Publications

a clinical and aetiological study of adult patients hospitalised for acute diarrhoeal disease.	sixty adult patients with diarrhoea discharged from the infectious disease unit, auckland hospital in the 15 months from 1 january 1980 were reviewed. thirty had diarrhoea due to enteric organisms (campylobacter fetus 8, shigella 6, salmonella typhi 4, salmonella typhimurium 4, clostridium difficile causing pseudomembranous colitis 3). other diagnoses included ulcerative colitis and a colonic carcinoma. eighteen had no specific diagnosis. combinations of admission fever, faecal leucocytes and le ...	1982	6952128
clostridium difficile-associated colitis: cross infection in predisposed patients with renal failure.	four men with renal failure developed clostridium difficile-associated diarrhoea while being cared for in the same ward at about the same time. cross infection appeared to play a role. all patients had received antibiotics; three were treated for chest infections and one for a urinary tract infection. the antibiotics implicated were cefoxitin alone in two patients, cefoperazone alone in one patient and cloxacillin, cefoperazone and amoxycillin in the last patient. two patients had received immun ...	1982	6953368
reactive arthritis due to clostridium difficile.		1982	6953381
susceptibilities of anaerobic bacteria to n-formimidoyl thienamycin (mk0787) and to other antibiotics.	the susceptibilities of 462 clinical anaerobic bacterial isolates to n-formimidoyl thienamycin and 16 other currently available and investigational antibiotics were determined by the agar dilution technique. n-formimidoyl thienamycin was significantly more active than the reference antibiotics against most organisms tested, especially bacteroides sp., including clindamycin-resistant strains. all 462 isolates were inhibited by 4 micrograms of n-formimidoyl thienamycin per ml, and no resistant str ...	1982	6956247
contamination and crossinfection with clostridium difficile in an intensive care unit.	an outbreak of pseudomembranous colitis in an intensive care unit is described. this resulted in environmental contamination by clostridium difficile. the outbreak could be traced to one patient who received several antibiotics over the preceding three months. a search was conducted for asymptomatic carriers among patient and staff but none were found. aquisition of c. difficile from inanimate environmental sources was the most probable means of transmission of the organism. its persistence in t ...	1982	6956292
reactive arthritis associated with clostridium difficile.	a case of reactive arthritis in a patient with a previously documented history of reiter's syndrome is described. the precipitating agent appears to have been clostridium difficile. high levels of toxin were demonstrable in the faeces and neutralising antitoxin was detected in the patient's serum but not synovial fluid. resolution of the polyarthropathy was slow despite successful eradication of the c. difficile with a course of vancomycin.	1982	6960877
clostridium difficile and antibiotic associated diarrhoea in sweden.	distribution of age and sex among patients with clostridium difficile enterocolitis shows an increased ratio female: male (3:1) in age group 20 to 40 years and a corresponding 2:1 ratio in patients over 70 years of age, the latter group constituting 45% of 505 patients investigated. being the only laboratory in sweden performing cytotoxin-assay from cases of c. difficile enterocolitis during 1979-1981, we have observed that the frequencies with which clindamycin/lincomycin are associated with c. ...	1982	6962998
bacillus pumilus in the induction of clindamycin-associated enterocolitis in guinea pigs.	antibiotic-associated enterocolitis was induced in guinea pigs by the intraperitoneal injection of clindamycin. the colonic and cecal mucosa and feces of acutely ill animals were cultured under aerobic and anaerobic conditions on 5% sheep blood agar plates and on a selective and differential medium for clostridium difficile. all morphologically distinct colony types were isolated in pure culture and identified. a sterile cell-free filtrate of each isolate was tested for ability to induce morphol ...	1982	7033138
clostridium difficile colitis associated with cancer chemotherapy.	administration of cancer chemotherapeutic agents to humans and animals is frequently complicated by diarrhea and enterocolitis. clostridium difficile and its toxin were found in the stools of two patients with colitis after chemotherapy for malignant neoplasms. diarrhea in both patients resolved with oral vancomycin hydrochloride therapy. clostridium difficile was also isolated from several fomites within the room of one of these patients and also from the hands of his nurses. based on these two ...	1982	7036924
infectious gastroenteritis in bone-marrow-transplant recipients.	we prospectively evaluated infections with several gastrointestinal pathogens in patients undergoing bone-marrow transplantation, in an attempt to correlate infection with morbidity and mortality. thirty-one of 78 patients (40 per cent) were infected with one or more of the following enteric pathogens during the study: adenovirus (12 infections), rotavirus (nine), coxsackievirus (four), or clostridium difficile (12). several patients were infected with more than one pathogen. infection correlate ...	1982	7038501
randomized controlled trial of colestipol in antibiotic-associated colitis.	thirty-eight patients with severe antibiotic-associated postoperative diarrhoea were entered into a randomized controlled trial to compare colestipol (an ion exchange resin) in 17 patients with placebo (sherbet) in 21 patients. clostridium difficile or its toxin was present before treatment in 12 of the colestipol group, compared with only 5 in the placebo group. because of the low incidence of cl. difficile or its toxin, the placebo group data from 22 patients receiving placebo in a previous tr ...	1982	7039758
antibiotic-associated diarrhoea and methicillin-resistant staphylococcus aureus.	methicillin-resistant staphylococcus aureus was thought to be the cause of 10 cases of antibiotic-associated diarrhoea observed over a 12-month period at the royal melbourne hospital. each patient had significant underlying disease, and all had been treated with multiple, broad-spectrum antibiotic agents. the diagnosis was made on the distinctive gram-stain appearance of faecal smears, the heavy predominant growth of methicillin-resistant staph. aureus from stool cultures, and the absence of oth ...	1982	7048039
antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases.	ten cases of antibiotic-associated colitis (aac) were identified at a hospital in washington, d.c., from march 17 to may 9, 1979. no geographic clustering of cases was found, nor was an association with increased use of antibiotics demonstrated. exposure to aminoglycosides, cephalosporins, and clindamycin was associated with aac, as was a history of enemas in the seven days before the onset of illness (p=0.045). this association was strengthened when gastrointestinal procedures-defined as (1) th ...	1982	7054330
office-based management of diarrhea.	diarrhea of unknown cause is a particularly challenging diagnostic problem as it may be trivial and self-limiting or the presenting symptom of a life-threatening disorder. antibiotic-associated diarrhea is a frequent complication of antimicrobial therapy, especially in the elderly. the more severe form, pseudomembranous colitis, is now known to be caused by a toxin produced in the colon by clostridium difficile.	1982	7056472
trimethoprim/sulfamethoxazole-associated pseudomembranous colitis.	a case of tmp/smx-associated pseudomembranous colitis is described in a patient being treated for a urinary tract infection. pseudomembranes are visualized on proctosigmoidoscopy, and stool cultures identified clostridium difficile as the causative organism. the patient was treated successfully with oral vancomycin. a review of this infrequently reported adverse reaction to tmp/smx is presented, emphasizing etiology and treatment.	1982	7060459
metronidazole: an alternate therapy for antibiotic-associated colitis.	the results of treatment of 13 consecutive cases of antibiotic-associated pseudomembranous colitis with oral metronidazole are described. the diagnosis was made by typical sigmoidoscopic appearance with a confirming characteristic colonic biopsy specimen and/or stools positive for clostridium difficile cytotoxin. all patients responded with the disappearance of diarrhea between 1 and 5 days. two patients experienced relapse when the therapy was discontinued. our experience with metronidazole sho ...	1982	7060906
counterimmunoelectrophoresis vs. cytotoxicity assay for the detection of clostridium difficile toxin.		1982	7061887
is clostridium difficile pathogenic in infants?		1982	7062169
clostridium difficile toxin in asymptomatic neonates.	clostridium difficile toxin was detected in the feces of 10.5% of normal newborn infants and 55% of neonates in the intensive care unit. none of the normal infants and less than one-third of those in the nicu had any signs of enteric illness. vaginal delivery and breast-feeding were associated with increased rates of toxin carriage. although toxin was not detected during antibiotic therapy, it could be found in 85% of infants two weeks or more, and for at least an additional two months, followin ...	1982	7062179
the prevalence of clostridium difficile and toxin in a nursery population: a comparison between patients with necrotizing enterocolitis and an asymptomatic group.	during a period when certain neonates in our nursery developed necrotizing enterocolitis, we studied stool specimens from a population of symptomatic and asymptomatic patients for the presence of clostridium difficile and its toxin. the presence of the organism among nursery personnel and in the nursery environment was also evaluated. results showed that five symptomatic neonates and 17 asymptomatic neonates in a population of 37 patients studied in our neonatal intensive care and intermediate c ...	1982	7062180
morphologic and functional effects of clostridium difficile enterotoxin in tissue culture.	the effects of the clostridium difficile toxin were examined in hela and mouse adrenal tumor (mat) cells. cytotoxicity was evaluated by vital dye exclusion and 51cr release. in both hela and mat cells, c. difficile toxin caused rounding of virtually 100% of cells. this rounding was distinguishable from rounding produced by the escherichia coli heat-labile enterotoxin (lt): (1) lt was inactive in hela cells; (2) in mat cells, c. difficile toxin produced uniformly rounded cells, while lt-rounded c ...	1982	7066760
isolation of clostridium difficile from patients with inactive crohn's disease.	based upon studies of patients with inflammatory bowel disease, clostridium difficile and an associated cytotoxin have been proposed as contributory factors in relapse of disease. these studies have not included a comprehensive search for other bacterial pathogens. fifty patients with crohn's disease were investigated to determine if selected enteric pathogens colonize the bowel and if they play a role in the activity of the disease. clostridium difficile was recovered from 8% of patients, all w ...	1982	7067956
ulcerative colitis and crohn's disease tissue cytotoxins.	bowel-wall tissue filtrates from patients with inflammatory bowel disease produce cytopathic effects in tissue culture. the cytopathic effects inducers have been reported to have the characteristics of a small rna virus. clostridium difficile toxin also produces cytopathic effects and has been found in the stools of patients with crohn's disease and ulcerative colitis. the present study concerns the further characterization of the cytopathic inducers in tissues of inflammatory bowel disease pati ...	1982	7067958
purification and characterization of toxins a and b of clostridium difficile.	toxin preparations were obtained by growing clostridium difficile vpi strain 10463 in 2-liter brain heart infusion dialysis flasks at 37 degrees c for 3 days. the initial step of the purification scheme involved ultrafiltration through an xm-100 membrane filter. two toxic activities, designated toxins a and b, were separated by ion-exchange chromatography on deae-nacl gradients. toxin a was purified to homogeneity by an acetic acid precipitation at ph 5.5. other separation techniques, including ...	1982	7068210
biological activities of toxins a and b of clostridium difficile.	examination of the biological activities of the two known toxins of clostridium difficile revealed that one of the toxins (toxin a) elicited a hemorrhagic fluid response in rabbit intestinal loops and a positive fluid response in infant mice. the other toxin (toxin b) did not produce a significant fluid response in either model, although the toxin was more lethal in infant mice. both toxins elicited erythematous and hemorrhagic skin reactions and increased vascular permeability in rabbit skin.	1982	7068215
colonization of the large bowel by clostridium difficile in healthy infants: quantitative study.	colonization of the large bowel of healthy infants by clostridium difficile was studied. feces were collected from five breast-fed aand five formula-fed infants throughout the first year of life, and levels of c. difficile were quantitated. three breast-fed and five formula-fed infants were colonized for periods of between 8 and 42 weeks, and another infant harbored the organism only during week 1. colonization of breast-fed infants commenced before or during weaning, with levels reaching 10(3) ...	1982	7068220
analysis of short-chain acids from bacteria by gas-liquid chromatography with a fused-silica capillary column.	the use of a flexible, fused-silica capillary column for gas-liquid chromatographic analysis of short-chain acids from bacteria is illustrated with a standard acid mixture and with a derivatized extract of culture medium from clostridium difficile.	1982	7068826
problems associated with counterimmunoelectrophoresis assays for detecting clostridium difficile toxin.	the antitoxins currently used for the detection of clostridium difficile by counterimmunoelectrophoresis react with other c. difficile antigens in addition to the toxins produced by the bacterium.	1982	7068832
the plain abdominal radiograph in pseudomembranous colitis due to clostridium difficile.	the plain abdominal radiographs have been reviewed in nine patients with proven pseudomembranous colitis. these demonstrated small intestinal dilatation in eight patients, colonic thumb-printing and haustral thickening in seven, ascites in five and colonic dilation in two cases. the elucidation of these signs, especially in combination, may suggest the diagnosis of pseudomembranous colitis in those at risk.	1982	7075131
clostridium difficile toxin in acute diarrhoea complicating inflammatory bowel disease.	the incidence of clostridium difficile cytotoxin has been studied in 69 consecutive patients with inflammatory bowel disease complicated by severe diarrhoea or ileostomy flux during 74 admissions to hospital. the cytotoxin was identified in only four patients, all of whom had received antimicrobials. clostridium difficle, but not cytotoxin, was identified in 10 of 43 admissions. this followed antimicrobial prophylaxis to cover a recent operation in two patients, and five were on long-term sulpha ...	1982	7076018
use of sodium taurocholate to enhance spore recovery on a medium selective for clostridium difficile.	isolation of clostridium difficile from fecal specimens has been facilitated by the development of a selective and differential medium, cefoxitin-cycloserinefructose agar (ccfa). we substituted 0.1% sodium taurocholate for the 2.5% egg yolk in ccfa and compared the growth of 15 isolates of c. difficile on the resulting medium with growth on conventional ccfa. the taurocholate-containing medium (tccfa) quantitatively recovered vegetative forms of c. difficile in the same numbers as ccfa medium. r ...	1982	7076817
rapid identification of clostridium difficile by toxin detection.	rapid identification of clostridium difficile in a stool specimen could be accomplished within 24 h by detection of toxin elaborated in an agar or broth culture containing cycloserine and cefoxitin. broth culture seemed to give a more rapid and sensitive result than the agar plate culture. for cultivation of c. difficile in stool, we recommend the use of chopped meat broth and blood agar plate, the former for toxin detection in 1 to 2 days and the latter for colonial morphology and isolation of ...	1982	7076819
possible foodborne transmission in a case of pseudomembranous colitis due to clostridium difficile: influence of gastrointestinal secretions on clostridium difficile infection.	a 78-yr-old woman with a history of hypochlorhydria was found to have pseudomembranous colitis due to clostridium difficile. she had not received previous antimicrobial therapy. her onset of disease followed ingestion of possibly contaminated canned salmon, suggesting possible oral transmission of disease. we assessed the possibility of ingested clostridium difficile organisms or cytotoxin surviving passage through the upper gastrointestinal tract. normal gastric juice, hypochlorhydric gastric j ...	1982	7084623
effects of the two toxins of clostridium difficile in antibiotic-associated cecitis in hamsters.	hamsters were vaccinated with toxoids containing toxin a, toxin b, both toxins, or a preparation containing neither toxin of clostridium difficile, the causative agent of antibiotic-associated cecitis in hamsters and pseudomembranous colitis in humans. to determine whether these vaccines would reduce the severity of antibiotic-associated cecitis, the hamsters were injected subcutaneously with clindamycin. nearly all of the hamsters protected against neither toxin or only one toxin died. these an ...	1982	7085078
clostridium difficile and cytotoxin in routine faecal specimens.	over a five-month period 1239 unselected, routine faecal specimens from 856 patients were examined for clostridium difficile. one hundred specimens representing 69 patients were culture-positive. toxin was detected in the stool of ten. during the study period, there were 41 salmonella, 12 campylobacter and 9 shigella infections. c difficile was isolated together with salmonella from 12 patients. no patient required specific treatment for c difficile infection. the significance of these findings ...	1982	7085901
antimicrobial susceptibility of clostridium difficile from different sources.	a total of 79 clostridium difficile strains from healthy young and elderly adults, elderly patients without gastrointestinal disease, elderly patients receiving antibiotics without gastrointestinal complications, and elderly patients with antibiotic-associated diarrhea or pseudomembranous colitis were tested for their susceptibilities to 24 antimicrobial agents. all of the 79 strains were inhibited by low concentrations of rifampicin, metronidazole, fusidic acid, vancomycin, ampicillin, and peni ...	1982	7087801
clostridium difficile in normal infants and sudden infant death syndrome: an association with infant formula feeding.	large numbers clostridium difficile were found in the stools of two victims of sudden infant death syndrome (sids). this prompted a study of normal infants in the sids age group. thirty-two infants were studied, using two selective culture techniques and two assays for bacterial products. thirteen of the normal infants (39%) were found to carry c difficile, and fecal toxins were detected in eight of these, four with cytotoxin detectable at 10(-4) or higher dilution. colonization was observed in ...	1982	7088640
clostridium difficile: epidemiology and clinical features.	to determine the epidemiologic features of clostridium difficile in halifax, nova scotia, the authors studied two groups of hospitalized patients, one group of outpatients and a fourth group of 54 healthy subjects. the first group consisted of 29 patients with diarrhea, whose stool was found to contain c. difficile or its cytotoxin, or both. twenty-two underwent sigmoidoscopic examinations; of these, 18 had abnormal colonic mucosa and 6 of the 18 had pseudomembranous colitis. in the second group ...	1982	7093841
discontinuous counterimmunoelectrophoresis in the diagnosis of antibiotic-associated colitis.	discontinuous counterimmunoelectrophoresis (dcie) was employed to detect the toxin of clostridium difficile, etiologic antibiotic-associated colitis (aac), in bacteria-free stool filtrates from 51 patients with diarrhea. stool samples from 31 patients contained c. difficile toxin as determined by tissue-culture assay. a positive result was obtained by dcie in 20 of the 31 patients (65%) and was influenced by the titer of toxin present. when toxin was present by tissue-culture assay in a dilution ...	1982	7096958
[recurrence of antibiotic associated diarrhea caused by clostridium difficile].		1982	7101511
possible evidence for a shwartzman reaction in pseudomembranous colitis.	pseudomembranous colitis is a potentially fatal disorder associated with gastrointestinal surgery and the use of antibiotics. the aetiological agent has been shown to be clostridium difficile but the pathogenesis of the disease is unknown. it has been suggested that the lesions produced are due to a local shwartzman effect. such an effect may be accompanied by activation of the serum complement system and we therefore looked for evidence of complement consumption in 4 patients with the diagnosti ...	1982	7106415
myoelectric effects of clostridium difficile: motility-altering factors distinct from its cytotoxin and enterotoxin in rabbits.	clostridium difficile is a bacterium that causes antibiotic-associated pseudomembraneous enterocolitis. this bacterium produces a cytotoxin that induces tissue culture assay positivity and an enterotoxin that causes in vivo mucosal injury. in previous studies we have described two altered myoelectric patterns in response to certain diarrheagenic organisms in an in vivo rabbit model. the first pattern was called the migrating action potential complex and is associated with noninvasive agents; the ...	1982	7106514
clostridium difficile and its cytotoxin in feces of patients with antimicrobial agent-associated diarrhea and miscellaneous conditions.	fecal specimens from 223 subjects were evaluated for the presence of clostridium difficile by use of a selective medium developed in our laboratory and for the presence of c. difficile cytotoxin. c. difficile and cytotoxin were detected in 89 and 83%, respectively, of patients with antimicrobial agent-associated pseudomembranous colitis (pmc). in patients in whom pmc was not documented, c. difficile and cytotoxin were present in only 37 and 21%, respectively. c. difficile and cytotoxin were also ...	1982	7107838
differential effects of clostridium difficile toxins on tissue-cultured cells.	two immunologically distinct clostridium difficile toxins elicited similar morphological changes on cultured cells, although there were differences in both toxin potency and cell sensitivities.	1982	7107845
varying results of counterimmunoelectrophoresis for the detection of clostridium difficile toxins.		1982	7108287
immunochemistry of the cell-surface carbohydrate antigens of clostridium difficile.	two carbohydrate cell-surface antigens were extracted from clostridium difficile. one was extracted from pure cell walls by naoh and contained glucose, mannose, galactosamine and phosphate in the approximate molar proportions of 2:0.65:1:0.63. the other antigen was extracted with phenol from the disrupted contents of whole cells and purified by chromatography on sepharose 6b and an immunoabsorbent column; it contained glucose, glucosamine, phosphate and fatty acid in the approximate molar propor ...	1982	7119739
clostridium difficile: the epidemiology and prevention of hospital-acquired infection.		1982	7129641
clostridium difficile and cytotoxin in feces of patients with antimicrobial agent-associated pseudomembranous colitis.	thirty patients with antimicrobial agent-associated pseudomembranous colitis (pmc) were studied for the presence of clostridium difficile and its cytotoxin in feces. either colonoscopy or barium enema radiography was required in three patients for the diagnosis of pmc because of nondiagnostic findings at sigmoidoscopy. both the organism and cytotoxin were detected in 27 of the 30 patients; staphylococcus aureus was excluded as the cause of pmc in two of the remaining patients. eighteen of 19 pat ...	1982	7129642
toxin-induced cell membrane injury in guinea pigs given lincomycin.	guinea pigs treated with lincomycin developed colitis, acute cholecystitis and abnormalities in red blood cell morphology. the present study was designed to study the production of clostridial toxins after lincomycin treatment. lincomycin produced abnormalities in conventional but not in germ-free guinea pigs. clostridium difficile was cultured from cecal contents of conventional guinea pigs treated with lincomycin. cecal filtrate from sick guinea pigs was subjected to sepharose 4b-cl and sephad ...	1982	7133762
clostridium difficile toxin in faecal specimens of healthy children and children with diarrhoea.	presence of cytopathogenic effect (cpe) that could be inhibited by an antitoxin to clostridium sordelli, known to cross-react with clostridium difficile toxin, was sought in faecal specimens from 101 infants. of the children, 45 were healthy, while 56 had been hospitalized because of diarrhoea. cpe was found in 12 of the healthy infants and in 5 of those hospitalized. faecal specimens of these 5 gave a cpe at titres of 10(3-4), whereas in the 12 healthy infants the titres were 10(1-2). studies o ...	1982	7136636
epidemiology of clostridium difficile in infants.	the epidemiology of clostridium difficile was studied prospectively in 451 newborn infants by daily screening of fecal samples. colonization rates in three postnatal wards ranged from 2% to 52%. many colonizations were sporadic, but on two wards there was evidence of clustering. on one of these occasions prospective environmental sampling yielded c. difficile organisms from a potential common source. mothers were shown not to be the sources of their infants' organisms. both toxin-producing and n ...	1982	7142747
survey of the extrachromosomal gene pool of clostridium difficile.	pseudomembranous colitis, a severe diarrheal disease, has been linked to the administration of antibiotics and to two toxins produced by clostridium difficile. eighty-two strains of c. difficile isolated from humans and hamsters were assayed for the presence of plasmid dna. agarose gel electrophoresis of sarkosyl-lysed cells indicated that 18% of the strains contained from one to four plasmids. the plasmid dna in these strains ranged in molecular weight from 2.7 x 10(6) to 60 x 10(6). strains wi ...	1982	7153313
isolation of clostridium difficile from hospitalized patients without antibiotic-associated diarrhea or colitis.	stool samples from 100 hospitalized patients and 21 healthy adults, obtained between march and june 1980, were cultured on a special selective medium containing cefoxitin and cycloserine to detect clostridium difficile. this organism was isolated from 13 of the hospitalized patients and from 1 healthy subject. none of the patients with positive cultures had received antimicrobial therapy in the 3 preceding months. the observed rate of c. difficile isolation from adults not suffering from antibio ...	1982	7153315
effect of incubation time, and calcium carbonate and glucose in the growth medium, upon the fermentation end-product profile of clostridium difficile.	the effects of time, glucose and calcium carbonate upon fermentation profiles of clostridium difficile were determined. the test organism was grown in three media, viz. fastidious anaerobe broth (fab), fab with 1% w/v glucose, and fab with 1% glucose plus calcium carbonate. fermentation products were analysed after 24, 48 and 72 h incubation. by 48 h, qualitatively 'typical' profiles could be produced. glucose supplementation of fab suppressed formation of certain branched-chain carboxylic acids ...	1982	7154979
clostridium difficile in a pediatric outpatient population.	clostridium difficile has been implicated as one cause of hospital-acquired diarrhea in children, yet the prevalence of this organism in outpatient children with diarrhea has not been established. over a 1-year period, 306 outpatient children ranging in age from 2 weeks to 16 years were cultured for c. difficile and potential bacterial pathogens. c. difficile was isolated from 7.0% of patients with diarrhea (12 of 171) and 14.8% of controls with nondiarrheal illnesses (20 of 135). the 32 patient ...	1982	7155966
investigation of an outbreak of antibiotic-associated colitis by various typing methods.	during an outbreak of diarrheal disease due to clostridium difficile in a surgical ward, 16 c. difficile isolates were cultured from fecal samples of 15 patients. agarose gel electrophoresis for the detection of plasmid dna, crossed immunoelectrophoresis for the detection of extracellular antigens and toxins, polyacrylamide gel electrophoresis for analyses of soluble proteins, assays for cytotoxicity, and a comparison of susceptibility to antimicrobial agents were employed. at least 12 of the 16 ...	1982	7161375
biochemical and pathological effects of clostridium difficile toxins in mice.	toxins produced by clostridium difficile are lethal to mice after i.p. administration. among the alterations observed when mice were given a preparation containing both toxin a and toxin b were a 1.6 +/- 0.2 degrees c (mean +/- s.e., n = 7) depression of rectal body temperature, blood in the liver (318 +/- 13% of control levels) and a decrease in glutathione concentration (74 +/- 2% of control). purified toxin a and purified toxin b were both able to alter these parameters. toxin b, however, had ...	1982	7164114
effect of clindamycin on cytotoxin production by clostridium difficile.	a total of 80 strains of clostridium difficile, 33 toxigenic and 11 nontoxigenic clindamycin (cldm)-sensitive (mic less than 12.5 micrograms/ml), and 23 toxigenic and 13 nontoxigenic cldm-resistant (mic 200 to 6,400 micrograms/ml) were tested for cytotoxin production in the presence of cldm. none of the 24 nontoxigenic strains produced cytotoxin regardless of the presence of cldm and only six out of the 56 toxigenic strains showed 16- to 64-fold higher levels of cytotoxic activity in the presenc ...	1982	7167065
further experience with augmentin in the treatment of skin infections.	thirty-two patients with skin infections were treated with augmentin, a combination of amoxycillin with the beta-lactamase inhibitor clavulanic acid. these infections were primary skin sepsis (7), infected eczema (11), infected trauma (10) and leg ulcers (4). the majority of cases were caused by amoxycillin-resistant staphylococcus aureus either alone or in combination with streptococcus pyogenes. thirty patients (94%) responded to treatment with only one withdrawal (for side effects). side effe ...	1982	7167811
intestinal occurrence of campylobacter fetus subspecies jejuni and clostridium difficile in children in sweden.	stool samples were cultured from 356 children in different states of health and in different age groups between birth and six years of age in order to investigate the occurrence of campylobacter jejuni and clostridium difficile. campylobacter jejuni was isolated from two of 56 children with diarrhoea but was not isolated from any of 300 healthy children or children recently treated with antibiotics. campylobacter jejuni does not seem to be a common cause of diarrhoea in children in sweden and is ...	1982	7173168
clostridium difficile typhlitis in hamsters not associated with antibiotic therapy--.		1982	7174490
inhibition of clostridium difficile by faecal streptococci.	the inhibitory activity of seven strains of faecal streptococci against 34 strains of clostridium difficile was examined in vitro after growth of the streptococci for 24 and 48 h. all strains of c. difficile were inhibited at 48 h but at 24 h the inhibition was variable. streptococcus faecium, a group d streptococcus and an ungroupable streptococcus exhibited the most striking inhibitory activity. lowering of ph of the medium occurred at the site of inhibition, but the ph change alone did not ex ...	1982	7175918
[role of clostridium difficile in human and animal pathology].		1982	7178505
antibiotic-associated hemorrhagic colitis.	pseudomembranous colitis arising from clostridium difficile super-infection after treatment with various antibiotics is a well-defined portion of the pathological spectrum of antibiotic related bowel injury. we have observed two patients with hemorrhagic colitis associated with the use of penicillin derivatives. the colitis was characterized by predominant right-sided involvement, sparing of the rectum and distal colon, absence of pseudomembrane formation, and presence of marked hemorrhage in th ...	1982	6979926
[2 cases of colitis caused by clostridium difficile during antibiotic therapy].	defined the most important clinical, endoscopic and pathological aspects of antibiotic-associated colitis, the aa. examine the clostridium difficile as the etiological agent. the range of examination has been limited to two cases of pseudomembranous colitis, a diagnostic and a therapeutic evaluation is suggested for patients with aad and pmc. furthermore the importance of a strictly observance of hospital hygienic rules in the prevention of such pathological cases is strongly stressed.	1982	6927221
clostridium difficile in paediatric infections.		1982	7185999
nosocomial spread of clostridium difficile.	environmental transmission of clostridium difficile, the causative agent of antibiotic-associated pseudomembranous colitis (pmc), has been supported by animal studies and implicated in spread of c. difficile among leukemic children receiving non-absorbable antibiotics. we report antibiotic-associated c. difficile-related colitis in two adults who shared a commode chair during hospitalization.	1983	6550579
intestinal beta-lactamase activity in ampicillin-induced, clostridium difficile-associated ileocecitis.	daily oral administration of ampicillin to hamsters consistently resulted in fatal ileocecitis due to ampicillin-susceptible strains of clostridium difficile. ampicillin was not detected in the cecal contents of these hamsters once c. difficile appeared. cecal contents obtained from hamsters with ampicillin-induced ileocecitis displayed beta-lactamase activity, whereas cecal contents obtained from untreated control hamsters did not. colonization of the ceca with c. difficile corresponded to a de ...	1983	6600772
[reactive arthritis caused by non-yersinia intestinal infections].	aseptic arthritis can occur following intestinal infections due to shigella, salmonella, campylobacter jejuni and clostridium difficile. these rheumatisms are rare, only occurring in about 1 p. cent of cases, generally in patients with the hla-b27 antigen. whatever the causative organism, the arthritis has features in common with all reactive arthrites. they generally have a favourable course.	1983	6607501
household pets as a potential reservoir for clostridium difficile infection.	the purpose of this study was to assess the carriage of clostridium difficile by household pets to determine their potential as a reservoir of infection. the selective cycloserine-cefoxitin medium was used for c difficile isolation, and tissue culture used for detection of cytotoxin. carriage of c difficile by household pets was found to be common (23%). the carriage tends to be transient and does not appear to be associated with gastrointestinal disease. although carriage was higher in animals ...	1983	6822681
isolation of clostridium difficile from patients and the environment of hospital wards.	rectal swabs from 122 patients and 497 environmental swabs from several wards were examined for the presence of clostridium difficile in order to assess the role of the environment in the spread of this organism. clostridium difficile was isolated from 6/27 (22.2%) oncology patients and from 8/163 (4.9%) environmental specimens obtained from the oncology unit. items found positive for c difficile were those subjected to faecal contamination such as commode chairs, bed pans, dust pans, discard bi ...	1983	6822682
vancomycin.	vancomycin is a narrow-spectrum bactericidal antistaphylococcal antibiotic that was introduced in 1956 because of its efficacy against resistant penicillinase-producing staphylococci. it was effective for serious staphylococcal infections for which no satisfactory alternative to penicillin g was available at the time. when methicillin and the other semisynthetic penicillins and the cephalosporins were introduced, the role of vancomycin was relegated to the alternative therapy of choice when the ...	1983	6823162
clostridium difficile cytotoxin in a pediatric population.	assays for cytotoxin of clostridium difficile were performed on stool samples submitted to the laboratory for routine microbiologic study. cytotoxin was recovered from 8.6% of 208 pediatric patients studied. cytotoxin was identified significantly more often in younger patients (median age, 11 months) and in those with hospital-associated illness (17%) and antibiotic-associated illness (18%). hospitalization and antibiotic use were significant independent risk factors. clinical diagnoses in patie ...	1983	6823926
chronic diarrhea associated with clostridium difficile in children.	clostridium difficile toxin was associated with chronic diarrhea without classic symptoms of colitis in seven children (age range, 7 weeks to 7 years). all patients had received antibiotics. six of the seven were treated with vancomycin hydrochloride and demonstrated improvement. after treatment, four patients suffered relapses, and three required further therapy. one patient had four relapses. during all clinical relapses, toxin reappeared in the stool; recovery was always associated with its d ...	1983	6823927
differentiation of clostridium difficile toxin from clostridium botulinum toxin by the mouse lethality test.	the mouse lethality test is the most sensitive method for confirming the diagnosis of infant botulism. both clostridium difficile and clostridium botulinum produce heat-labile toxins which are lethal for mice and can be found in the feces of infants. these two toxins can be distinguished from one another in this assay when both are present in the same fecal specimen because they appear to be immunologically distinct toxins.	1983	6824325
relapse of antibiotic associated colitis: endogenous persistence of clostridium difficile during vancomycin therapy.	this study reports 24 patients with antibiotic associated colitis due to clostridium difficile. fifteen patients were treated with vancomycin due to the severity of the colitis and in eight of these a clinical relapse of the colitis occurred after vancomycin therapy was stopped. bacteriological investigations of these patients indicated that c difficile was able to persist in stool samples during vancomycin therapy in the absence of detectable cytotoxin. this was in contrast with the seven patie ...	1983	6826104
outbreaks of diarrhea associated with clostridium difficile and its toxin in day-care centers: evidence of person-to-person spread.	clostridium difficile was associated with five outbreaks of diarrhea occurring in three day-care centers caring for children less than 2 years of age during a three and one-half-month period; two centers had one outbreak of diarrhea, and one had three outbreaks. the frequency of isolation of c. difficile and its toxin was determined in stool specimens from 65 children attending the three day-care centers. twelve of 21 (57%) children who had diarrhea excreted c. difficile and its toxin, whereas o ...	1983	6827409
the use of cie for the detection of clostridium difficile toxin in stool filtrates: laboratory and clinical correlation.	two cie procedures (cie-1, cie-2) for the detection of clostridium difficile in diarrheal stools were evaluated by comparison to cytotoxin assay and culture results and by comparison to a clinical likelihood of c. difficile-induced diarrhea. using a combination of toxin assay and culture results for reference, the cie-1 and cie-2 procedures had sensitivities of 33% and 47%, specificities of 89% and 91%, and positive predictive values of 42% and 54%, respectively. using clinical likelihood for re ...	1983	6829506
the non-value of counterimmunoelectrophoresis for the direct rapid detection of clostridium difficile toxin in stool filtrates.		1983	6829507
clostridium difficile colitis unassociated with antibiotic therapy.		1983	6831181
double-contrast enema in antibiotic-related pseudomembranous colitis.	pseudomembranous colitis (pmc) is a potentially fatal disease often associated with antibiotic therapy. the condition is now known to be due to an enterotoxin produced by clostridium difficile. diagnosis is based on the endoscopic finding of the typical pseudomembranes, stool culture, and assay of the stools for the specific toxin. radiography with double-contrast medium (dce), which can be performed in patients not critically ill, often yields pathognomonic findings and permits early diagnosis.	1983	6832539
norleucine-tyrosine broth for rapid identification of clostridium difficile by gas-liquid chromatography.	a new medium, norleucine-tyrosine (nt) broth, was developed for rapid identification of clostridium difficile on the basis of caproic acid and p-cresol production. the nt broth consists of 0.5% trypticase (bbl microbiology systems, cockeysville, md.), 0.5% yeast extract (difco laboratories, detroit), 0.2% l-norleucine and 0.2% l-tyrosine (wt/vol; final concentrations), and a mixture of salts. the procedure for demonstrating caproic acid and p-cresol production involves extracting nt broth cultur ...	1983	6833488
clostridium difficile toxin associated with chronic diarrhea and failure to gain weight.	two young children are described in whom chronic diarrhea associated with the presence of clostridium difficile toxin responded to treatment with oral vancomycin. c. difficile infection should be considered in the evaluation of young children with diarrhea who fail to gain weight, even in the absence of prior antibiotic treatment.	1983	6839628
pseudomembranous colitis in clostridium difficile-monoassociated rats.	germfree rats were monoassociated with either a toxin-producing strain of clostridium difficile (tox+) or a variant of this strain (toxr) which produced much less toxin (1/10,000) in vivo and in vitro. monoassociation of germfree rats with c. difficile tox+ resulted in mortality (17%) and in pathology to the small and large intestines, livers, and lungs. cecal filtrates from the tox+-monoassociated rats were cytotoxic for tissue culture cells. the cytotoxicity of cecal filtrates could be blocked ...	1983	6840842
antagonism of toxigenic clostridium difficile by nontoxigenic c. difficile.	cefoxitin-treated hamsters were first colonized with a nontoxigenic strain of clostridium difficile, and then a toxigenic strain of c. difficile was administered. toxigenic c. difficile was suppressed to a mean cecal population level of less than 0.2% of that found in control animals given only toxigenic c. difficile after cefoxitin treatment. colonization with nontoxigenic c. difficile before toxigenic c. difficile was associated with 93% survival, as opposed to 21% survival of the control anim ...	1983	6842009
comparison of bacterial isolation, cytotoxicity assay, and counterimmunoelectrophoresis for the detection of clostridium difficile and its toxin.		1983	6842010
diarrhoea associated with clostridium difficile in a hospital population.	the incidence of disease associated with clostridium difficile was investigated in a general hospital population over a period of six months. in 26 (14.5%) of 179 patients studied, c. difficile was either isolated or faecal cytotoxin was detected. the incidence of other enteropathogenic bacteria, except aeromonas hydrophila, was low. faecal cytotoxin was not detected in nine patients (35%), and non-cytotoxigenic strains of c. difficile were isolated from these patients. in seven patients, a sele ...	1983	6843465
isolation of clostridium difficile from pigs.		1983	6845597
foodborne transmission of clostridium difficile.		1983	6847849
study of diarrhea in critically ill patients.	there has been an impression that diarrhea occurs commonly in seriously ill patients treated in icus. in view of the sparsity of published work on the problem, we embarked on a prospective study of all patients admitted to the icu for more than 48 h over a 12-month period. three factors were examined in detail: nasogastric feeding, cimetidine administration, and antibiotic treatment. other factors also were considered, notably the nature of the underlying illness and the spread of a possible inf ...	1983	6848311
absorption of oral vancomycin - possible associated toxicity.	we report a case of an anephric child who accumulated significant concentrations of vancomycin during oral therapy for clostridium difficile pseudomembranous colitis. sustained serum vancomycin levels of 34 microgram/ml and csf level of 4.2 microgram/ml were documented during an unexplained clinical syndrome of fever and encephalopathy. discontinuation of drug and performance of hemodialysis reduced serum concentrations to 24 microgram/ml and were associated with rapid resolution of symptoms. pa ...	1983	6853034
evaluation of the usefulness of counterimmunoelectrophoresis for diagnosis of clostridium difficile-associated colitis in clinical specimens.	results of counterimmunoelectrophoresis (cie) were compared with those of isolation of clostridium difficile and assay for cytotoxicity in hela cells. on the basis of 471 stool specimens, cie exhibited a sensitivity of 38% and a specificity of 88% as compared with the cytotoxin assay. the predictive value of a reactive cie results is low (17%), whereas the predictive value of a nonreactive cie result is significant (96%) and therefore warrants its use as a screening test. in addition, stool filt ...	1983	6853688
enzyme-linked immunosorbent assay (elisa) for antibodies to clostridium difficile toxins in patients with pseudomembranous colitis and antibiotic-associated diarrhoea.	enzyme-linked immunosorbent assay (elisa) was established with purified toxins from clostridium difficile as antigen to measure antibody response in patients with pseudomembranous colitis (pmc) and prolonged antibiotic-associated diarrhoea (aad). positive elisa titres were defined in a control population. antibodies of igg class against toxin b were demonstrated in 6/88 (7%) control sera and in 31/61 (51%) sera from 11/19 (58%) patients. antibodies of iga class were found in one patient while an ...	1983	6854035
splenic abscess due to clostridium difficile.		1983	6854068
[studies on clostridium difficile and antimicrobial associated diarrhea or colitis].	clostridium difficile has been implicated as the major cause of antimicrobial associated colitis or diarrhea. c. difficile was found in stools from 21 of 120 healthy subjects. c. difficile was found in stools from 8 of 9 patients with antimicrobial associated pseudomembranous colitis and in stools from 16 of 96 patients with antimicrobial associated diarrhea. the cytopathic toxin to hela cell neutralized by antitoxin to c. difficile was found in stools from all patients with antimicrobial associ ...	1983	6854944
an outbreak of clostridium difficile necrotizing enterocolitis: a case for oral vancomycin therapy?	during a 2-month period, 13 infants in this neonatal intensive care unit developed necrotizing enterocolitis, increasing the prevalence in inborns from 5.2 to 20.5/1,000 live births. fifty-seven perinatal and neonatal factors, many of which have previously been associated with necrotizing enterocolitis, were compared between the infants with necrotizing enterocolitis and 17 unaffected inborn control infants admitted concurrently. clostridium difficile cytotoxin was detected in the stools of 12 a ...	1983	6856405
antibiotic-associated diarrhoea and pseudomembranous colitis caused by clostridium difficile. a review of 40 cases.	we found antibiotic-associated diarrhoea (aad) and pseudomembranous colitis caused by clostridium difficile in 19% of patients with diarrhoea related to antibiotic therapy or with diarrhoea for which no other cause could be found. ampicillin, cephalosporins and co-trimoxazole appear to be the agents most commonly associated with this complication. the clinical presentation of aad falls into two categories: (i) an early-onset type characterized by severe diarrhoea with watery stools which may con ...	1983	6857419
[clostridium difficile in the feces in acute diarrhea, irritable colon and ulcerative colitis].		1983	6857791
role of clostridium difficile and campylobacter jejuni in relapses of inflammatory bowel disease.	findings from recent studies on the role of clostridium difficile and campylobacter jejuni in exacerbations of inflammatory bowel disease are in conflict. we examined stool specimens from 32 patients who had inflammatory bowel disease in relapse for the presence of c difficile and c difficile cytotoxin. in the last 19 cases stool specimens were also cultured for c jejuni. c difficile was identified in one patient who was receiving antimicrobial therapy. in no patient was c difficile cytotoxin de ...	1983	6858121
[clostridium difficile - enterocolitis as a nosocomial problem].		1983	6862991