Publications

prevention of clostridium difficile outbreaks in hospitals.		1986	2874362
clostridium difficile toxin in chronic idiopathic colitis.	clostridium difficile toxin was isolated from the stools of three patients with chronic idiopathic colitis. two patients were known to have chronic idiopathic colitis before cl difficile toxin was isolated. the third patient was subsequently found to have ulcerative colitis after presentation with cl difficile toxin in the stool. two patients were on sulphasalazine at the time of diagnosis of cl difficile infection and one had taken sulphasalazine two months previously. only one patients had ant ...	1986	2875426
hospital outbreaks of clostridium difficile.		1986	2876218
clostridium difficile--a neglected pathogen in chronic-care wards?		1986	2876242
anaerobic infections in childhood.	bacteroides melaninogenicus and bacteroides oralis are predominant anaerobes in orofacial infections and aspiration pneumonia. fusobacterium species are common pathogens in aspiration pneumonia, brain abscesses and orofacial infections. clostridium perfringens can cause bacteremia and wound infections. clostridium botulinum can produce a paralytic toxin that causes a paralytic syndrome in infants. clostridium difficile can cause diarrhea or antibiotic-associated colitis.	1986	2876620
pathogenicity of clostridium species with other bacteria in mixed infections.	the relationship of clostridial isolates with other bacteria in mixed infections was studied by means of a subcutaneous abscess model in mice. we used 26 isolates of seven clostridial species, two bacteroides spp., eight gram-positive facultative or anaerobic cocci and three enteric gram-negative aerobic rods. abscesses were induced by all seven clostridium perfringens and three c. butyricum isolates and by some of the others. selective antimicrobial therapy experiments showed that enteric gram- ...	1986	2878957
clostridium difficile in the normal adult faecal flora.	one hundred and seventy-seven out of 324 routine non-diarrhoeal faecal specimens investigated for the presence of clostridium difficile were culture-positive. twelve of the faecal specimens obtained from thirty-six normal healthy volunteers yielded cl. difficile prior to oral administration of clindamycin. thereafter all the volunteers excreted the organism from the second day to the fifth day during clindamycin administration. three months after stoppage of oral clindamycin sixteen of the thirt ...	1986	3031964
bacterial agglutination and polyacrylamide gel electrophoresis for typing clostridium difficile.	bacterial agglutination and polyacrylamide gel electrophoresis (page) were methods evaluated for typing strains of clostridium difficile. a panel of four antisera, obtained by immunizing rabbits with washed whole cells of different strains of c. difficile, produced distinctive patterns of agglutination. ethylenediaminetetraacetate (edta) extracts subjected to page also produced distinctive protein profiles. excellent correlation between the two methods was observed when geographically distant is ...	1986	3080531
diarrhoea due to clostridium difficile associated with antibiotic treatment in patients receiving dialysis: the role of cross infection.		1986	3081086
efficacy of routine fiberoptic endoscope cleaning and disinfection for killing clostridium difficile.	we have evaluated a standard procedure for cleaning and disinfection of endoscopes for efficacy in eradicating a spore-forming bacterial organism, clostridium difficile. initially, 23 endoscopes were cultured for the presence of c. difficile after hanging in storage for at least 24 hours after cleaning and disinfection. all cultures were negative. subsequently, endoscopes used in 15 patients who had stool cultures positive for c. difficile were cultured immediately after use and again after clea ...	1986	3081401
commercial latex test for clostridium difficile toxin a does not detect toxin a.	the rapid latex test recently marketed by marion scientific (div. marion laboratories, inc., kansas city, mo.) for the detection of clostridium difficile toxin a does not react with the toxin, based on the following findings: culture filtrates from nontoxigenic strains of c. difficile gave positive reactions in the test, culture filtrate in which toxin a had been removed gave positive reactions, purified toxin a did not react in the test, and the latex reagent bound an antigen which is distinct ...	1986	3082928
comparison of culture, cytotoxicity assays, and enzyme-linked immunosorbent assay for toxin a and toxin b in the diagnosis of clostridium difficile-related enteric disease.	clostridium difficile culture, test tube, and microtiter cytotoxicity assays, and enzyme-linked immunosorbent assays (elisas) for toxin a and toxin b, were simultaneously performed on 113 fresh diarrheal stool specimens randomly selected from those submitted to our clinical laboratory for routine c. difficile testing. the performance of these tests in diagnosing c. difficile-related enteric disease (cdred) was based on a clinical assessment of the likelihood of cdred as determined by a systemati ...	1986	3086027
evaluation of a commercially available latex immunoagglutination test kit for detection of clostridium difficile d-1 toxin.		1986	3086678
growth of clostridium difficile and production of toxins a and b in complex and defined media.	the ability of several strains of clostridium difficile to grow and to produce toxins a and b in complex and defined culture media has been studied with special reference to the amino-acid composition of the medium. the production of these toxins varied with the strain used and with the composition of the growth medium. toxin a production was not inextricably linked to production of toxin b since conditions were found in which only one or other toxin was produced.	1986	3088279
asymptomatic carriage of clostridium difficile in patients with cystic fibrosis.	faecal samples from 37 patients with cystic fibrosis and 40 control patients at the brompton hospital and the london chest hospital were examined for the presence of clostridium difficile. the organism was isolated from 2 (17%) of control patients who were receiving antibiotics and from one (3.6%) of control patients who had no antimicrobial treatment. thirty two per cent of the patients with cystic fibrosis excreted c difficile, though none of them had diarrhoea. two of the three isolates from ...	1986	3093537
screening for clostridium difficile in chronic inflammatory bowel disease in relapse. is it helpful? is it cost efficient?		1986	3093561
[detection of clostridium difficile and its clinical significance].		1986	3094851
[intestinal microflora of patients with antibiotic-associated hemorrhagic colitis associated with klebsiella oxytoca and clostridium difficile enterotoxin].		1986	3097201
characterization of toxins a and b of clostridium difficile with monoclonal antibodies.	two monoclonal antibodies (mabs) were used to learn more about the structures of clostridium difficile toxins a and b. one of the antibodies, the pcg-4 mab, reacted specifically with toxin a. this mab precipitated toxin a and neutralized the enterotoxic but not the cytotoxic activity of the toxin. the site to which the antibody bound was resistant to denaturation with sodium dodecyl sulfate; however, it was destroyed by n-bromosuccinimide. immunoblot analysis with the pcg-4 mab revealed the pres ...	1986	2428753
immunoblotting to demonstrate antigenic and immunogenic differences among nine standard strains of clostridium difficile.	the epidemiology of clostridium difficile-associated disease is being elucidated with the development of typing schemes for the organism. we recently described a new typing scheme based on the incorporation of [35s]methionine into bacterial proteins followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography. nine standard strains were identified. we report here some observations on the antigenic differences among these nine strains when studied by immunoblotting. t ...	1986	2428826
stimulation of enzyme secretion from isolated pancreatic acini by clostridium difficile toxin b.	exposure of isolated rat pancreatic acini to increasing concentrations (10 ng - 800 ng/ml) of toxin b from clostridium difficile produced a biphasic effect on the rate of secretion of amylase, trypsinogen, and chymotrypsinogen. whereas doses of toxin b from 10-30 ng/ml increased enzyme secretion by 15-20%, doses between 30 ng and 60 ng/ml showed a regression of this effect, whereafter the rate of secretion of amylase, trypsinogen, and chymotrypsinogen increased with increasing concentrations of ...	1986	2432695
[enterocolitis caused by clostridium difficile. analysis of 15 cases in adults].	each of 48 patients with suspected clostridium difficile enterocolitis after treatment with antibiotics underwent a faecal test in which a clostridium difficile culture was set up and a cytotoxin test carried out. the detection of clostridium difficile was positive in 15 cases. diarrhoea with varying severity was present in all patients, most frequently after medication with the newer cephalosporins. nine patients also underwent rectoscopy: a typical pseudo-membranous colitis was seen only in 5 ...	1986	3940837
the epidemiology of clostridium difficile with use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients.		1986	3941281
testing for clostridium difficile.		1986	3941630
clostridium difficile-associated diarrhea and colitis in adults. a prospective case-controlled epidemiologic study.	in a one-year period, 149 adult cases of clostridium difficile-associated diarrhea and colitis were compared with 148 diarrhea-free controls. eighty-seven percent were nosocomial and 75% were on surgical services. endoscopy revealed pseudomembranes in 51% of the 109 cases in which stool cytotoxin was present, compared with 11% of the 40 cases that were culture-positive but cytotoxin-negative. cases diagnosed only by stool culture showed essentially no differences from controls, 21% of whom had a ...	1986	3942469
clostridium difficile colitis/diarrhea.		1986	3942643
purification and properties of clostridium difficile cytotoxin b.	toxin b, a potent cytotoxin produced by clostridium difficile, was purified to homogeneity from 6-day broth cultures of a toxigenic isolate. cytotoxin was purified approximately 4000-fold by sequential ammonium sulfate precipitation, deae-sepharose chromatography, and high performance liquid chromatography on a mono q anion-exchange column. the molecular weight of reduced purified toxin was 50,000 on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, compared to 150,000 for unreduced tox ...	1986	3944088
effect of toxin a and b of clostridium difficile on rabbit ileum and colon.	the effect of purified toxin a and partially purified toxin b on rabbit ileum and colon was investigated. toxin a caused tissue damage which was followed by permeability changes and fluid accumulation in both tissues. toxin a did not increase the permeability of the colon to the extent observed for ileum; secreted fluid contained less protein of plasma origin. toxin b had no effect on either tissue. secretory and tissue damaging properties of crude c difficile toxins were found to be due to toxi ...	1986	3949240
latex particle agglutination for detecting and identifying clostridium difficile.	a total of 329 selective enrichment broth cultures were tested for detection of clostridium difficile by latex particle agglutination (lpa), gas-liquid chromatography, and bacterial culture. of 53 broths positive by lpa, 36 were positive by gas-liquid chromatography, and 42 were positive by bacterial culture. the sensitivity and specificity of lpa relative to bacterial culture was 95.6% and 96.3%, respectively, while the sensitivity and specificity of gas-liquid chromatography relative to bacter ...	1986	3950045
clostridium difficile in general practice and community health.	the isolation rate for clostridium difficile in diarrhoeal stools was investigated in patients from general practice and community health centres over a 14-month period. c. difficile or its cytotoxin was detected in specimens from 89 (4.7%) of 1882 patients studied and accounted for 30.3% of all enteropathogenic micro-organisms isolated. overall c. difficile was second only to giardia lamblia in frequency. recovery rates in the different groups of patients surveyed varied from 3.6 to 27.5%. the ...	1986	3950393
detection of clostridium difficile toxins by enzyme immunoassay.	an enzyme-linked immunosorbent assay (elisa) for the rapid diagnosis of antibiotic-associated colitis (aac) is presented. commercially available antisera to clostridium difficile toxins contain antibodies to other antigens found in non-toxigenic c. difficile and other bacteria. removal of these unwanted antibodies by absorption increased the specificity of elisa for detection of c. difficile toxins. specimens tested included 40 faecal extracts positive for cytotoxicity from cases of aac, 30 diar ...	1986	3950397
chronic diarrhoea in dogs associated with clostridium difficile infection.		1986	3952954
pseudomembranous colitis in children and adults.	pseudomembranous colitis remains a potentially lethal complication of antibiotic usage. identification of clostridium difficile as the major pathogen has led to a rational successful approach to therapy and has widened the spectrum of associated disease. the frequent asymptomatic colonization of healthy neonates by c. difficile remains an enigma.	1986	3955286
significance of clostridium difficile and its cytotoxin in children.	stools of 147 children belonging to different age groups were examined for the presence of clostridium difficile, its cytotoxin and other enteric pathogens. none of the 31 full-term neonates, 5 (16%) of the 32 premature neonates, 27 (46%) of the 59 infants and 1 (4%) of the 25 older children excreted c. difficile in their stools. faecal cytotoxin was only detected in four infants (7%). there was no correlation with diarrhoea, previous antibiotic therapy, type of diet, or the concomitant presence ...	1986	3956538
recurrent clostridium difficile-associated colitis responding to cholestyramine.	we describe a patient with relapses of clostridium difficile cytotoxin-positive pseudomembranous colitis (pmc) after treatment with vancomycin, a course of metronidazole and a trial of bacitracin. she remains free of disease after a prolonged course of cholestyramine. we suggest there may be a role for anion-exchange resins in patients with pmc relapsing after vancomycin therapy.	1986	3956890
nosocomial diarrhoeas in a surgical division hyperendemic for clostridium difficile: epidemiologic aspects emerging from an analysis of clinical records.	having previously shown that clostridium difficile was responsible for an intense and protracted endemic of nosocomial diarrhoeas in the surgical division of a tuscan hospital, we started a retrospective analysis on all records from the affected division, to cover a period of 15 months. a statistical description is given of a large series of nosocomial diarrhoeas, as well as direct estimates of their incidence rates in selected high risk subgroups. the situation described is epidemiologically un ...	1986	3803539
fever due to clostridium difficile during hemodialytic treatment.	a ten-year-old on hemodialysis had a prolonged unexplained fever secondary to clostridium difficile antibiotic-associated colitis and posed a great diagnostic challenge.	1986	3804581
a comparison of the clinico-pathological features with stool pathogens in patients hospitalised with the symptom of diarrhoea.	the clinico-pathological features of 515 adult patients admitted to a major regional infectious diseases unit in united kingdom with the symptom complex of diarrhoea were compared to the pathogens detected in their stool specimens. routine clinical examination supported by basic pathological and laboratory investigations identified 138 (28%) in whom the cause of diarrhoea was extragastrointestinal or non-infectious gastrointestinal. of the 351 patients (72%) with infectious gastroenteritis 72 (2 ...	1986	3810049
[clostridium difficile infections].		1986	3810619
[clostridium difficile infections].		1986	3810620
prevention of clostridium difficile induced mortality in gnotobiotic mice by saccharomyces boulardii.	oral preventive treatment of gnotobiotic mice by saccharomyces boulardii significantly decreased mortality following clostridium difficile infection. a single s. boulardii ingestion protected 16% of mice, whereas 56% were protected when s. boulardii was given continuously in the drinking water. no direct antagonistic effect of the yeast on c. difficile numbers was detected, whereas a modulation of fecal cytotoxin production was demonstrated.	1986	3815159
[the immunoenzyme system in research on e. coli enterotoxin lt and c. difficile toxins].		1986	3826991
epidemiology of an outbreak of clostridium difficile-associated-diarrhoea. application of a typing system.		1986	3826999
faecal carriage of clostridium difficile in cystic fibrosis patients.		1986	3827000
[clostridium difficile colitis in patients with blood diseases].		1986	3827004
inhibitory activity of fecal flora against the multiplication of clostridium difficile.		1986	3296983
enterocolitis in hirschsprung's disease: a controlled study of the etiologic role of clostridium difficile.	cytopathic toxin neutralized by clostridium sordellii antiserum was found in the feces of seven out of 13 children with hirschsprung's disease complicated by enterocolitis (54%). clostridium difficile was isolated from ten of these 13 children (77%). the frequency of fecal toxin positivity, the magnitude of toxin titers, and the isolation rate of c difficile were all significantly greater in children with hirschsprung's enterocolitis than in children whose hirschsprung's disease was not complica ...	1986	3511213
gnotobiotic models for study of the microbial ecology of clostridium difficile and escherichia coli.	hamster flora introduced into germfree mice reduced the cecum to conventional size, suppressed populations of escherichia coli and clostridium difficile to the same degree that mouse flora did, and corrected the hypocellularity that is characteristic of the small bowel of germfree mice. a highly toxigenic strain of c. difficile readily induced cecitis in germfree and antibiotic-treated conventional mice, and histological examination frequently revealed pseudomembranes. toxins a and b were both d ...	1986	3512730
bacterial diarrhoea.	bacterial infections are important causes of diarrhoea in infants and children, particularly in developing countries and in other settings where standards of personal and community hygiene are low. knowledge of bacterial diarrhoeas has been significantly expanded in recent years by the finding that many episodes of acute diarrhoea are due to infections with bacteria which produce enterotoxins that interfere with intestinal fluid and electrolyte transport (the 'enterotoxigenic' diarrhoeas). sever ...	1986	3514008
effect of clindamycin on the ability of a continuous culture of colonic bacteria to ferment carbohydrate.	a continuous culture model of the proximal colon was used to study the effect of clindamycin on the ability of colonic bacteria to ferment carbohydrate. six steady state anaerobic cultures of human faeces, in a medium simulating ileostomy effluent, were treated with 26 micrograms/ml clindamycin. they were paired with six untreated cultures, run under identical conditions. clindamycin treatment eliminated the anaerobic bacteria, significantly decreased osmolality and the output of volatile fatty ...	1986	3514388
[transfer of the cecal flora of the hamster to the germfree c3h mouse: use of this model to study the flora of the anti-clostridium difficile barrier].	the purpose of this work was the research and development of an experimental model to study anti-clostridium difficile caecal microflora in the hamster. first the existence of this "barrier" was verified in conventional hamsters. then, the caecal flora from these animals was orally transferred to c3h germfree mice. the barrier effect was maintained in the axenic mice. the comparative bacteriological analysis of hamster and mouse feces did not reveal important variations in the dominant anaerobic ...	1986	3516351
considerations in the laboratory diagnosis of antibiotic-associated gastroenteritis.	clostridium difficile has been shown to be the major cause of antibiotic-associated gastroenteritis in both humans and experimental animals. during the past few years an increasing number of laboratories have attempted to detect, isolate, and identify this organism and its toxin from clinical samples. direct visualization of c. difficile in patient specimens using immunofluorescent microscopy has been proposed. the major disadvantage of this method was its lack of specificity due to crossreactio ...	1986	3516548
detection of clostridium difficile toxin a by immunoblotting.	a clinical isolate of clostridium difficile has been tested for its toxin production. both toxins, toxin a and toxin b, could be detected by tissue culture and in animal models as well. antibodies against a crude toxin a preparation have been prepared. these antibodies are able to neutralize the toxin both in the mouse lethality test and tissue culture test systems. the specificity of this antiserum has been analysed by electroimmunoprecipitation methods. using immunoblotting, it could be demons ...	1986	3518293
comparison of minitek anaerobe ii, api an-ident, and rapid ana systems for identification of clostridium difficile.	three commercial anaerobic systems, minitek (bbl microbiology systems, cockeysville, md), api an-ident (analytab products, plainview, ny), and rapid ana (innovative diagnostic systems, decatur, ga) were evaluated for ability to identify 45 clostridium difficile isolates accurately. minitek correctly identified 66% of c. difficile isolates to species, 27% were incompletely identified, and 7% were misidentified. most of the discrepancies with minitek were due to false negative biochemical results. ...	1986	3518405
[clostridium difficile-induced enterocolitis: pathogenesis, clinical course, epidemiology and laboratory diagnosis].	clostridium difficile-induced enterocolitis almost exclusively occurs associated with antibiotic exposure. the organisms produce several exotoxins of which toxins a (enterotoxin) and b (cytotoxin) are of primary importance. it is assumed that preceding antibiotic therapy creates an ecological niche allowing massive proliferation of the organisms and production of their toxins. the clinical course varies from mild diarrhoea to severe pseudomembranous colitis. patients over 40 years of age are pri ...	1986	3519433
antibiotic-associated colitis caused by clostridium difficile: relapse and risk factors.	relapse is a common sequel of antibiotic-associated colitis due to clostridium difficile. it has been suggested that cl. difficile may persist in the stools in spite of the resolution of symptoms after treatment and this may cause the relapse. our study was designed to define the factors that predispose to relapse and to determine if prolonging treatment to clear cl. difficile from the stools might prevent relapse. of 60 consecutive patients, 36 with more severe disease required treatment. treat ...	1986	3520264
oral bacitracin vs vancomycin therapy for clostridium difficile-induced diarrhea. a randomized double-blind trial.	the effectiveness of a ten-day course of either oral bacitracin or oral vancomycin hydrochloride for treatment of clostridium difficile-induced antibiotic-associated diarrhea was compared in a randomized double-blind study. bacitracin was as effective as vancomycin in resolving diarrhea; most patients responded within five days of therapy with either drug. three patients receiving bacitracin worsened during therapy; two of these were considered treatment failures. neither c difficile nor its tox ...	1986	3521518
clostridium difficile in habitats other than the human gastro-intestinal tract.		1986	3522751
review of clostridium difficile-associated diseases.	clostridium difficile has recently become recognized as an important nosocomial pathogen. this review summarizes what is known about the isolation of the organism, the spectrum of clinical disease, virulence factors, treatments, and methods of prevention. risk factors for c. difficile disease are also discussed. the most important risk factor is the use of certain antibiotics (ampicillin, cephalosporins, and clindamycin). c. difficile is associated with 96% to 100% of cases of pseudomembraneous ...	1986	3524319
[adverse effects of antimicrobiological agents and countermeasures--clostridium difficile enteritis: with special reference to early diagnosis].		1986	3531585
interaction of clostridium difficile and escherichia coli with microfloras in continuous-flow cultures and gnotobiotic mice.	we studied the interactions between the entire cecal flora of hamsters and the pathogens clostridium difficile and escherichia coli in gnotobiotic mice and in a continuous-flow (cf) culture system in which the growth medium consisted of an extract of fecal pellets from germfree mice. cf cultures and germfree mice were colonized first with c. difficile and e. coli and then with the cecal flora of hamsters. both in vivo and in vitro hamster flora markedly suppressed the potential pathogens. conten ...	1986	3533778
review of frequency-pulsed electron-capture gas-liquid chromatography studies of diarrheal diseases caused by members of the family enterobacteriaceae, clostridium difficile, and rotavirus.		1986	3533981
[isolation of clostridium difficile from the stools of hospitalized patients with diarrhea].	408 stool samples from 354 hospitalized patients with diarrhea were evaluated for the presence of clostridium difficile. c. difficile was detected in stools of 42 patients (12%), 19 of them being hospitalized in neurosurgery units. the strains were cytotoxigenic in 31 cases and non cototoxigenic in 11 cases. the diagnosis of c. difficile induced diarrhea was based on the clinical setting [presence of diarrhea that could be attributed to antimicrobial therapy and endoscopy for detection of pseudo ...	1986	3534766
[clostridium difficile--one of the causes of enterocolitis in man].		1986	3538722
diagnosis of clostridium difficile-associated intestinal disease.	toxigenic clostridium difficile is the major cause of antimicrobial agent-associated pseudomembranous colitis and is the etiological agent of approximately 30% of cases of nonspecific colitis and diarrhea (without colitis) induced by antimicrobial agents. in addition, c. difficile has been implicated in certain intestinal diseases not related to prior antimicrobial administration. c. difficile has been reported to be one of the most common enteropathogens isolated from stool specimens submitted ...	1986	3539522
[clostridium difficile and its cytotoxin in the stools of young hospitalized children. influence of antibiotic treatment].	clostridium difficile has been searched in 153 stool samples from 138 children aged 0 to 12 months. we divided the population in two groups depending on the antibiotic treatment. we have found c difficile in 39 samples (25%). the colonization rate increases with age ranging from 5% before 1 month, to 36% between 1 and 6 months and 54% between 6 and 13 months. an environmental sampling yielded once c difficile. contamination may be related to the environment. 29% of the isolates produced a cytopa ...	1986	3543815
evaluation of aztreonam, cefoperazone, latamoxef and ceftazidime in the hamster colitis model.	aztreonam, ceftazidime, cefoperazone and latamoxef (moxalactam) were evaluated in a hamster model for antibiotic-associated colitis. aztreonam, a novel monocyclic beta-lactam antibiotic specifically directed against aerobic gram-negative bacteria with limited activity against gram-positive and anaerobic bacteria did not cause haemorrhagic caecitis and death in hamsters when administered intraperitioneally or orally. quantitative caecal cultures showed no changes in the anaerobic caecal microflor ...	1986	3546243
anaerobic infections and clostridium difficile colitis emerging during antibacterial therapy.	almost all cases of clostridium difficile-related pseudomembranous colitis are related to antimicrobial therapy. virtually all antibacterial agents have been implicated, notable exceptions being vancomycin and parenterally administered aminoglycosides. the most prominent causes of colitis are ampicillin, clindamycin and various cephalosporins. in general, this complication is related to suppression of indigenous flora and overgrowth of c. difficile. in the case of ampicillin, however, c. diffici ...	1986	3547621
effect of beta-lactam prodrugs on human intestinal microflora.	the ampicillin prodrugs bacampicillin, pivampicillin, and talampicillin, the mecillinam prodrug pivmecillinam and the sulbactam prodrug sulbactam pivoxil all have a greatly improved oral availability compared to the parent drug. they show no antibacterial activity themselves until transformed into active drugs after absorption. this double advantage makes them less likely to influence the intestinal microbial ecosystem. ampicillin has been reported to cause marked changes in the colon microflora ...	1986	3547627
pharmacokinetic differentiation and consequences for normal microflora.	the pharmacokinetic properties of a drug are decisive for effective antibacterial therapy, the ability of the drug to reach a site of infection, but they also contribute to whether concentrations become undesirably high in places where the antibiotics are not wanted but where they may interfere with the normal microflora. the microflora in the intestines is particularly important because of the sheer numbers of bacteria present there and the consequences of imbalance such as diarrhoea and select ...	1986	3547629
successful pregnancy in a renal transplant recipient taking cyclosporin a.	a 27 year old woman with a fourth cadaveric renal transplant successfully completed a 33 week pregnancy whilst taking cyclosporin a and prednisolone. her renal function remained stable despite recurrent urinary tract infections, hypertension, gestational diabetes, and clostridium difficile associated diarrhea. the infant, delivered electively at 33 weeks, was small for gestational age but otherwise normal.	1986	3551903
prevalence of clostridium difficile in pseudomembranous and antibiotic-associated colitis in north india.		1986	3584906
clinical considerations in the diagnosis of antimicrobial agent-associated gastroenteritis.	most gastrointestinal infections secondary to the use of antimicrobial agents that have been documented are related to overgrowth of clostridium difficile which produces a spectrum from severe pseudomembranous colitis to mild diarrhea or asymptomatic carriage. the most common inducers of pseudomembranous colitis or antimicrobial agent-associated diarrhea are ampicillin, clindamycin, and various cephalosporins, but almost all antimicrobials may cause this problem. symptoms vary from watery to blo ...	1986	3698542
yersinia colitis masquerading as pseudomembranous colitis.	we describe a 15-month-old male who presented with fever and diarrhea 24 hr after receiving antibiotics for otitis media. a flexible sigmoidoscopy was initially interpreted endoscopically as antibiotic-associated pseudomembranous colitis, and the patient was treated with vancomycin. the diagnosis of antibiotic-associated colitis was excluded in our patient by the negative stool examination for clostridium difficile toxin, the failure to obtain supportive features on rectal biopsy, and the failur ...	1986	3698772
method for the typing of clostridium difficile based on polyacrylamide gel electrophoresis of [35s]methionine-labeled proteins.	a typing method for clostridium difficile based on the incorporation of [35s]methionine into cellular proteins, their separation by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and their visualization by autoradiography is described. on analysis of the radiolabeled-protein profiles, nine distinct groups were observed (a to e and w to z). the method, which is simple, reproducible, and readily expandable, has been applied in epidemiological studies to demonstrate cross-infection and ...	1986	3700603
evaluation of a commercial kit for the routine detection of clostridium difficile cytotoxin by tissue culture.	the toxi-titer microtiter plate system (bartels immunodiagnostic supplies, inc., bellevue, wash.) is a simplified procedure for detecting the cytotoxin produced by clostridium difficile in stool filtrates. in a parallel study of 74 stool specimens, results from the toxin-titer system compared favorably with those from the conventional system. our experience with the toxin-titer system in testing 540 stool specimens was, in general, satisfactory, although a few problems with toxin control did occ ...	1986	3700631
clostridium difficile in diarrheal disease.		1986	3701124
variations in the anaerobic faecal flora of ten healthy human volunteers with special reference to the bacteroides fragilis-group and clostridium difficile.	ninety nine stool specimens of ten healthy human volunteers were collected over a one year period, and processed anaerobically. the individual variations in intestinal colonization with bacteria of the bacteroides fragilis-group were detected, using the bacteroides bile esculin medium and an identification scheme for bile-resistant bacteroides species. clostridium difficile agar supplemented with cycloserine/cefoxtin was used to detect the incidence of c. difficile in this group. the species of ...	1986	3705797
evaluation of a commercial cytotoxicity assay for detection of clostridium difficile toxin.	a comparative study was performed to determine the accuracy of clostridium difficile toxin detection. a commercial cytotoxicity assay (bartels immunodiagnostic supply, bellevue, wash.) was compared with conventional microcytotoxicity assays, using vero and mrc-5 cells. the bartels system was found to be essentially equivalent to conventional cytotoxicity assays currently being performed for routine c. difficile toxin detection.	1986	3711282
changing epidemiology, diagnosis, and treatment of clostridium difficile toxin-associated colitis.	one hundred and ninety patients with clostridium difficile toxin-associated colitis (ctac) or pseudomembranous colitis (pmc) were identified, from microbiology records, disease index and proctoscopy service records, and studied retrospectively. ctac was associated with cephalosporin antibiotic administration in 70 per cent of the patients. ctac developed postoperatively in 108 patients after all types of surgery with no preponderance for abdominal surgery. identification of cytotoxin in stool sa ...	1986	3719271
rapid identification of clostridium difficile by determination of leucine arylamidase activity.		1986	3720738
technique for measuring 50% end points in cytotoxicity assays for clostridium difficile toxins.	serial dilutions of clostridium difficile culture filtrates were incubated overnight with hela cell monolayers. cells were fixed in formalin, stained with crystal violet, rinsed, and drained. cell rounding could be observed microscopically in the stained monolayers. absorbance of the retained dye on monolayers in the drained wells was measured at 595 nm-405 nm. end points could also be estimated visually. the dilution at which dye absorbance was reduced by 50% agreed with that determined by micr ...	1986	3722420
an in-vitro model of colonisation resistance to clostridium difficile infection.	to investigate the importance of the normal gut flora in preventing the establishment of clostridium difficile in vivo we have developed an in-vitro test system based on growth in faecal emulsions. growth of c. difficile and cytotoxin production are inhibited in faecal emulsions from healthy adults, but not in sterilised emulsions; the importance of viable bacteria in the inhibitory system is evident. generally, faecal emulsions derived from infants, children and geriatric patients were less inh ...	1986	3723582
[clostridium difficile and its significance as an intestinal pathogenic bacterium].		1986	3725396
effect of moxalactam on human fecal microflora.	five healthy male adults received 2 g of moxalactam every 12 h for 7 days. the alterations of fecal microflora were investigated before, during, and after treatment with moxalactam. on day 7 of treatment, the number of total bacteria was decreased in all subjects. there was marked suppression of the obligate anaerobic bacteria and enterobacteria to undetectable levels, but the counts of streptococcus spp. and lactobacillus spp. increased. on day 7, two subjects had clostridium innocuum and clost ...	1986	3729329
application of a technique for serogrouping clostridium difficile in an outbreak of antibiotic-associated diarrhoea.	a severe outbreak of clostridium difficile antibiotic-associated diarrhoea (aad) in an orthopaedic surgical unit is reported. thirty-seven cases and eight relapses were observed. the 45 related strains together with another 13 strains of c. difficile isolated during the same period in other wards of the same hospital were typed by detection of cytotoxin production, determination of sorbitol fermentation and serogrouping by agglutination with six rabbit antisera defining the serogroups a, b, c, d ...	1986	3734468
aetiology and epidemiology of acute gastro-enteritis in swedish children.	in a prospective 1-year study, 144 children attending or admitted to hospital and 272 children outside hospital with acute gastro-enteritis and 200 controls were investigated by a broad panel of diagnostic methods for enteropathogenic agents in the faeces and for related antibody responses. enteropathogens were identified in 77% of the inpatients, 63% of the outpatients and 8% of the controls. rotavirus and yersinia enterocolitica were detected significantly more often among inpatients. altogeth ...	1986	3734469
detection of clostridial toxins in stools from children with diarrhoea.	a cell-culture assay was used to detect toxins directly in stools from sporadic cases of infantile diarrhoea. cytotoxins were revealed in 11 out of 58 samples from children with diarrhoea, nine of whom had no common enteric pathogens in their stools. a preliminary characterisation of the cytotoxins was obtained by neutralisation tests with clostridial antitoxins.	1986	3735388
sporogenesis and toxin a production by clostridium difficile.	the kinetics of spore production by clostridium difficile were not paralleled by release of c. difficile toxin a in vitro. toxin a was not found to be associated with either purified whole spores or spore coats. residual traces of toxin a detected in spore contents were almost certainly derived from contaminating vegetative cell debris. thus, toxin a is unlikely to be a spore constituent or associated with sporogenesis.	1986	3735389
detection of clostridium difficile toxins a (enterotoxin) and b (cytotoxin) in clinical specimens. evaluation of a latex agglutination test.	a new latex test, culturette brand rapid latex test for detection of clostridium difficile toxin a, was tested on 408 stool samples. in 247 frozen tissue culture supernate specimens previously obtained from patients with c. difficile-associated diarrhea (cad), the latex test (enterotoxin) was positive in 182 (74%) as compared with 194 (79%) for the repeat tissue culture (p greater than 0.1) cytotoxin (toxin b) test. testing of 161 fresh stool samples found the latex test superior to tissue cultu ...	1986	3739972
[incidence and origin of clostridium difficile in neonatology].	the epidemiology of clostridium difficile was studied prospectively in 101 newborn infants by screening of fecal samples collected in the first or second day of life and in the fourth or fifth one. a vaginal swab and a stool specimen were collected from mothers before delivery. environmental cultures were obtained from selected sites in the ward, while colonization of intestinal tract and contamination of the hands were evaluated in the personnel. c. difficile was isolated from the feces of 13 i ...	1986	3741636
cell surface binding site for clostridium difficile enterotoxin: evidence for a glycoconjugate containing the sequence gal alpha 1-3gal beta 1-4glcnac.	this study was undertaken to determine whether a binding site for clostridium difficile enterotoxin (toxin a) exists in the brush border membranes (bbms) of the hamster, an animal known to be extremely sensitive to the action of the toxin. toxin a was the only antigen adsorbed by the bbms from the culture filtrate of c. difficile. the finding that binding activity could not be destroyed by heat indicated that a carbohydrate moiety might be involved. we therefore examined erythrocytes from variou ...	1986	3744552
the carrier state: clostridium difficile.		1986	3745032
predicting the susceptibility of anaerobes to cefoperazone, cefotaxime, and cefoxitin with the thioglycolate broth disk procedure.	a variety of clinical anaerobic isolates were tested against cefoperazone (216 strains), cefoxitin (120 strains), and cefotaxime (120 strains) by the thioglycolate anaerobic broth disk method, and the results were compared with the national committee for clinical laboratory standards reference agar dilution method. the broth disk and reference breakpoint concentrations were as follows: cefoperazone, 60 and 64 or 30 and 32 micrograms/ml; cefotaxime, 30 and 32 micrograms/ml; cefoxitin, 18 and 16 m ...	1986	3745418
isolation of clostridium difficile from human jejunum: identification of a reservoir for disease?	the possibility that the small intestine may represent a reservoir for clostridium difficile was studied, using segments of human jejunum collected at necropsy. our results (three of 100 specimens positive for c difficile culture) support the hypothesis that c difficile can be found in human jejunum and that it adheres to the normal mucosa as a resident bacterium. these findings suggest that gastrointestinal disease caused by c difficile has an endogenous origin.	1986	3745477
[undesirable colorectal effects of drugs].	the most severe adverse reactions associated with medicinal treatment of the colon involve pseudomembranous colitis following antibiotic treatment, notably with clindamycin, lincomycin and betalactamine. the frequency of this adverse reaction is poorly defined: 1 per 100 to 1 per 5 000 treatments depending on the study. lesions are explained by the cytotoxic effect of clostridium difficile toxin. necrotizing anorectitis has been seen in cases of abuse of suppositories containing propoxyphene. th ...	1986	3752909
[pseudomembranous rectocolitis].	the following conclusions were drawn from a study of 15 cases of pseudo-membranous coloproctitis (pmcp): pmcp was seen in subjects of both sexes and all ages. the causative agent was found in all antibiotic classes. clinical signs comprised constant diarrhea, fever, abdominal pain, toxic shock and, more rarely, pseudo-occlusive, pseudo-perforative surgical evidence. diagnosis involved visualization of pseudo-membranes by endoscopy. lesions were most frequent in the left colon and increased in se ...	1986	3752911
hydrophobic and adherence properties of clostridium difficile.	nine strains of clostridium difficile isolated from symptomatic and asymptomatic patients and four other species of clostridia were tested for relative hydrophobicity by determining the degree of adherence to polystyrene. under three different conditions of growth all strains of clostridium difficile had high rates of adherence, whereas the other clostridial species showed no pronounced adherence. isolates of clostridium difficile were also tested for their ability to adhere to human embryonic i ...	1986	3758054
clostridium difficile cytotoxin inhibits protein synthesis in fibroblasts and intestinal mucosa.	the pathophysiology of clostridium difficile colitis is thought to be mediated by release of toxin a, an enterotoxin, and toxin b, a cytotoxin. we compared the differential effects of toxin b on protein synthesis in imr-90 fibroblasts and in hamster esophagus, stomach, gallbladder, small intestine, and cecum in organ culture. toxin b in low concentrations stimulated (p less than 0.001) incorporation of [3h]leucine into fibroblast proteins, whereas at higher dosages it inhibited incorporation (p ...	1986	3758606
[role of clostridium difficile toxins in pseudomembranous colitis with special reference to experimental studies using germfree rats].		1986	3761681