization of toxin b re ...	1989	2545447
presence of fructokinase in pancreatic islets.	homogenates of rat pancreatic islets that had been heated for 5 min at 70 degrees c to inactive hexokinases, catalyzed the atp-dependent phosphorylation of d-fructose. this reaction was dependent on the presence of k+ and was inhibited by d-tagatose although not by d-glucose or d-glucose 6-phosphate. the phosphorylation product was identified as fructose 1-phosphate through its conversion to a bisphosphate ester by clostridium difficile fructose 1-phosphate kinase. these findings allowed the con ...	1989	2551726
comparative study of clostridium difficile toxin a and cholera toxin in rabbit ileum.	the purpose of this study was to compare the effects of clostridium difficile toxin a and cholera toxin on fluid secretion, intestinal permeability, and arachidonate metabolites in rabbit ileum. injection of 25 micrograms of either purified toxin into 10-cm ileal loops caused significant increases in fluid secretion and intestinal permeability to mannitol as well as release of prostaglandin e2 into the lumen. toxin a, but not cholera toxin, caused a severe inflammatory reaction of the lamina pro ...	1989	2551764
cloning and hybridization analysis of ermp, a macrolide-lincosamide-streptogramin b resistance determinant from clostridium perfringens.	the erythromycin resistance determinant from clostridium perfringens cp592 was cloned and shown to be expressed in escherichia coli. the resultant plasmid, pjir122 (7.9 kilobase pairs [kb]), was unstable since in both reca+ and reca e. coli hosts spontaneous deletion of 2.7 kb, including the erythromycin resistance determinant, was observed. subcloning, as well as deletion analysis with bal 31, localized the erythromycin resistance gene (ermp) to within a 1.0-kb region of pjir122. a 0.5-kb fragm ...	1989	2552908
enterotoxin induced diarrhoea--an update.	the pathogenic personality or the criteria required to be a successful pathogen, of enteric bacteria includes, among others, the ability to produce potent proteins which by different intracellular mechanisms elicit what we overtly see as diarrhoea. enteropathogens belonging to several genera like vibrio, escherichia, shigella, salmonella, campylobacter, aeromonas and yersinia include species capable of elaborating strikingly similar exotoxins which seem to share common mechanisms of action invol ...	1989	2554547
hybridization analysis of three chloramphenicol resistance determinants from clostridium perfringens and clostridium difficile.	the chloramphenicol resistance determinant from a nonconjugative strain of clostridium perfringens was cloned and shown to be expressed in escherichia coli. subcloning and deletion analysis localized the resistance gene, catq, to within a 1.25-kilobase (kb) partial sau3a fragment. the catq gene contained internal hindii, haeiii, and drai restriction sites and was distinct from the catp gene, which was originally cloned (l. j. abraham, a. j. wales, and j. i. rood plasmid 14:37-46, 1985) from the ...	1989	2554801
bacteriotherapy for chronic relapsing clostridium difficile diarrhoea in six patients.	six patients with chronic relapsing diarrhoea caused by clostridium difficile were treated with rectal instillation of homologous faeces (one patient) or a mixture of ten different facultatively aerobic and anaerobic bacteria diluted in sterile saline (five patients). the mixture led to a prompt loss of cl difficile and its toxin from the stools and to bowel colonisation by bacteroides sp, which had not been present in pre-treatment stool samples. strains of escherichia coli, cl bifermentans, an ...	1989	2566734
protein-losing enteropathy associated with clostridium difficile infection.	a commercially available radial immunodiffusion assay was used to measure serum alpha-1-antitrypsin levels in stool samples from subjects aged over 60 years as a marker of protein-losing enteropathy. alpha 1-antitrypsin was found in all of 12 patients with colonoscopy-confirmed pseudomembranous colitis, 6 of 14 (43%) patients with clostridium difficile diarrhoea without pseudomembranes, 6 of 12 (50%) nursing-home patients culture-positive for cl difficile but negative for its cytotoxin, and none ...	1989	2567373
outbreak of clostridium difficile diarrhoea in an orthopaedic unit: evidence by phage-typing for cross-infection.	in a three-week period five patients had diarrhoea in an orthopaedic unit. the first case was clinically diagnosed as pseudomembranous colitis but the causative agent was not sought. of the remaining cases, two were clostridium difficile positive. the outbreak then apparently ceased, but during the following several days two of seven stool samples taken at random from asymptomatic patients yielded c. difficile. phage-typing of the isolates showed that all apparently belonged to the same strain.	1989	2567761
bacteriotherapy for clostridium difficile diarrhoea.		1989	2570250
clostridium difficile infection in health-care workers.		1989	2571792
clostridium difficle infection in health-care workers.		1989	2572809
bacteriotherapy for clostridium difficile colitis.		1989	2572812
intravenous metronidazole and clostridium difficile-associated diarrhea or colitis.		1989	2584759
intravenous/oral ciprofloxacin versus ceftazidime in the treatment of serious infections.	seventy-one adult patients with 72 infections were treated, by random selection, with intravenous/oral ciprofloxacin or intravenously administered ceftazidime. twenty-seven additional patients with 29 infections who were not appropriate for random assignment were treated in an open study with intravenously administered ciprofloxacin only; the latter infections were generally more serious or were caused by ceftazidime-resistant organisms. the most common doses were ciprofloxacin, 200 mg intraveno ...	1989	2589361
[hospital epidemic of clostridium difficile diarrhea: demonstration of cross-infection using a typing technic].	two hospital outbreaks of clostridium difficile diarrhoea in two general surgery units of different hospitals are described. moreover, the results of a study on the circulation of c. difficile in a neurosurgery unit following two cases of colitis are reported. c. difficile strains isolated from patients and environment have been typed using antimicrobial susceptibility testing and electrophoretic profiles of edta-extracted proteins. the majority of strains isolated in each hospital shared the sa ...	1989	2589733
high incidence of false positives by a latex agglutination test for the diagnosis of clostridium difficile associated colitis in compromised patients.	detection of clostridium difficile cytotoxin using cell culture assays for the diagnosis of antibiotic-associated colitis has been used for over a decade. because the methodology is time consuming and cumbersome, a recently introduced commercial latex agglutination (la) kit has attracted much attention. we compared the sensitivity and specificity of this method with the cytotoxic assay (cta) using diarrheal stools from 652 patients at a referral tertiary care center. specimens from 71 (10.9%) pa ...	1989	2591165
[the occurrence of clostridium difficile in fecal samples of dogs and cats].	fecal samples of 150 dogs and 175 cats originating from different veterinary practices were investigated for assessing the occurrence of clostridium (cl.) difficile by using a selective medium for cultural isolation. from dogs without enteric symptoms 7 (9.3%) of 75 samples were positive for cl. difficile, with 2 strains being cytotoxic for bovine embryonic lung fibroblast cells, which could be neutralized by cl. difficile-antitoxin. in samples of 75 dogs with enteric symptoms cl. difficile coul ...	1989	2596198
antibiotic exposure delays intestinal colonization by clostridium difficile in the newborn.	two antibiotic regimens commonly used in neonatal intensive care were compared for the rate at which clostridium difficile appeared in the faeces. over a nine month period neonates with suspected sepsis admitted to a special care baby unit (scbu) were randomly allocated to receive either cefotaxime or penicillin and netilmicin. a contemporaneous group also admitted to scbu but without sepsis served as non-treated controls. four hundred and sixteen stool specimens from 158 neonates without diarrh ...	1989	2600001
[infectious diarrhea in the adult].	infectious diarrhoeas are usually divided into two types; toxinogenic and invasive. invasive diarrhoeas are copious and responsible for dehydration which is the principal clinical sign; mucosal lesions and bacteraemia are absent. the most typical of toxinogenic diarrhoeas is cholera, but enterotoxicogenic e. coli and aeromonas infections have similar clinical features. in invasive diarrhoeas the responsible microorganisms penetrate into the epithelial cells of the intestine, producing fever and ...	1989	2602888
clostridium difficile in elderly patients.		1989	2603844
inhibition of clostridium difficile toxin a and b by 1,2-cyclohexanedione modification of an arginine residue.	toxin a (enterotoxin) and toxin b (cytotoxin) of clostridium difficile were both inactivated by the arginine specific reagent 1,2-cyclohexanedione. molecular stability during the inactivation process was demonstrated by sds-page analysis showing the same migration rates for modified and unmodified forms of the 230 kda toxin a and of the 250 kda toxin b. cytotoxicity of both toxins as well as mouse lethality of the enterotoxin were drastically decreased as a result of the arginine modification. t ...	1989	2610698
the effect of new broad-spectrum antibiotics on faecal flora of cancer patients.	the effects of newly available broad-spectrum antibiotics, used for infection prophylaxis and therapy in cancer patients, on faecal aerobic and anaerobic bacteria were investigated. quantitative and qualitative aerobic and anaerobic cultures were performed in 34 patients before therapy and between the sixth and eleventh day of therapy. of the two prophylactic regimens norfloxacin plus amphotericin-b eliminated enterobacteriaceae and enterococci without encouraging growth of yeasts or clostridium ...	1989	2613606
effect of erythromycin acistrate and erythromycin stearate on human colonic microflora.	the effects of erythromycin acistrate (2'-acetyl erythromycin stearate), a new erythromycin derivative, and erythromycin stearate on the faecal microflora were compared in a randomized cross-over study. 12 healthy volunteers were given either drug 500 mg t.i.d. for 1 week. their faeces were studied before, immediately after, and 1 week after the drug administration period. after a wash-out period of 4 weeks, the drugs were interchanged. both erythromycin acistrate and erythromycin stearate induc ...	1989	2617212
medical implications of nosocomial infection with clostridium difficile.	88 patients above the age of 60 years who contracted clostridium difficile associated diarrhoea (cdad) between 1979 and 1986, mostly during their stay in hospital were studied retrospectively as regards nursing time and clinical outcome. these patients were compared with 176 control patients who were matched according to diagnosis on admission to hospital, sex, age and underlying disease. thromboembolic complications occurred in 14% in cdad patients (controls 4%) (p = 0.0042). the mortality rate ...	1989	2617213
[a rapid test for detecting clostridium difficile].	staphylococcus aureus cells, strain cowan 1, were coated with an anti-clostridium difficile serum, produced in rabbits. this reagents were used in the coagglutination (coa-test) for detection of clostridium difficile. a total of 275 bacterial cultures of different species were tested for detection of clostridium difficile by coa-test and bacterial culture. of 183 strains positive by isolation of the organism, 181 were positive by coa-test. the sensitivity and specificity of the coa-test relative ...	1989	2618112
[clostridium difficile enterocolitis in subjects treated with wide-spectrum antibiotics].	after a concise description the main aetiopathogenic features of clostridium difficile colitis, three clinical cases are reported. it is considered that this disease could be easily cured as long as high risk patients are determined.	1989	2622575
disease associated with clostridium difficile infection.		1989	2643913
anaerobic bacteremia in patients with acute leukemia.	we reviewed 402 hospital admissions of patients with acute leukemia to define the frequency and characteristics of anaerobic bacteremia in this patient population. six (5.2%) of the 116 septicemia episodes documented in these patients were caused by anaerobes (bacteroides species, 3; fusobacterium species, 2; and clostridium tertium, 1); two of these episodes were polymicrobial. five patients had had prior bacteremia. all six patients were receiving broad-spectrum antibiotics, including an anti- ...	1989	2647821
clostridium difficile associated reactive arthritis in an hla-b27 positive female: report and literature review.	a case of clostridium difficile associated reactive arthritis in an hla-b27 positive female is reported and compared to 9 other cases. the clinical course of c. difficile associated reactive arthritis is similar to that caused by other enteric pathogens. therefore, c. difficile should be considered in the differential diagnosis of the reactive arthritides.	1989	2654390
[antibiotic-associated diarrhea and colitis caused by clostridium difficile].		1989	2658892