Publications

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
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
production of antitoxins to two toxins of clostridium difficile and immunological comparison of the toxins by cross-neutralization studies.	we prepared antitoxins specific for each of two toxins of clostridium difficile and used these to demonstrate that the toxins are immunologically distinct.	1982	6172384
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
clostridium difficile in paediatric infections.		1982	7185999
[mild spontaneous course of a case of pseudomembranous colitis. case report and literature review].	pseudomembranous colitis (pmc) caused by a toxin produced by clostridium difficile is described in the literature as a severe diarrheal disease with a high mortality rate. a case which tends to absolve pmc from this reputation is reported involving an outpatient who developed well documented pmc subsequent to ampicillin therapy but required no treatment. the number of unreported cases of antibiotic-associated colitis with and without pseudomembrane formation is probably very high, since only sev ...	1981	7194502
association of clostridium difficile toxin with symptomatic relapse of chronic inflammatory bowel disease.		1981	7202941
occurrence of clostridium difficile toxin during the course of inflammatory bowel disease.	clostridium difficile toxin, the presumed mechanism of antibiotic-associated pseudomembranous colitis, has been suggested as a contributory factor to mucosal injury in inflammatory bowel disease. we evaluated its incidence and apparent role in 65 consecutive patients with diarrheal and inflammatory bowel diseases. toxin was demonstrated in 3 of 18 patients with ulcerative colitis (17%), 1 of 26 with crohn's colitis (4%), and 5 of 21 with a variety of diarrheal illnesses (24%). toxin appeared onl ...	1981	7202942
clostridium difficile and inflammatory bowel disease.		1981	7202955
case report. clindamycin associated pseudomembranous colitis.	pseudomembranous colitis is rare in children. we describe a case associated with clindamycin in which clostridium difficile and its enterotoxin were isolated from the stool. treatment with oral vancomycin brought about a prompt and complete recovery.	1981	7211374
epidemiology of antibiotic-associated colitis; isolation of clostridium difficile from the hospital environment.	clostridium difficile is the most important cause of antibiotic-associated colitis. using selective media, it was found that contamination with this organism was common in the environment of patients in the hospital with the disease. it was often found on floors, hoppers, toilets, bedding, mops, scales and furniture. this organism was also present on these items, but less often, in areas in which patients known to carry this hardy spore-forming organism had not been detected. air, food and walls ...	1981	7211925
[role of clostridium and its toxin in pseudo-membranous colitis (author's transl)].	at present many authors consider that pseudo-membranous colitis is of bacterial origin. the main pathogenic agent is clostridium difficile. it is not easy to isolate this organism in the stool, selective media are under study. it liberates a lipo-glycoprotein exotoxin during lysis. it is only partially purified, its structure is not fully elucidated. its molecular weight is not yet precisely determined. it consists of several polymerised polypeptide fragments of molecular weight 50 000. it is a ...	1981	7011118
[detection of "clostridium difficile" on minimal and selective medium and by immunofluorescence antibody staining (author's transl)].	a minimal and selective medium containing 5 aminoacids, 3 vitamins, a low sugar concentration and 2 antibiotics (cefoxitin at 16 microgram/ml and streptomycin at 500 microgram/ml) is described for isolation of clostridium difficile from the gut. comparable results were obtained with this medium and using spore isolation by the sodium thioglycolate-lysozyme technique. an antiserum specific to c. difficile was prepared and used for detection by immunofluorescent antibody staining. this is a very s ...	1981	7015956
pseudomembranous (antibiotic-associated) colitis.	we have come to understand the cause of antibiotic-associated pseudomembranous colitis (pmc) only in the last decade. clostridium difficile produces the intestinal dysfunction and the characteristic finding of exudative plaques on the mucosa by elaborating a toxin in the colon. this report reviews the development of our knowledge of this disease and the rapid adoption of a rational therapy once the cause was specified. c. difficile or its toxin can be cultured or isolated from the stools of 90% ...	1981	7016935
rapid detection and presumptive identification of clostridium difficile by p-cresol production on a selective medium.	a modification of a selective medium for clostridium difficile is described. the ability of cl difficile to produce p-cresol from p-hydroxy phenyl acetic acid provides a means for the rapid, sensitive detection and presumptive identification of this species in faecal cultures.	1981	7019263
enzyme immunoassay for the detection of clostridium difficile antigen.		1981	7026694
pseudomembranous colitis in renal transplant recipients; plain film findings.	the plain abdominal film findings in nine renal transplant patients with pseudomembranous colitis were characteristic of but not specific for this entity and most commonly showed "thumb-printing" reflecting submucosal edema (five patients) and a persisting localized segmental ileus in the colon (five patients). based on the plain film findings, the differential diagnosis will include the acute stages of ulcerative colitis, granulomatous colitis, ischemic colitis and other inflammatory colitides, ...	1981	7028758
bacteria newly recognized as nosocomial pathogens.	bacteria recently recognized as nosocomial pathogens generally fall into three categories: those that grow slowly, those that are fastidious in their nutritional or atmospheric requirements and those that resemble commensals. each characteristic has contributed to the delay in perceiving their importance. mycobacterium chelonei and myco. fortuitum--which grow slowly, although characterized as "rapid-growing" mycobacteria--cause sternal osteomyelitis, pericarditis and endocarditis after cardiac s ...	1981	7008590
simplified procedure for the routine isolation of clostridium difficile from faeces.	the use of alcohol, at a final concentration of 50%, as a selective procedure for the isolation of clostridium difficile was compared to a selective medium containing 250 microgram /ml of cycloserine and 10 microgram /ml of cefoxitin. of 266 faecal samples 82 were shown to be positive by one or other method. seventy-seven (94%) of these were detected by the selective agar (sa) and 72 (88%) by the alcohol procedure (ap). ten samples (12%) were positive only by sa and five samples (6%) by ap only ...	1981	7031097
simple method for isolation and presumptive identification of clostridium difficile.	clostridium difficile can be isolated from stools and presumptively identified by inoculating the stools onto cccba and the culture looked at under ultra violet light where the golden-yellow fluorescent colonies show up against a dark background. the colonies are then identified by testing them using the api zym system and the results further confirmed by testing the culture for toxin production using the tissue culture technique employing cl. sordellii antitoxin.	1981	7032146
evaluation of eight cephalosporins in hamster colitis model.	eight commonly used cephalosporins were evaluated in the hamster colitis mode. they were all found to cause hemorrhagic cecitis and death within 10 days of being given as subcutaneous or oral challenges. necropsy findings were indistinguishable from clindamycin-induced cecitis. bacteria-free cecal filtrate obtained from hamsters dying of cephalosporin-induced cecitis contained toxin similar or identical to hat produced by clostridium difficile isolated from the cecum of a hamster. daily oral adm ...	1981	6973951
fatal pseudomembranous colitis despite eradication of clostridium difficile.		1981	6779895
bacterial interference between clostridium difficile and normal fecal flora.	clostridium difficile has been shown to be the cause of virtually all cases of pseudomembranous colitis related to the administration of antimicrobial agents. it is possible that some antimicrobial agents alter the normal bacterial flora of the gastrointestinal tract so as to permit colonization and/or proliferation by c. difficile. the inhibitory activity of representative fecal bacteria from 23 anaerobic and aerobic genera against c. difficile was examined using two in vitro procedures. strain ...	1981	6785366
in vitro susceptibility of anaerobic bacteria to nitroimidazoles.	the in vitro susceptibility of 355 swedish clinical isolates of anaerobic bacteria to three nitroimidazole drugs was determined by the agar dilution method. the drugs were metronidazole, tinidazole and ornidazole. in addition the in vitro susceptibility of 32 strains of clostridium difficile to metronidazole was determined. gram-negative rods and clostridia were inhibited by 4 microgram/ml or less of all three compounds except one strain of c. difficile, which was not inhibited by 16 microgram/m ...	1981	6941455
the role of anaerobes in human infections.	anaerobic bacteria have been shown to play a role in infection of all types in humans. certain infections are notable for the prominent role played by anaerobes; included are brain abscess, chronic sinusitis and otitis media, oral and dental infections, neck space infections, bite infections, lung abscess, aspiration pneumonia, empyema, intra-abdominal infections of all types (notably peritonitis, intra-abdominal abscess, and liver abscess), abdominal surgical wound infections, female genital tr ...	1981	6941463
isolation rates and toxigenic potential of clostridium difficile isolates from various patient populations.	stool specimens in various patient populations were examined to determine isolation rates of clostridium difficile and the frequency with which this organism produces a cytopathic toxin in vitro. clostridium difficile was isolated from 13 of 45 healthy neonates who had never received antimicrobials and the cytotoxin was detected in 12. with 23 healthy children aged 4 to 24 mo the organism was recovered from 2 children and the cytotoxin was detected in 1. neither the organism nor the cytotoxin wa ...	1981	7239125
antitoxin production in antibiotic-associated colitis?	the production of antitoxin after clostridium difficile-induced diarrhoea has not been reported previously. the stool of a patient with prolonged antibiotic-associated diarrhoea contained c. difficile toxin, and the serum neutralised the cytopathic effect of c. difficile toxin in tissue culture.	1981	7240430
clostridium difficile antitoxin neutralization of cecal toxin(s) from guinea pigs with penicillin-associated colitis.		1981	7242013
antibiotic-associated pseudomembranous colitis in children.	ten cases of antibiotic-associated pseudomembranous colitis in children are reviewed. the ages ranged from 4 years to 17 years; the most frequently implicated antimicrobial agents were penicillins in six children and clindamycin in two. stool assays showed specimens from all ten patients yielded a cytopathic toxin which was neutralized by clostridium sordellii antitoxin with titers ranging from 1:40 to 1:40,000. bacterial cultures of nine specimens uniformly yielded clostridium difficile with a ...	1981	7243476
recovery of clostridium difficile from children.	the occurrence of clostridium difficile in faecal specimens of 218 children, aged 2 weeks to 15 years, was studied. the organism was recovered from 43 (20%) of the children (range 2 weeks to 10 years). the isolation frequency was significantly correlated to age. thus, in children 1 to 8 months of age the organism occurred in 64%, while in children below and above that age c. difficile could only be recovered in 4%. no significant difference in the recovery frequency could be demonstrated between ...	1981	7244558
the biological and clinical significance of clostridium difficile.		1981	7249664
aetiology of acute diarrhoea in adults.	we have studied 73 adults with acute diarrhoea and identified a micro-organism or toxin likely to be the cause in 58%. in addition to routinely cultured bacteria, campylobacter coli/jejuni and clostridium difficile were important pathogens in the community. patients who developed diarrhoea after antibiotic use had a distinctive clinical syndrome and comprised the third largest group of cases. clinical, epidemiological, and histological features in an additional group with negative cultures and n ...	1981	7250751
faecal toxin and severity of antibiotic-associated pseudomembranous colitis.	the relationship between faecal toxin titre, histological evidence of pseudomembrane in the rectum, and severity of antibiotic-associated colitis has been analysed from data on 62 patients whose faeces contained clostridium difficile toxin. there was a significant correlation between a toxin titre of 6400 or more and the presence of pseudomembrane (p less than 005). there was no correlation between toxin titre, duration of diarrhoea, total white cell count, temperature, serum albumin or serum or ...	1981	7251895
antimicrobial agents implicated in clostridium difficile toxin-associated diarrhea of colitis.	records were reviewed for 329 patients who had antibiotic-associated diarrhea or colitis with stools showing a cytopathic toxin which is neutralized by clostridium sordellii antitoxin. previous studies indicate that the detection of this toxin implicate clostridium difficile as the responsible pathogen. a spectrum of anatomical results in the colonic mucosa were found ranging from pseudomembranous colitis in 136 patients to an entirely normal endoscopic condition in 36 patients. the most frequen ...	1981	7253364
isolation of clostridium difficile from the feces and the antibody in sera of young and elderly adults.	attempts were made to isolate clostridium difficile from a total of 431 fecal specimens from 149 young and 213 elderly healthy adults, and 69 elderly adults with cerebrovascular disease but no gastrointestinal disease. c difficile was isolated from 49 specimens, and the frequency of isolation was 15.4% in healthy young adults, 7.0% in healthy elderly adults, and 15.9% in elderly adults with cerebrovascular disease. thirty-four (about 70%) of the 49 c. difficile strains isolated produced cytotoxi ...	1981	7253967
presence of clostridium difficile toxin in guinea pigs with penicillin-associated colitis.	cecal filtrates from guinea pigs treated with penicillin contained a toxin which produced cytotoxic changes in hela cell cultures and was lethal to guinea pigs when administered intracecally. the cytotoxicity could be neutralized by clostridium difficile and c. sordellii antitoxins, but not by other clostridial antitoxins. rabbit immunization with toxic cecal extracts produced antibody which neutralized the cytotoxicity of guinea pig cecal extracts, of stool extracts from humans with antibiotic- ...	1981	7254132
survival after necrotizing enterocolitis of leukemia treated with oral vancomycin.	a 56-yr-old female with chronic lymphocytic leukemia developed hemolytic anemia and thrombocytopenia. prednisone therapy was instituted, but her disease was further complicated by the development of necrotizing enterocolitis. no specific enteropathogens were identified, and the stools were consistently negative for clostridium difficile toxin. treatment with vancomycin was instituted and resulted in complete recovery. in view of the high mortality and poor results of treatment in necrotizing ent ...	1981	7262524
relative frequency of clostridium difficile in patients with diarrheal disease.	we have studied 161 patients with diarrheal disease to determine the frequency with which clostridium difficile occurs in such patients. c. difficile or its toxin or both were detected in stools from 19 patients (11.9%), 17 of whom had previously received antimicrobial agents. enteric pathogens other than c. difficile were recovered less frequently, with salmonella sp., giardia lamblia, and campylobacter fetus being recovered from 4.1, 2.5, and 1.3%, respectively, of the patients studied. these ...	1981	7263852
role of clostridium difficile in ulcerative colitis.		1981	7270555
transferable tetracycline resistance in clostridium difficile.	the transfer of tetracycline resistance among strains of clostridium difficile is described. transfer occurred by a conjugation-like event that was insensitive to deoxyribonuclease, could not be mediated by donor culture filtrates or chloroform-treated donor cultures, and required cell-to-cell contact. tetracycline-resistant progeny recovered from matings displayed a resistance phenotype identical to that of the donor in level of resistance, constitutive expression, and transmissibility. althoug ...	1981	7271279
[isolation of clostridium difficile toxin from the feces of a patient with ulcerative colitis (author's transl)].		1981	7277815
clostridium difficile toxin.		1981	7280010
clostridium difficile associated with pseudomembranous colitis. occurrence in a 12-week-old infant without prior antibiotic therapy.	in a previously healthy 12-week-old male infant with a two-week history of poor feeding, colic, and bloody stools, pseudomembranous colitis developed. no prior antibiotics were administered although the child had received dicyclomine hydrochloride. clostridium difficile and its toxin were detected in the child's stool. severe disseminated intravascular coagulopathy developed; the patient required total colectomy but eventually recovered. clostridium difficile colonization has not, to our knowled ...	1981	7282658