Publications

rifaximin: a nonabsorbable rifamycin antibiotic for use in nonsystemic gastrointestinal infections.	rifaximin is a poorly water-soluble and minimally absorbed (<0.4%) rifamycin with in vitro activity against enteric gram-negative bacteria including enteric pathogens. fecal levels of the drug after 3 days' oral therapy exceed 8000 microg/g. rifaximin is effective in the treatment and prevention of travelers' diarrhea due to escherichia coli-predominant bacterial pathogens. it shows lower activity against dysenteric forms of bacterial diarrhea. the drug may be useful in other enteric infectious ...	2005	15918778
distal ventriculoperitoneal shunt failure secondary to clostridium difficile colitis.	distal ventriculoperitoneal shunt obstruction is typically associated with cerebrospinal fluid (csf) infection, fluid pseudocysts, bowel obstruction, bowel perforation, or improper shunt placement in the abdomen. we describe a unique etiology for distal shunt obstruction secondary to clostridium difficile pancolitis that occurred because of inflammation and ascites, which led to incomplete drainage and absorption of csf. this case illustrates the importance of considering distal shunt obstructio ...	2005	15931467
pathogenesis and treatment of clostridium difficile infection.	this paper reviews the pathogenesis and management of clostridium difficile diarrhoea, in particular the management of recurrent episodes.	2005	15937201
linezolid contributed to clostridium difficile colitis with fatal outcome.	linezolid, the first of a new class of antibacterial drugs, the oxazolidinones, has inhibitory activity against a broad range of gram-positive aerobic cocci and also against certain anaerobes. although diarrhea is one of the most frequently encountered adverse effects of linezolid, clostridium difficile-related complications are very uncommon. one case of fatal c. difficile colitis in a patient with spondylodiscitis, who had received a long-term course of linezolid therapy, is presented. colitis ...	2005	15940418
screening of yeasts as probiotic based on capacities to colonize the gastrointestinal tract and to protect against enteropathogen challenge in mice.	probiotics are defined as viable microorganisms that exhibit a beneficial effect on the host's health when they are ingested. two important criteria are used for selection of probiotic microorganisms: they must be able to survive in the gastrointestinal environment and to present at least one beneficial function (colonization resistance, immunomodulation or nutritional contribution). generally, in vitro assays demonstrating these properties were used to select probiotics but it is unclear if the ...	2005	15942869
parasites in nosocomial diarrhoea: are they underestimated?	nosocomial diarrhoea, defined as diarrhoea occurring more than 72 h after hospital admission, is reported to account for <1% of endemic nosocomial infections and 17% of epidemic nosocomial infections. the yield of diagnoses from stool cultures in nosocomial diarrhoea is low, and information regarding the role of parasites is limited. we conducted a study to determine the responsible bacterial and parasitological pathogens from nosocomial diarrhoea cases in our 2000-bed tertiary care facility ove ...	2005	15949620
clostridium difficile-associated disease.		2005	15954540
quebec reports c. difficile mortality statistics.		2005	15956018
molecular epidemiology of endemic clostridium difficile infection and the significance of subtypes of the united kingdom epidemic strain (pcr ribotype 1).	we previously identified two subtypes of the epidemic strain clostridium difficile pcr ribotype 1, one clindamycin-sensitive strain (arbitrarily primed pcr [ap-pcr] type ia) and a closely related clindamycin-resistant strain (ap-pcr type ib) in our institution. we have now carried out prospective epidemiological surveillance for 4 years, immediately following the relocation of two acute medicine wards for elderly patients (wards a and b), to determine the clinical epidemiology of subtypes of the ...	2005	15956384
frequency of sample submission for optimal utilization of the cell culture cytotoxicity assay for detection of clostridium difficile toxin.	we reviewed the results of repeated sample submissions within a 7-day time frame for clostridium difficile toxin testing. a total of 2,940 samples were tested during a 3-month period using a cell culture cytotoxicity assay (ccca). the results from all second samples (n = 1,101) were concordant with the original test result. in only two cases (0.8%; n = 247) was a third sample positive when the first two samples were negative. in this study, submission of multiple samples for ccca did not increas ...	2005	15956442
limited clinical utility of clostridium difficile toxin testing in infants in a pediatric hospital.	previous studies have shown high rates of asymptomatic carriage of toxin-producing clostridium difficile in infants. we performed a retrospective case control study comparing infants younger than 1 year old with diarrhea and c. difficile toxin (cdt) in the stool, to age-matched controls with diarrhea lacking cdt in the stool. we found no difference in clinical characteristics including fever, vomiting, or hematochezia. treatment with metronidazole had no significant effect on the clinical outcom ...	2005	15964495
analysis of clostridium difficile-associated diarrhea among patients hospitalized in tertiary care academic hospital.	the frequency of clostridium difficile strains in stool samples of patients with diarrhea hospitalized in the hematology/oncology, surgery, orthopedics, transplantology ward, and emergency room of davis medical center was analyzed. a total of 786 stool samples collected from patients with diarrhea and 180 samples taken from the hospital environment were cultured for c. difficile by routine methods. there were 119 strains of c. difficile isolated: 97 (12.3%) strains from patients' stools (no ente ...	2005	15964504
[study on clostridium difficile-associated diarrhea suspected as nosocomial infection in urology ward].	between june 2000 and january 2001, 11 patients were diagnosed with clostridium diffcile (c. difficile)-associated diarrhea in the ward of urology at the kakegawa municipal hospital. of these 11 patients, 10 had exposure to antimicrobial agents, before the onset of diarrhea. all patients' stools were positive for c. difficile toxin a. after discotinuing antimicrobial agents with or without administering vancomycin, they recovered from c. difficile-associated diarrhea. between january 2001 and se ...	2005	15977595
pseudomembranous colitis.		2005	15978456
[reactive arthritis due to clostridium difficile].	extracolonic manifestations of clostridium difficile infections have rarely been reported as a cause of reactive arthritis. we report the case of a monoarticular arthritis following pseudomembranous colitis. a 45 year-old man was admitted for fever and monoarthritis of the left knee, 8 days after the onset of a c. difficile enterocolitis associated with urethritis. samples obtained from the knee, urine, and blood cultures remained sterile. bone scintigraphy revealed a left knee and forefoot hype ...	2005	15982847
acute renal failure in a renal allograft: an unusual infectious cause of thrombotic microangiopathy.		2005	15983970
the emergence of clostridium difficile as a pathogen of food animals.	clostridium difficile causes pseudomembranous colitis in humans, usually after disruption of the bowel flora by antibiotic therapy. factors mediating the frank disease include the dose and toxigenicity of the colonizing strain, its ability to adhere to colonic epithelium, the concurrent presence of organisms that affect multiplication and toxin production or activity, and the susceptibility of the host. toxins a (an enterotoxin) and b (a cytotoxin) play the major role in pathogenesis and the det ...	2004	15984348
clostridium difficile: a questionnaire survey of laboratory practice in england, wales, and northern ireland.	since january 2004, the incidence of clostridium difficile associated disease (cdad) has been monitored by a systematic, national, laboratory surveillance system. this system incorporates the recommendations of a body of experts, the national clostridium difficile standards group, which was convened in 2002 to advise the department of health (doh). the recommendations of the group were informed by a questionnaire survey of current practice, and the results of that survey have been used to assess ...	2004	15779799
[the study of the pro-nucleating activity of bacteria identified in cholesterol gallstones in model bile systems].	to explore the relationship of bacteria identified in cholesterol gallstones and gallstone formation.	2004	15733482
[probiotics--an alternative for antibiotics?].	the condition and function of gastrointestinal (gi) tract are essential to our well being. probiotics are defined as the microbial food supplements, which beneficially affect the host by improving its intestinal microbial balance. probiotics are the functional food ingredients. they are used therapeutically to improve lactose tolerance and to prevent diarrhoea (especially viral diarrhoea in infants, antibiotic-associated diarrhoea, clostridium difficile-associated diarrhoea and traveler's diarrh ...	2004	15765768
clostridium difficile toxin assay in psoriatic patients.	chemotherapy-induced pseudomembranous colitis is most commonly associated with methotrexate and 5-fluorouracil. methotrexate and mesalazine have also been used for the treatment of psoriasis but the effect of these therapies on the clostridium difficile carriage in the stool of psoriatic patients has not been studied. our aim was to detect the presence of c. difficile toxin in patients with psoriasis hospitalized for systemic therapy and in those receiving methotrexate and mesalazine. a total of ...	2004	15912974
isolation of non-toxigenic strains of clostridium difficile from cases of diarrhea among patients hospitalized in hematology/oncology ward.	clostridium difficile has become the most common cause of hospital acquired diarrhea after antibiotic treatment. the aim of this study was to determine the frequency of c. difficile associated diarrhea among hematology/oncology ward patients and to characterize isolated strains. twenty three toxigenic and thirteen non-toxigenic strains were detected among fecal isolates. antibiotic susceptibility testing to erythromycin and clindamycin demonstrated a high degree of resistance (mic > 256 ug/ml) t ...	2004	15702921
probiotics and prebiotics in gastrointestinal disorders.	this review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect.	2004	15703637
a hospital outbreak of clostridium difficile disease associated with isolates carrying binary toxin genes.	the binary toxin genes cdt and cdtb have been detected in approximately 5% of clostridium difficile strains. severe c. difficile disease (cdd) may be associated with strains that carry the binary toxin genes.	2004	15655746
"keeping each patient safe": quality safety teaching/learning packets.	background: university of pittsburgh medical center (upmc) mckeesport developed a tool, the upmc mckeesport quality safety teaching/learning packet, to provide physicians, nurses, and therapists with a common language to address complex safety issues. teaching/learning packets were developed to "keep each patient safe": by calling for help early; from falls and confusion; and from hospital-acquired infections (http://mckeesport.upmc.com/keepingpatientssafe.htm). teaching/learning packets: in jul ...	2004	15646100
[bacteremia due to clostridium difficile].	we describe a case of bacteremia due to clostridium difficile, which was successfully treated by intravenous vancomycin. a 69-year-old woman was admitted to our hospital because of third degree burn injuries. she was treated with cefazolin for two weeks followed with flomoxef for one week before the operation (debridement and grafting of skin). on the third postoperative day high fever (temperature 40 degrees c), abdominal pain and severe watery diarrhea developed. antibiotic-associated colitis ...	2004	15678979
[risk factors for nosocomial clostridium difficile diarrhoea in an infectious and tropical diseases department].	foreword: clostridium difficile associated diarrhea (cdad) accounts for 25% of all cases of diarrhea occurring in hospital. infectious diseases departments are considered as presenting with an important risk of cdad because of the large quantity of antibiotics used. objectives and method: the authors made a prospective study in the first 6 months of 2001, in order to identify the risk factors of cdad in their department. one hundred and fifty-two patients hospitalized for at least 6 days were in ...	2004	15620015
nurses and the control of infectious disease. understanding epidemiology and disease transmission is vital to nursing care.	epidemiology examines the distribution and source of a disease in a population. understanding epidemiology and disease transmission is vital to nursing care. infectious disease transmission requires three components: an agent (virus, bacterium, parasite or other microbe), a vulnerable host and a conducive environment. disease spread can occur through direct contact or via indirect methods (airborne droplets, vectors, fomites, water or food). intervention can occur by attacking the agent (e.g., u ...	2004	15623008
saccharomyces cerevisiae fungemia in an elderly patient with clostridium difficile colitis.	saccharomyces boulardii is widely used as a probiotic compound and is generally thought to be safe. we report one case of fungemia caused by saccharomyces cerevisiae occurring in an elderly patient treated orally with s. boulardii in association with vancomycin for clostridium difficile colitis. we do not recommend administering this viable yeast particularly in debilited patient with active colitis.	2004	15597730
clostridium difficile-associated colitis.	to review the basic microbiology, pathogenesis of disease, and diagnosis of the nosocomial pathogen clostridium difficile and to examine therapies recommended by the canadian task force on preventive health care. quality of evidence medline: was searched using mesh headings. controlled trials for therapy were sought, but case-control studies and observational reviews were included.	2004	15597970
risk factors and mortality associated with clostridium difficile-associated diarrhoea at a va hospital.	the objective of this study was to evaluate the risk of certain patient co-morbidities and antibiotics in the development of clostridium difficile-associated diarrhoea (cdad). hospitalized patients developing cdad during a specified period were compared with a cohort of patients, matched by age, without a diagnosis of cdad, who were hospitalized during the same time period. data collection included demographics, hospital ward, co-morbid conditions, antibiotics received, and mortality. gender and ...	2004	15555878
resistance determinants in strains of clostridium difficile from two geographically distinct populations.	ninety-three clinical isolates of clostridium difficile, comprising 65 from royal gwent hospital, newport and 28 from southmead hospital, bristol were examined to determine the prevalence of genes coding for macrolide resistance and to explore differences in susceptibility patterns. antibiogram testing produced similar results for both sets of strains with respect to amoxicillin, tetracycline, erythromycin and cefotaxime. results differed for rifampicin, where 53% of the bristol isolates were re ...	2004	15555889
a question of ethics.		2004	15557570
clostridium difficile colitis: a marker for ischemic colitis?		2004	15557572
novel evidence suggesting clostridium difficile is present in human gut microbiota more frequently than previously suspected.	prevalence rate of clostridium difficile in healthy human adults is believed to be very low. our rt-pcr system using glass powder, which can eliminate pcr inhibitors, detected c. difficile toxin b mrna in 16 of 30 fecal samples (53.3%) from healthy human adults. in contrast, we failed to detect toxin b in the same fecal samples by pcr using dna templates extracted with phenol-chloroform. our results suggest that pcr inhibitors in feces carried through phenol-chloroform extraction procedure might ...	2004	15557747
leukemoid reactions complicating colitis due to clostridium difficile.	we sought to describe the characteristics of patients who had clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 x 10(9)/l) and to determine whether this complication is associated with higher morbidity or mortality than c difficile colitis without leukemoid reactions.	2004	15558922
["in vitro" activity of ten antimicrobial agents against anaerobic bacteria. a collaborative study, 1999-2002].	the antimicrobial activity of ampicillin, ampicillin-sulbactam, cefoxitin, ceftriaxone, imipenem, piperacillin, piperacillin-tazobactam, clindamycin, metronidazole, and azitromycin was assesed against 166 strains of anaerobic bacteria recovered from eight hospitals in buenos aires. the strains studied were bacteroides fragilis group (65), fusobacterium spp. (26), prevotella spp. (21), porphyromonas spp. (10), clostridium difficile (10), other clostridia (12), and gram-positive cocci (22). the mi ...	2004	15559195
[a case of pseudomembranous enterocolitis caused by methicillin-resistant staphylococcus aureus].	a 47-year-old woman was hospitalized because of urinary-tract infection. she was treated with antibiotics for 6 days. however, severe watery diarrhea and pyrexia developed 6 days after stopping administration of antibiotics. stool, throat and blood cultures were positive for methicillin-resistant staphylococcus aureus (mrsa) and negative for clostridium difficile di toxin. in spite of administration of vcm, she died of septic shock. at autopsy, macroscopic observation revealed a pseudomembrane i ...	2004	15560381
clostridium difficile: causes and interventions.	human infection with clostridium difficile can take many forms. it can exist in many patients who are relatively well or who have symptoms similar to irritable bowel syndrome. it can also infect the patient in the acute care facility. these patients typically have received antibiotics for more than 3 days and begin to experience foul-smelling, watery stools within a few days of initiation of antibiotic coverage. good hand washing and environmental cleanliness remain the primary ways of preventin ...	2004	15571943
clostridium difficile-associated diarrhea: risk factors, diagnostic methods, and treatment.	clostridium difficile-associated diarrhea (cdad) has become the most common cause of infectious diarrhea acquired in the hospital, with an estimated 3 million annual cases and an annual cost of $1 billion. risk factors for cdad include antibiotic use (especially ampicillin, clindamycin, and cephalosporins), advanced age, and gastrointestinal surgery. specific diagnosis of cdad is made with an enzyme immunoassay to detect toxins a and b. metronidazole remains the initial treatment of choice, with ...	2004	15580153
the laparoscopic repair of suprapubic ventral hernias.	the complexity of dissection and the close proximity of the hernia to bony, vascular, nerve, and urinary structures make the laparoscopic repair of suprapubic hernias (lrsph) a formidable operation. we performed a prospective evaluation of the outcomes of patients undergoing lrsph.	2004	15580440
multiplex pcr targeting tpi (triose phosphate isomerase), tcda (toxin a), and tcdb (toxin b) genes for toxigenic culture of clostridium difficile.	a multiplex pcr toxigenic culture approach was designed for simultaneous identification and toxigenic type characterization of clostridium difficile isolates. three pairs of primers were designed for the amplification of (i) a species-specific internal fragment of the tpi (triose phosphate isomerase) gene, (ii) an internal fragment of the tcdb (toxin b) gene, and (iii) an internal fragment of the tcda (toxin a) gene allowing distinction between toxin a-positive, toxin b-positive (a+b+) strains a ...	2004	15583303
nosocomial diarrhea.	to study the occurrence of nosocomial diarrhea in pediatric wards and the role of infections in its causation.	2004	15531828
the role of the intestinal tract as a source for transmission of nosocomial pathogens.	the intestinal tract provides an important source for transmission of many nosocomial pathogens, including enterococcus species, clostridium difficile, candida species, enterobacteriaceae, and other gram-negative bacilli. recent data suggest that the intestinal tracts of hospitalized patients may also be an important reservoir of staphylococcus aureus. although the clinical manifestations of these pathogens are diverse, a common pathogenesis is involved in their colonization of and dissemination ...	2004	15538978
outcome after colectomy for clostridium difficile colitis.	clostridium difficile colitis is a relatively common entity, yet large series of patients with fulminant c. difficile colitis are infrequently reported. this study was designed to identify risk factors, clinical characteristics, and outcome of patients who required colectomy for fulminant c. difficile colitis.	2004	15540290
[comparative study of thermoresistance spores of clostridium difficile strains belonging to different toxigenicity groups].	the thermoresistance of spores of clostridium difficile strains belonging to the different toxigenicity groups was compared in the study. among spores of toxigenicity c. difficile strains (26 c. difficile strains produced toxins a and b (tcda+tcdb+) and 32 c. difficile strains produced only toxin b (tcda-tcdb+) were high thermoresistant. between spores of non-toxigenic c. difficile strains much lower thermoresistance was observed. in conclusion, more studies are needed to clarify the importance ...	2004	15544087
development of an extensive set of 16s rdna-targeted primers for quantification of pathogenic and indigenous bacteria in faecal samples by real-time pcr.	the microbiota of the human intestinal tract constitutes a complex ecosystem. we report the design and optimization of an extensive set of 16s rdna-targeted species- and group-specific primers for more accurate quantification of bacteria from faecal samples with real-time pcr.	2004	15546407
glycogen synthase kinase-3beta negatively regulates group iia phospholipase a2 expression in human aortic smooth muscle and hepg2 hepatoma cells.	the present study shows that the ifn-gamma-mediated upregulation of secretory phospholipase a2 of group iia (spla2-iia) in hasmc and hepg2 cells is synergistically increased after simultaneous inhibition of glycogen synthase kinase-3beta (gsk-3beta) by indirubin-3'-monoxime, 5-iodo or ar-a014418. the effect of gsk-3beta inhibition was dose- and time-dependent and can be further augmented by its concomitant incubation with clostridium difficile toxin b, an inhibitor of small rho proteins, or h-11 ...	2004	15527765
[sudden death of twins: botulism because of contamination by pap vegetables].	botulism is caused by the blockage of the neural transmission in the cholinergic synapses by botulinum neurotoxin (bont) which is produced by clostridium botulinum or other clostridia. the classic form of botulism occurs after the ingestion of food contaminated by bont. the course of the infection can be asymptomatic, mild with subtle paralysis ("failure to thrive") oder severe with generalized paralysis ("floppy infant"). infected infants can also die sudden and unexpectedly. these deaths often ...	2004	14747969
cases from the osler medical service at johns hopkins university.	a 47-year-old white woman with a history of stage iii squamous cell carcinoma of the anus was transferred to johns hopkins hospital for further evaluation of renal failure, hemolytic anemia, and thrombocytopenia. the patient was first diagnosed with squamous cell carcinoma of the anus 1 year before admission. she was treated with external beam radiation of the pelvis and two cycles of mitomycin c-based chemotherapy (a cumulative dose, 34 mg/m(2)). her clinical course was complicated by clostridi ...	2004	14749166
comparative analysis of clostridium difficile clinical isolates belonging to different genetic lineages and time periods.	recent studies have shown that clostridium difficile strains with variant toxins and those with resistance to macrolide-lincosamide-streptogramin b (mlsb) are increasingly causing severe disease and outbreaks in hospital settings. here, the pathogenicity locus (paloc), the acquisition of binary toxin, and the genotypic and phenotypic characteristics of antibiotic resistance of 74 c. difficile clinical strains isolated from symptomatic patients in italy during different time periods were studied. ...	2004	15496392
impact of mandatory clostridium difficile surveillance on diagnostic services.		2004	15501344
hemolytic uremic syndrome associated with clostridium difficile colitis.		2004	15503176
clostridium difficile.		2004	15504208
epidemiology and cost of nosocomial gastroenteritis, avon, england, 2002-2003.	healthcare-associated outbreaks of gastroenteritis are an increasingly recognized problem, but detailed knowledge of the epidemiology of these events is lacking. we actively monitored three hospital systems in england for outbreaks of gastroenteritis in 2002 to 2003. a total of 2,154 patients (2.21 cases/1,000-hospital-days) and 1,360 healthcare staff (0.47 cases/1,000-hospital-days) were affected in 227 unit outbreaks (1.33 outbreaks/unit-year). norovirus, detected in 63% of outbreaks, was the ...	2004	15504271
experimental clostridium difficile enterocolitis in foals.	despite empirical clinical association of infection with clostridium difficile with colitis in horses, a causal link has not been confirmed. the objective of this study was to develop a model of c. difficile-associated diarrhea in foals with normal transfer of passive immunity. nine 1-day-old pony foals were inoculated intragastrically with spores or vegetative cells of c. difficile. five foals were challenged with spores, with 2 receiving 10(5) colony-forming units (cfus) and concurrently 3 rec ...	2004	15515592
clostridium difficile diarrhea: infection control in horses.	c difficile has emerged as an important cause of diarrheic disease in horses. c difficile diarrhea is usually diagnosed in mature horses, mostly when they are treated with antimicrobials and hospitalized. it is important for clinicians at veterinary hospitals to have knowledge about the organism and the infection. to prevent c difficile diarrhea, judicious use of antimicrobials is important, as is minimizing different stress factors at the animal hospital or clinic. infected horses must be isola ...	2004	15519822
c. difficile: by the numbers.		2004	15523050
non-antibiotic associated c. difficile diarrhea in a 7 week-old infant.	we describe a rare case of non-antibiotic associated severe c. difficile diarrhea in a 7-week-old boy. he had massive fluid loss and electrolyte imbalance. he required total parentral nutrition for 10 days and eventually recovered with oral metronidazole. most of the reported cases in literature are associated with prior antibiotic exposure or in hospitalized patients.	2004	15523132
clostridium difficile-associated reactive arthritis in two children.	in adults, reactive arthritis (rea) following clostridium difficile-enterocolitis has been documented. in children, only one case of c. difficile-associated rea has been reported. we now describe two other cases of rea associated with c. difficile in children. the characteristics of rea due to c. difficile appear to be similar in adults and children. both children show polyarthritis after an episode of diarrhoea with positive stool cultures for c. difficile. arthritis is asymmetrical with a self ...	2004	14769523
role of phospholipase d1 in the regulation of mtor activity by lysophosphatidic acid.	mitogens activate protein translation through phosphorylation of p7s6 kinase (p70(s6k)) and eif4e binding protein 1 (4e-bp1) mediated by the mammalian target of rapamycin (mtor) or phosphoinositide 3-kinase (pi3k). a recent report (science 294, 1942, 2001) has implicated phospholipase d (pld) in mtor signaling. we studied the role of pld in the phosphorylation of p70(s6k) and 4e-bp1 induced by lysophosphatidic acid (lpa) and platelet-derived growth factor (pdgf) using fibroblasts deficient in pl ...	2004	14769825
coinfection with giardia lamblia and clostridium difficile after use of ranitidine.	a 49-year-old man presented with a 3-week history of vomiting and diarrhea. he reported foamy stools but no blood or melena and had crampy epigastric pain. he denied usage of antibiotics. he had been taking ranitidine for intermittent epigastric pain for the last few months and noted an 11-pound weight loss during the 3 weeks before admission. stool was positive for clostridium difficile toxin and giardia lamblia antigen. cultures and occult blood tests were negative. oral metronidazole, 500 mg ...	2004	14770026
increase in the rate of nosocomial clostridium difficile-associated diarrhoea during shortages of piperacillin-tazobactam and piperacillin.		2004	14963072
immunological detection and cytotoxic properties of toxins from toxin a-positive, toxin b-positive clostridium difficile variants.	clostridium difficile is a major nosocomial pathogen and a causative agent of antibiotic-associated diarrhoea and pseudomembranous colitis. pcr analysis of the toxin a and b genes of this bacterium has revealed 20 variant types (toxinotypes i-xx), many of which can cause human disease. strains comprising the 15 toxin a-positive, toxin b-positive toxinotypes are not usually differentiated from non-variant strains by routine laboratories that do not utilize pcr tests. consequently, the toxins from ...	2004	14970244
essential involvement of ifn-gamma in clostridium difficile toxin a-induced enteritis.	clostridium difficile has emerged as the important causative agent of antibiotics-associated pseudomembranous colitis; especially its toxin a is presumed to be responsible for the colitis. we examined the pathophysiological roles of ifn-gamma in toxin a-induced enteritis using ifn-gamma knockout (ko) mice. when toxin a of c. difficile was injected into the ileal loops of balb/c wild-type (wt) mice, massive fluid secretion, disruption of intestinal epithelial structure, and massive neutrophil inf ...	2004	14978106
isolated gastrointestinal histoplasmosis: case report and review of the literature.	the usual manifestation of histoplasmosis is in the form of respiratory illness. we report the case of a 67-year-old man who presented with chronic diarrhea and did not respond to the conventional treatment, including that for clostridium difficile. he was found to have isolated colonic histoplasmosis infection, which was treated with itraconazole. there was no evidence of any disseminated disease. his only immunocompromised state was end-stage renal disease, for which he was on chronic hemodial ...	2004	14982268
outbreak of clostridium difficile infection in a long-term care facility: association with gatifloxacin use.	to determine the cause of an increase in the rate of clostridium difficile-associated diarrhea (cdad) in a long-term care facility (ltcf), we analyzed cdad cases among ltcf patients from october 2001 through june 2002. cdad cases were identified from review of all enzyme immunoassays positive for c. difficile toxin a. the increase coincided with a formulary change from levofloxacin to gatifloxacin. we performed a case-control study in which we randomly selected control subjects from 612 ltcf adm ...	2004	14986246
clindamycin, cephalosporins, fluoroquinolones, and clostridium difficile-associated diarrhea: this is an antimicrobial resistance problem.		2004	14986247
ionizing radiation-induced e-selectin gene expression and tumor cell adhesion is inhibited by lovastatin and all-trans retinoic acid.	e-selectin mediated tumor cell adhesion plays an important role in metastasis. here we show that ionizing radiation (ir) induces e-selectin gene and protein expression in human endothelial cells at therapeutically relevant dose level. e-selectin expression is accompanied by an increase in the adhesion of human colon carcinoma cells to primary human umbilical vein endothelial cells (huvec). the hmg-coa reductase inhibitor lovastatin impairs ir-stimulated e-selectin expression as analyzed at the l ...	2004	14988223
phase i and pharmacokinetic study of topotecan administered orally once daily for 5 days for 2 consecutive weeks to pediatric patients with refractory solid tumors.	we conducted a phase i trial of the injectable formulation of topotecan given orally once daily for 5 days for 2 consecutive weeks (qd x 5 x 2) in pediatric patients with refractory solid tumors.	2004	14990638
successful treatment with rifampin for fulminant antibiotics-associated colitis in a patient with non-hodgkin's lymphoma.	a 74-year-old man was admitted to the hospital because of chemotherapy for relapsed non-hodgkin's lymphoma (nhl). the patient became febrile and experienced diarrhea after chemotherapy. although ceftazidime and amikacin sulfate were administered as empiric therapy, diarrhea was continued. after several days, stool cytotoxin assay for clostridium difficile (c. difficile) was positive and he was diagnosed as having antibiotics-associated colitis (aac). although antibiotics were discontinued and bo ...	2004	14991957
clostridium difficile colitis in children with cystic fibrosis.		2004	14992445
images in clinical medicine. nodular clostridium difficile colitis.		2004	14999125
characterization of toxin a-negative, toxin b-positive clostridium difficile isolates from outbreaks in different countries by amplified fragment length polymorphism and pcr ribotyping.	clinical clostridium difficile isolates of patients with diarrhea or pseudomembranous colitis usually produce both toxin a and toxin b, but an increasing number of reports mention infections due to toxin a-negative, toxin b-positive (a(-)/b(+)) strains. thirty-nine clinical toxin a(-)/b(+) isolates, and 12 other unrelated isolates were obtained from canada, the united states, poland, the united kingdom, france, japan, and the netherlands. the isolates were investigated by high-resolution genetic ...	2004	15004050
performance assessment of the fecal leukocyte test for inpatients.	traditionally, fecal leukocyte testing detects large bowel inflammation or disruption, conditions that allow leukocytes into the stool. however, test usefulness with inpatients is unclear. two hundred five inpatients who had undergone one to three tests were identified, and their flt results were compared to their gastrointestinal disease diagnoses at time of discharge. a specificity of 92% for detecting intact colonic mucosae in inpatients was found.	2004	15004086
the large resolvase tnpx is the only transposon-encoded protein required for transposition of the tn4451/3 family of integrative mobilizable elements.	chloramphenicol resistance in clostridium perfringens and clostridium difficile is often encoded by catp genes located within the 6.3 kb integrative mobilizable elements tn4451 and tn4453 respectively. this family of transposons is capable of being mobilized into a recipient cell in the presence of another conjugative element. transposition is mediated by the large resolvase tnpx, which excises the element to produce a circular molecule that is the integrative intermediate. in this study, in viv ...	2004	15009902
rectal nitric oxide gas and stool cytokine levels during the course of infectious gastroenteritis.	nitric oxide (no) is known to be an important inflammatory mediator with a potential role in gastrointestinal diseases. we prospectively studied the luminal no levels in 51 patients with infectious gastroenteritis, 35 patients with nonenteric bacterial infections, and 11 healthy control subjects. the levels of proinflammatory cytokines were simultaneously measured in the stools of patients with gastroenteritis. rectal gas was sampled with balloon catheters made of silicone and was analyzed for n ...	2004	15013971
the small gtp-binding protein rhoa regulates serotonin-induced na+-current response in the neurons of aplysia.	application of serotonin (5-ht) induces a slow inward current response in identified neurons of aplysia ganglia under voltage clamp. the 5-ht-induced current response was depressed in na+-free media, but augmented in ca2+-free media, and unaffected by a change in external k+. the 5-ht-induced response was markedly blocked by intracellular injection of guanosine 5'-o-(2-thiodiphosphate) (gdpbetas). after the injection of guanosine 5'-o-(3-thiotriphosphate) (gtpgammas), the responses to 5-ht gradu ...	2004	14687879
how do we assess hospital cleaning? a proposal for microbiological standards for surface hygiene in hospitals.	increasing numbers of hospital-acquired infections have generated much attention over the last decade. the public has linked the so-called 'superbugs' with their experience of dirty hospitals, but the precise role of cleaning in the control of these organisms in unknown. hence the importance of a clean environment is likely to remain speculative unless it becomes an evidence-based science. this proposal is a call for bacteriological standards with which to assess clinical surface hygiene in hosp ...	2004	14706265
detergent versus hypochlorite cleaning and clostridium difficile infection.		2004	14706280
mechanisms of internalization and recycling of the chemokine receptor, ccr5.	ccr5 is a g protein-coupled receptor that binds several natural chemokines but it is also a coreceptor for the entry of m tropic strains of hiv-1 into cells. levels of ccr5 on the cell surface are important for the rate of hiv-1 infection and are determined by a number of factors including the rates of ccr5 internalization and recycling. here we investigated the involvement of the actin cytoskeleton in the control of ligand-induced internalization and recycling of ccr5. cytochalasin d, an actin ...	2004	14717692
clostridium difficile colitis associated with valaciclovir.	to report a case of clostridium difficile colitis associated with valaciclovir treatment.	2004	15018252
clostridium difficile-the next step in mandatory reporting.		2004	15019217
[characteristics of post antibiotic clostridium difficile and staphylococcus aureus diarrhoea].		2004	15029014
gp91phox-containing nadph oxidase mediates endothelial dysfunction in renovascular hypertension.	isoforms of the nadph oxidase contribute to vascular superoxide anion (*o2-) formation and limit no bioavailability. we hypothesized that the endothelial gp91phox-containing nadph oxidase is predominant in generating the o2- to scavenge endothelial no and thus is responsible for the development of endothelial dysfunction.	2004	15037533
study of faecal shedding of clostridium difficile in horses treated with penicillin.		2004	15038443
active and passive immunization against clostridium difficile diarrhea and colitis.	clostridium difficile, a gram-positive bacterium, is the major cause of hospital-acquired infectious diarrhea and colitis in industrialized nations. c. difficile colonization results from antibiotic administration and subsequent loss of protection provided by intestinal flora. c. difficile induced-colitis is caused by the release of two exotoxins, toxin a and b. host factors including advanced age, pre-existing severe illness and weakened immune defenses predispose individuals to symptomatic inf ...	2004	15040937
alpha c protein of group b streptococcus binds host cell surface glycosaminoglycan and enters cells by an actin-dependent mechanism.	group b streptococcus (gbs) colonizes mucosal surfaces of the human gastrointestinal and gynecological tracts and causes disease in a wide range of patients. invasive illness occurs after organisms traverse an epithelial boundary and enter deeper tissues. previously we have reported that the alpha c protein (acp) on the surface of gbs mediates gbs entry into me180 cervical epithelial cells and gbs translocation across layers of these cells. we now demonstrate that acp interacts with host cell gl ...	2004	15044471
infectious enteritis after intestinal transplantation: incidence, timing, and outcome.	to review the incidence, timing, and outcome of infectious enteritis after intestinal transplantation (it).	2004	15050165
clostridium difficile istron cdist1: discovery of a variant encoding two complete transposase-like proteins.	screening a clostridium difficile strain collection for the chimeric element cdist1, we identified two additional variants, designated cdist1-0 and cdist1-iii. in in vitro assays, we could prove the self-splicing ribozyme activity of these variants. structural comparison of all known cdist1 variants led us to define four types of istrons that we designated cdist1-0 through cdist1-iii. since cdist1-0 encodes two complete transposase-like proteins (tlpa and tlpb), we suggest that it represents the ...	2004	15060058
index of suspicion.		2004	15060182
the rac/cdc42 guanine nucleotide exchange factor beta1pix enhances mastoparan-activated gi-dependent pathway in mast cells.	carbachol stimulates granule exocytosis, phospholipase c (plc), and phospholipase d (pld) in rbl-2h3hm1 mast cells by a mechanism that involves galphaq. however, mastoparan stimulates the same responses through gi protein. both gi and galphaq pathways are suppressed by clostridium difficile toxin b, suggesting that rac and cdc42 small gtpases are also involved. over-expression of beta1pix, a guanine nucleotide exchange factor for rac and cdc42, enhances mastoparan-but not carbachol-induced hexos ...	2004	15063769
detergent versus hypochlorite cleaning and clostridium difficile infection.		2004	15066750
descriptive study of intravenous immunoglobulin for the treatment of recurrent clostridium difficile diarrhoea.	clostridium difficile diarrhoea (cdd) cases treated with intravenous immunoglobulin during a 2 year period were reviewed to determine disease severity and response to treatment.	2004	15073160
inhibition and redistribution of nhe3, the apical na+/h+ exchanger, by clostridium difficile toxin b.	nhe3, the apical isoform of the na(+)/h(+) exchanger, is central to the absorption of salt and water across the intestinal epithelium. we report that treatment of epithelial cells with toxin b of clostridium difficile, a diarrheal pathogen, causes a pronounced inhibition of nhe3 activity, with little effect on the basolateral nhe1 isoform. depression of nhe3 activity is accompanied by the translocation of apical exchangers to a subapical endomembrane compartment. treatment of cells with toxin b ...	2004	15078917
clostridium difficile associated diarrhoea in hospitalised patients: onset in the community and hospital and role of flexible sigmoidoscopy.	clostridium difficile associated diarrhoea (cdad) is a hospital acquired infection in which optimal methods for diagnosis and the scale of the problem in the community remain to be determined. in hospitalised patients with cdad, we aimed to (i) study patients in whom the onset of diarrhoea was in the community and (ii) investigate the role of bedside flexible sigmoidoscopy in diagnosis.	2004	15082585
radiology quiz case 2. cervical necrotizing fasciitis (cnf), odontogenic origin.		2004	15096437
factors associated with failure of metronidazole in clostridium difficile-associated disease.	to identify patients likely to fail metronidazole as initial treatment of c. difficile infection.	2004	15100520
clostridium difficile toxin a carboxyl-terminus peptide lacking adp-ribosyltransferase activity acts as a mucosal adjuvant.	the receptor binding domains of the most potent mucosal adjuvants, bacterial toxins and plant lectins, are organized in repeat units to recognize specific sugar residues. the lectin-like structure of the c-terminal region of clostridium difficile toxin a prompted us to investigate the mucosal adjuvant properties of a nontoxigenic peptide corresponding to amino acids 2394 to 2706 (txa(c314)). we compared txa(c314) adjuvant activity to those of cholera toxin (ct) and escherichia coli heat-labile e ...	2004	15102793
the host cell chaperone hsp90 is necessary for cytotoxic action of the binary iota-like toxins.	the heat shock protein hsp90 is essential for uptake of the binary actin adp-ribosylating toxins clostridium perfringens iota-toxin and clostridium difficile transferase into eukaryotic cells. inhibition of hsp90 by its specific inhibitor radicicol delayed intoxication of vero cells by these toxins. a common hsp90-dependent mechanism for their translocation is discussed.	2004	15102823