Publications

infectious gastro-enteritis: an uncommon cause of diarrhoea in adult allogeneic and autologous stem cell transplant recipients.	the incidence and aetiology of acute diarrhoea in 60 adult allogeneic or autologous stem cell transplant (sct) recipients was determined in a prospective study. stool specimens were obtained prior to sct and on days +20, +40, +60 and +100 post transplant. microbiological evaluation was performed for pathogenic bacteria, fungi, parasites and viruses. forty-seven patients were evaluable of whom 31 had a total of 48 acute diarrhoeal episodes. diarrhoea occurred in 79% of allogeneic and 47% of autol ...	2000	10967569
effect on the human normal microflora of oral antibiotics for treatment of urinary tract infections.	oral administration of antibiotics for treatment of urinary tract infections (utis) can cause ecological disturbances in the normal intestinal microflora. poorly absorbed drugs can reach the colon in active form, suppress susceptible microorganisms and disturb the ecological balance. suppression of the normal microflora may lead to reduced colonization resistance with subsequent overgrowth of pre-existing, naturally resistant microorganisms, such as yeasts and clostridium difficile. new coloniza ...	2000	10969051
phenotypic and genotypic diversity of the flagellin gene (flic) among clostridium difficile isolates from different serogroups.	phenotypic and genotypic diversity of the flagellin gene (flic) of clostridium difficile was studied in 47 isolates from various origins belonging to the serogroups a, b, c, d, f, g, h, i, k, x, and s3. electron microscopy revealed 17 nonflagellated strains and 30 flagellated strains. pcr and reverse transcription-pcr demonstrated that the flagellin gene was present in all strains and that the flic gene was expressed in both flagellated and nonflagellated strains. southern blotting showed the pr ...	2000	10970353
hormone-stimulated calcium release is inhibited by cytoskeleton-disrupting toxins in ar4-2j cells.	we have studied the role of the actin cytoskeleton in bombesin-induced inositol 1,4,5-trisphosphate (ip(3))-production and ca(2+)release in the pancreatic acinar tumour cell line ar4-2j. intracellular and extracellular free ca(2+)concentrations were measured in cell suspensions, using fura-2. disruption of the actin cytoskeleton by pretreatment of the cells with latrunculin b (10 microm), cytochalasin d (10 microm) or toxin b from clostridium difficile (20 ng/ml) for 5-29 h led to inhibition of ...	2000	10970764
prevalence of toxin a negative/b positive clostridium difficile strains.		2000	10973753
developmental control of endocytosis in dendritic cells by cdc42.	dendritic cells (dcs) developmentally regulate antigen uptake by controlling their endocytic capacity. immature dcs actively internalize antigen. however, mature dcs are poorly endocytic, functioning instead to present antigens to t cells. we have found that endocytic downregulation reflects a decrease in endocytic activity controlled by rho family gtpases, especially cdc42. blocking cdc42 function by toxin b treatment or injection of dominant-negative inhibitors of cdc42 abrogates endocytosis i ...	2000	10975523
update on clostridium difficile infection.	clostridium difficile is a major cause of antibiotic-associated diarrhea in hospital and community settings, spreading endemic and epidemic disease in developed and developing areas throughout the world. its toxins a and b cause epithelial disruption, inflammation, and secretion. diagnosis of infection with c. difficile is based on appropriate clinical presentation and demonstration of the presence of either toxin a or b, or both. established treatment is still predominantly metronidazole and va ...	2000	10981029
microbiology, epidemiology and diagnosis of clostridium difficile infection.		2000	10981355
genetics of clostridium difficile toxins.		2000	10981356
molecular mode of action of the large clostridial cytotoxins.		2000	10981357
cytotoxic effects of the clostridium difficile toxins.		2000	10981358
large clostridial cytotoxins as tools in cell biology.		2000	10981359
pathogenesis and clinical manifestations of clostridium difficile diarrhea and colitis.		2000	10981360
treatment of clostridium difficile-associated diarrhea and colitis.	treatment of c. difficile diarrhea with metronidazole or vancomycin is highly effective at relieving symptoms. the high rate of diarrhea recurrence is concerning, but fortunately most patients respond to a second course of treatment. the problem of vancomycin resistance in hospital organisms has markedly reduced usage of this agent as a first-line treatment for c. difficile diarrhea, leaving metronidazole as the mainstay of treatment in the united states where teicoplanin and fusidic acid are no ...	2000	10981361
antibiotic policies and clostridium difficile-associated diarrhoea.		2000	10985451
metronidazole resistance in clostridium difficile.		2000	10987742
toxin gene analysis of a variant strain of clostridium difficile that causes human clinical disease.	a toxin variant strain of clostridium difficile was isolated from two patients with c. difficile-associated disease (cdad), one of whom died from extensive pseudomembranous colitis. this strain, identified by restriction endonuclease analysis (rea) as type cf2, was not detected by an immunoassay for c. difficile toxin a. culture supernatants of cf2 failed to elicit significant enterotoxic activity in the rabbit ileal loop assay but did produce atypical cytopathic effects in cell culture assay. s ...	2000	10992443
toxins, butyric acid, and other short-chain fatty acids are coordinately expressed and down-regulated by cysteine in clostridium difficile.	it was recently found that a mixture of nine amino acids down-regulate clostridium difficile toxin production when added to peptone yeast extract (py) cultures of strain vpi 10463 (s. karlsson, l. g. burman, and t. akerlund, microbiology 145:1683-1693, 1999). in the present study, seven of these amino acids were found to exhibit a moderate suppression of toxin production, whereas proline and particularly cysteine had the greatest impact, on both reference strains (n = 6) and clinical isolates (n ...	2000	10992498
diagnosis of clostridium difficile antibiotic associated diarrhoea culture versus toxin assay.	to compare the results of clostridium difficile (cd) on culture with detection of c. difficile toxin by enzyme immunoassay (eia) in the stool specimens of hospitalized patients with antibiotic associated diarrhoea (aad).	2000	10992705
pediatric clostridium difficile: a phantom menace or clinical reality?		2000	10997362
extrinsic surgical denervation inhibits clostridium difficile toxin a-induced enteritis in rats.	clostridium difficile enteritis is caused by toxin a (ta) which stimulates substance p release and subsequent receptor activation. this receptor stimulation results in secretion, inflammation, and structural damage. however, it is unclear as to which subset of neurons is required to initiate substance p release following toxin stimulation. five centimeter ileal segments were surgically denervated. after 10 days, three ileal loops were constructed in each rat: the denervated loop was injected int ...	2000	10998557
surveillance for nosocomial and central line-related infections among pediatric hematology-oncology patients.	to determine the incidence of all nosocomial infections (nis) in pediatric hematology-oncology patients, as well as central venous access device (cvad)-associated infections acquired during home care.	2000	11001263
regulation of dendritic spine morphology by the rho family of small gtpases: antagonistic roles of rac and rho.	dendritic spines mediate most excitatory transmission in the mammalian cns and have been traditionally considered stable structures. following the suggestion that spines may 'twitch', it has been recently shown that spines are capable of rapid morphological rearrangements. because of the role of the small gtpases from the rho family in controlling neuronal morphogenesis, we investigated the effects of several members of this biochemical signaling pathway in the maintenance of the morphology of e ...	2000	11007543
the role of sonography in children with abdominal pain after recent successful reduction of intussusception.		2000	11009308
inhibition of small g proteins of the rho family by statins or clostridium difficile toxin b enhances cytokine-mediated induction of no synthase ii.	in order to investigate the involvement of ras and/or rho proteins in the induction of the inducible isoform of nitric oxide synthase (nos ii) we used hmg-coa reductase inhibitors (statins) and clostridium difficile toxin b (tcdb) as pharmacological tools. statins indirectly inhibit small g proteins by preventing their essential farnesylation (ras) and/or geranylgeranylation (rho). in contrast, tcdb is a glucosyltransferase and inactivates rho-proteins directly. human a549/8- and dld-1 cells as ...	2000	11015307
the role of physical proximity in nosocomial diarrhea.	to examine physical proximity as a risk factor for the nosocomial acquisition of clostridium difficile-associated diarrhea (cdad) and of antibiotic-associated diarrhea (aad), we assessed a retrospective cohort of 2859 patients admitted to a community hospital from 1 march 1987 through 31 august 1987. of these patients, 68 had nosocomial cdad and 54 had nosocomial aad. in multivariate analysis, physical proximity to a patient with cdad (relative risk [rr], 1.86; 95% confidence interval [ci], 1.06 ...	2000	11017821
in vitro activity of new generation fluoroquinolones against genotypically distinct and indistinguishable clostridium difficile isolates.	we compared the activities of ciprofloxacin and levofloxacin with those of the newer fluoroquinolones grepafloxacin, moxifloxacin, sparfloxacin and trovafloxacin against clostridium difficile isolates. as there is good evidence of marked clonal spread of c. difficile, we studied both genotypically distinct (n = 26) and indistinguishable (n = 28) isolates as determined by random amplified polymorphic dna and ribosomal spacer pcr fingerprinting. the indistinguishable strains examined represent the ...	2000	11020251
effect of supplements with lactic acid bacteria and oligofructose on the intestinal microflora during administration of cefpodoxime proxetil.	thirty healthy volunteers in three groups participated in a study of the effect on the intestinal microflora of oral supplementation with bifidobacterium longum, lactobacillus acidophilus and oligofructose, an indigestible oligosaccharide, during oral administration of cefpodoxime proxetil bd for 7 days. those in group a also received an oral supplement with c.1011 cfu of b. longum bb 536 and l. acidophilus ncfb 1748 and 15 g oligofructose daily, those in group b received a supplement with oligo ...	2000	11020259
clarithromycin appears to be linked with clostridium difficile-associated diarrhoea in the elderly.		2000	11020269
probiotics in pediatric gastrointestinal disorders.	probiotics have been defined most recently as living microorganisms which, upon ingestion in certain numbers, exact health benefits beyond inherent general nutrition. they have been a part of human nutrition for centuries, but in recent years they have been more closely studied for their potential to improve health and treat disease. this review of probiotics is not extensive, highlighting the most recent reviews and well controlled clinical studies in both animals and humans. the safety issues ...	2000	11021414
isolation of environmental clostridium difficile from a veterinary teaching hospital.	an environmental survey of a veterinary teaching hospital for the presence of clostridium difficile was performed using contact plates and cycloserine-cefoxitin-fructose with 0.1% sodium taurocholate agar. clostridium difficile was isolated from 24 of 381 sites (6.3%). growth was obtained from 4.5% (9/202) of sites sampled in the large animal clinic, from 8.1% (13/160) of sites within the small animal clinic, and from 20% (2/10) of sites sampled elsewhere. fourteen of 21 strains tested produced ...	2000	11021433
simultaneous occurrence of clostridium difficile and cytomegalovirus colitis in a recipient of autologous stem cell transplantation.		2000	11025618
activation of mmp-2 by clostridium difficile toxin b in bovine smooth muscle cells.	matrix metalloproteinase-2 (mmp-2) plays critical roles in cell migration through the breakdown of the extracellular matrix. cell movements require dynamic actin reorganization, which is controlled by rho family gtpases. in order to examine the relation between mmp-2 regulation and actin reorganization, we used several inhibitors of rho family gtpases. treatment of smooth muscle cells with clostridium difficile toxin b known to inactivate rho family gtpases activated mmp-2. however, neither c3 t ...	2000	11027636
clostridium difficile toxins influence hepatocyte protein synthesis through the interleukin 1 receptor.	clostridium difficile toxins require interleukin 1 (il-1) production or a functioning il-1 receptor to elicit acute-phase protein production by murine hepatocytes.	2000	11030883
[detection of toxin-producing pathogenic bacterial strains by polymerase chain reaction].	polymerase chain reaction (pcr) was used for detection of pathogenic clostridium botulinum, clostridium perfringens, clostridium difficile, and escherichia coli. with this aim in view, primers to botulinic toxins types a, b, c1, d, e, f, and g, perfringens enterotoxin, difficile toxin, and types 1 and 2 shigella-like toxins were chosen and synthesized. optimal amplification conditions were selected for each pair of primers, with dna and the respective agent as the reaction mixture matrices. pcr ...	2000	11031435
bifidobacterium strains from resident infant human gastrointestinal microflora exert antimicrobial activity.	the gastrointestinal microflora exerts a barrier effect against enteropathogens. the aim of this study was to examine if bifidobacteria, a major species of the human colonic microflora, participates in the barrier effect by developing antimicrobial activity against enterovirulent bacteria.	2000	11034580
purification and evaluation of large clostridial cytotoxins that inhibit small gtpases of rho and ras subfamilies.		2000	11036597
dna sequence of the insertional hot spot of tn916 in the clostridium difficile genome and discovery of a tn916-like element in an environmental isolate integrated in the same hot spot.	tn916 is a broad host range tetracycline resistance conjugative transposon. in most bacteria, this element enters the bacterial genome at multiple sites. however, in clostridium difficile, the element has a strong hot spot when introduced by filter mating from bacillus subtilis. in this work, the dna sequence of the preferred insertion site (att916) was obtained. an environmental isolate of c. difficile was also discovered which contained an element indistinguishable from tn916, tn916cd. tn916cd ...	2000	11040422
fermentation of 4-aminobutyrate by clostridium aminobutyricum: cloning of two genes involved in the formation and dehydration of 4-hydroxybutyryl-coa.	clostridium aminobutyricum ferments 4-aminobutyrate via succinic semialdehyde, 4-hydroxybutyrate, 4-hydroxybutyryl-coa and crotonyl-coa to acetate and butyrate. the genes coding for the enzymes that catalyse the interconversion of these intermediates are arranged in the order abfd (4-hydroxybutyryl-coa dehydratase), abft (4-hydroxybutyrate coa-transferase), and abfh (nad-dependent 4-hydroxybutyrate dehydrogenase). the genes abfd and abft were cloned, sequenced and expressed as active enzymes in ...	2000	11041350
evidence for rho protein regulation of renal tubular epithelial cell function.	rho proteins are small guanine 5'-triphosphate (gtp)-binding proteins felt to be important regulators of several aspects of cell function, including the organization of the actin cytoskeleton. the effects of rho proteins on the regulation of renal tubular epithelial cell function are not known.	2000	11044220
perioperative complications after living donor lobectomy.	clinical lung transplantation has been limited by availability of suitable cadaveric donor lungs. living donor lobectomy provides right and left lower lobes from a pair of living donors for each recipient. we reviewed our experience with living donor lobectomy from july 1994 to february 2000.	2000	11044317
environmental control to reduce transmission of clostridium difficile.	restrictive antibiotic policies and infection control measures have been shown to reduce the incidence of clostridium difficile-associated diarrhea (cdad) among hospitalized patients. to date, the role of environmental disinfectants in reducing nosocomial cdad rates has not been well studied. in a before-and-after intervention study, patients in 3 units were evaluated to determine if unbuffered 1:10 hypochlorite solution is effective as an environmental disinfectant in reducing the incidence of ...	2000	11049782
the search for a better treatment for recurrent clostridium difficile disease: use of high-dose vancomycin combined with saccharomyces boulardii.	recurrent clostridium difficile disease (cdd) is a difficult clinical problem because antibiotic therapy often does not prevent further recurrences. in a previous study, the biotherapeutic agent saccharomyces boulardii was used in combination with standard antibiotics and was found to be effective in reducing subsequent recurrences of cdd. in an effort to further refine a standard regimen, we tested patients receiving a regimen of a standard antibiotic for 10 days and then added either s. boular ...	2000	11049785
effect on the human normal microflora of oral antibiotics for treatment of urinary tract infections.	oral administration of antibiotics for treatment of urinary tract infections (utis) can cause ecological disturbances in the normal intestinal microflora. poorly absorbed drugs can reach the colon in active form, suppress susceptible microorganisms and disturb the ecological balance. suppression of the normal microflora may lead to reduced colonization resistance with subsequent overgrowth of pre-existing, naturally resistant microorganisms, such as yeasts and clostridium difficile. new coloniza ...	2000	11051623
evaluation of 16s rrna and cellular fatty acid profiles as markers of human intestinal bacterial growth in the chemostat.	chemostats were used to study the effects of carbon and nitrogen limitation and specific growth rate on 16s rrna synthesis and cellular fatty acid (cfa) profiles in four human intestinal bacteria (bacteroides thetaiotaomicron, bifidobacterium adolescentis, clostridium bifermentans and cl. difficile). cellular fatty acid synthesis varied with dilution rate and nutrient availability in different species, but these cellular constituents were relatively stable phenotypic characteristics in bact. the ...	2000	11054172
beneficial microbes: health or hazard?	normal microbial flora support the health of the host by diverse mechanisms. when antibiotics, stress, disease or medications disrupt normal microflora, the ability to ward off infection by pathogens is compromised. the use of beneficial microbes (also known as biotherapeutic agents, probiotics, synbiotics) has been shown to be an effective therapeutic agent for some diseases. various types of diarrhoea (antibiotic-associated diarrhoea, clostridium difficile disease, traveller's diarrhoea) are m ...	2000	11057450
knowledge of centers for disease control and prevention guidelines for the use of vancomycin at a large tertiary care children's hospital.	in 1994, the centers for disease control and prevention (cdc) published guidelines to encourage prudent use of vancomycin. we sought to determine whether physicians could demonstrate knowledge consistent with the guidelines.	2000	11060537
pharmacokinetics and comparative effects of telithromycin (hmr 3647) and clarithromycin on the oropharyngeal and intestinal microflora.	the pharmacokinetics in plasma and saliva of a new ketolide, telithromycin (hmr 3647), and the effect on the normal oropharyngeal and intestinal microflora were studied in healthy volunteers and compared with those of clarithromycin. ten subjects received 800 mg telithromycin perorally once daily and 10 other subjects received 500 mg clarithromycin bid for 10 days. blood, saliva and faecal specimens were collected at defined intervals before, during and after administration for pharmacokinetic a ...	2000	11062193
microflora-associated characteristics in faeces from allergic and nonallergic infants.	the prevalence of allergic diseases has increased particularly over the past 30-40 years. a reduced microbial stimulation during infancy may result in a development of a disturbed balance between th1- and th2-like immunity. the gut flora is, quantitatively, the most important source for such stimulation.	2000	11069568
transposition of tn4451 and tn4453 involves a circular intermediate that forms a promoter for the large resolvase, tnpx.	tn4451 is the paradigm element of a family of mobilizable chloramphenicol resistance transposons from clostridium perfringens and clostridium difficile. the unique feature of these 6.3 kb elements is that their excision to form a circular molecule is mediated by tnpx, a member of the large resolvase family of site-specific recombinases. by optimizing the transposition assay system in escherichia coli, we showed that tn4453a from c. difficile transposed at a higher frequency than the c. perfringe ...	2000	11069682
hospital disinfectants and spore formation by clostridium difficile.	evidence is lacking on how best to decontaminate the hospital environment of clostridium difficile. we compared sporulation levels in the uk epidemic c. difficile strain (p24), another clinical isolate (b31), and an environmental strain (e4) cultured in faecal emulsion containing subinhibitory concentrations of one of five hospital cleaning agents. the epidemic strain produced significantly more spores than the non-prevalent strains, and sporulation was further enhanced when this strain was cult ...	2000	11073024
the large resolvase tndx is required and sufficient for integration and excision of derivatives of the novel conjugative transposon tn5397.	tn5397 is a novel conjugative transposon, originally isolated from clostridium difficile. this element can transfer between c. difficile strains and to and from bacillus subtilis. it encodes a conjugation system that is very similar to that of tn916. however, insertion and excision of tn5397 appears to be dependent on the product of the element encoded gene tndx, a member of the large resolvase family of site-specific recombinases. to test the role of tndx, the gene was cloned and the protein wa ...	2000	11073898
clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality.	we retrospectively evaluated 75 allogeneic stem cell transplant recipients to ascertain the incidence, risk factors and outcome of infection with clostridium difficile. ten patients (13%) had clostridium difficile infection at a median of 38 days (range day -6 to day +72) following the transplant. there was no difference in the duration or severity of diarrhoea in patients with clostridium difficile infection compared to the uninfected patients and no relationship to the prior antibiotic or chem ...	2000	11081387
[diarrhea associated with clostridium difficile secondary to the use of ciprofloxacin, complicating a first occurrence of intestinal inflammatory disease].		2000	11084823
factors associated with nosocomial diarrhea and clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital.	a prospective survey of the adult inpatient population of an urban tertiary care hospital was conducted to determine factors associated with the development of nosocomial diarrhea and the acquisition of clostridium difficile-associated disease. during the 3-month survey, 98 patients with nosocomial diarrhea were enrolled, and 38 controls were recruited. the controls were patients without diarrhea lying in beds adjacent to the affected patients. factors significantly associated with nosocomial di ...	2000	11699546
clostridium difficile infections in hiv-positive patients.	the prevalence of clostridium difficile infections in hiv-positive patients with regard to the presence of its enterotoxin was investigated. enzyme immunoassay (eia, meridian diagnostic inc) was used for the detection of c. difficile enterotoxin in stool specimens collected from 201 hiv-positive and 271 hiv-negative diarrheal patients. culture was performed on cycloserine cefoxitin fructose agar. chromosomal dna types of c. difficile isolates were determined by pulsed-field gel electrophoresis ( ...	2000	11289016
[intestinal flora of patients with suspected antibiotic associated diarrhea (aad). i. clostridium perfringens].	stool samples of 158 patients suspected of antibiotic-associated diarrhoea (aad) were studied. toxin a of c. difficile and enterotoxin of c. perfringens were detected in stool samples by immunoenzymatic assays and pcr. in 35 stool samples toxin a of c. difficile was detected and in 48 cases (30%) c. difficile strains were cultured from 21 stool samples (13%). the presence of the cpe gene of c. perfringens, enabling the production of enterotoxin, could not be detected by pcr, both in stool sample ...	2000	11286179
co-morbidity, not age predicts adverse outcome in clostridium difficile colitis.	aim:to examine whether age alone or co-morbidity is a risk factor for death in older adults who developed clostridium difficile (cd) colitis during hospitalization.methods:a retrospective, observational study design was performed in our lady of mercy medical center,a 650-bed, urban, community-based, university-affiliated teaching hospital. 121 patients with a positive diagnosis of cd colitis (aged 23-97 years) were studied, and data pertinent to demographic variables, medical history, co-morbidi ...	2000	11819556
gastrointestinal infections in children.	new pathogens that cause gastroenteritis in children are being recognized. even well-recognized pathogens, such as clostridium difficile, may require more extensive testing than was previously thought necessary. several new tests have emerged that allow for faster identification of these pathogens so that same-day results may be possible. probiotic therapy has emerged as a novel strategy for the treatment of gastroenteritis. new vaccines against both viral and bacterial causes of gastroenteritis ...	2000	17024014
treatment of gastrointestinal infections.	treatment of gastrointestinal infections continues to be complicated by expanding resistance to antibiotics. this has led to both new antibiotic treatments and to research on alternative therapies. in the case of clostridium difficile colitis, interesting preliminary results have been obtained with both probiotic therapy and passive immunization strategies. the newer macrolides were found to be effective for multidrug-resistant salmonella typhi and safe in the pediatric population. the efficacy ...	2000	17024016
clostridium difficile-associated diarrhea - the new scourge of the health care facility.		2000	18159261
low prevalence of vre gastrointestinal colonization of hospitalized patients in manitoba tertiary care and community hospitals.	to determine the prevalence of vancomycin-resistant enterococci (vre) bowel colonization in hospitalized patients in manitoba who had stool specimens collected for clostridium difficile toxin and/or culture testing.	2000	18159264
comparative in vitro activity of moxifloxacin against gram-positive clinical isolates.	the in vitro activity of moxifloxacin was compared with that of 15 antibacterial agents against 513 gram-positive microorganisms. the mic(90) (mg/l) of moxifloxacin was 0.06 for quinolone-susceptible staphylococcus aureus and staphylococcus epidermidis, 0.12 for streptococcus pyogenes and streptococcus agalactiae; 0.25 for streptococcus pneumoniae, streptococcus mitis, streptococcus bovis, streptococcus anginosus and actinomyces pyogenes; 0.5 for streptococcus sanguis and listeria monocytogenes, ...	2000	10629010
value of lysozyme agar incorporation and alkaline thioglycollate exposure for the environmental recovery of clostridium difficile.	clostridium difficile is an increasingly prevalent nosocomial pathogen. environmental contamination by spores is believed to be a major factor propagating the spread of c. difficile. various approaches including the use of bile salts have been described to enhance the recovery of c. difficile from clinical and environmental specimens. we found that lysozyme (5 mg/l) incorporated into a selective medium containing bile salts significantly increased the recovery of c. difficile from swabs of 197 e ...	2000	10633056
probiotics and gastrointestinal health.	evidence for positive health benefits of lactobacilli applies to only a few strains used for commercial applications. it is generally agreed that a probiotic must be capable of colonizing the intestinal tract to influence human health; this requirement disqualifies many of the strains currently used in fermented dairy products. lactobacillus gg, a variant of l. casei sps rhamnosus, has been studied extensively in adults and children. when consumed as a dairy product or as a lyophilized powder, l ...	2000	10634218
the effect of probiotics on clostridium difficile diarrhea.	clostridium difficile is the leading cause of nosocomially acquired intestinal infection in the united states, affecting virtually all cases of pseudomembranous colitis and up to 20% of cases of antibiotic-associated diarrhea. even after receiving antibiotic treatment with either metronidazole or vancomycin, 20% of patients will have recurrent clostridium difficile diarrhea. an innovative approach to the problem involves the introduction of competing, nonpathogenic (probiotic) organisms into the ...	2000	10634221
probiotics and infectious diarrhea.	numerous probiotic agents have been studied for the management of diarrheal disease. in particular, the prevention and management of acute viral diarrhea, the treatment of recurrent clostridium difficile diarrhea, as well as the control of antibiotic-associated diarrhea seem to be areas of significant potential benefit. a few agents, including lactobacillus gg, lactobacillus reuteri, and saccharomyces boulardii, seem to be promising agents for the amelioration of the course of acute diarrhea in ...	2000	10634223
the macrolide-lincosamide-streptogramin b resistance determinant from clostridium difficile 630 contains two erm(b) genes.	the ermb macrolide-lincosamide-streptogramin b (mls) resistance determinant from clostridium difficile 630 contains two copies of an erm(b) gene, separated by a 1.34-kb direct repeat also found in an erm(b) determinant from clostridium perfringens. in addition, both erm(b) genes are flanked by variants of the direct repeat sequence. this genetic arrangement is novel for an ermb mls resistance determinant.	2000	10639372
clostridium difficile toxin: cytoskeletal changes and lactate dehydrogenase release in hepatocytes.	we have found that clostridium difficile toxins can evoke hepatocyte acute-phase protein synthesis, and that this effect is dependent on a functioning interleukin-1 (il-1) receptor. the present study was undertaken to determine if c. difficile toxicity, as determined by actin rearrangement and lactate dehydrogenase (ldh) release, also requires a functioning il-1 receptor.	2000	10644484
identification of a novel genetic locus that is required for in vitro adhesion of a clinical isolate of enterohaemorrhagic escherichia coli to epithelial cells.	enterohaemorrhagic escherichia coli (ehec) are food-borne intestinal pathogens with a low infectious dose. adhesion of some ehec strains to epithelial cells is attributed, in part, to intimin, but other factors may be required for the intestinal colonizing ability of these bacteria. in order to identify additional adherence factors of ehec, we generated transposon mutants of a clinical ehec isolate of serotype o111:h-, which displayed high levels of adherence to cultured chinese hamster ovary (c ...	2000	10652089
high prevalence of diarrhea but infrequency of documented clostridium difficile in autologous peripheral blood progenitor cell transplant recipients.	autologous peripheral blood progenitor cell (pbpc) transplant recipients frequently receive multiple antibiotics for neutropenic fever in addition to high-dose chemotherapy. although there are many possible causes for diarrhea in this population, empiric therapy for possible c. difficile colitis is common in some centers. this study sought to define the frequency of diarrhea and of a positive c. difficile toxin assay in pbpc transplant recipients. data were collected on 80 patients enrolled in a ...	2000	10654017
pseudomembranous colitis: an update.	clostridium difficile is the most common nosocomial infection of the gastrointestinal tract. most cases are associated with antibiotic therapy that alters the fecal flora, allowing overgrowth of c difficile with production of its toxins. diagnosis is made by detection of the organism or toxin in the stools. a variety of different tests can be used, but none is perfect. a stool culture can be positive in someone without diarrhea, ie, a carrier. while the cytotoxin is the gold standard, it is expe ...	2000	10655027
polymeric iga is superior to monomeric iga and igg carrying the same variable domain in preventing clostridium difficile toxin a damaging of t84 monolayers.	the two exotoxins a and b produced by clostridium difficile are responsible for antibiotic-associated enterocolitis in human and animals. when added apically to human colonic carcinoma-derived t84 cell monolayers, toxin a, but not toxin b, abolished the transepithelial electrical resistance and altered the morphological integrity. apical addition of suboptimal concentration of toxin a made the cell monolayer sensitive to toxin b. both toxins induced drastic and rapid epithelial alterations when ...	2000	10657645
antibiotics and clostridium difficile diarrhea in the ambulatory care setting.	the goal of this study was to determine the prevalence of clostridium difficile diarrhea (cdd) and the risk for cdd associated with different oral antibiotics commonly used in the ambulatory care setting.	2000	10688393
detection of the adp-ribosyltransferase toxin gene (cdta) and its activity in clostridium difficile isolates from equidae.	clostridium difficile is an antibiotic-associated emerging pathogen of humans and animals. thus far three toxins of c. difficile have been described: an enterotoxin (toxa), a cytotoxin (toxb) and an adp-ribosyltransferase (cdt). in the present work we describe the first isolation of cdt producing c. difficile from equidae with gastro-intestinal disease. out of 17 c. difficile strains isolated from equidae, 11 were positive for the genes tcda and tcdb encoding toxa and toxb. in addition four of t ...	2000	10689161
c. difficile epidemic raises difficult questions about antibiotic-prescribing practices.		2000	10691369
pseudomembranous colitis: report of a severe case with unusual clinical signs in a young nurse.	we describe the case of a young and otherwise healthy nurse who developed pseudomembranous colitis ten days after receiving oral clindamycin for dental infection. her clinical course was particularly stormy and was characterized by severe diarrhea and vomiting, profuse ascites, pleural effusion, abdominal tenderness, peritoneal irritation, and systemic toxicity. the clostridium difficile assay was negative on two occasions. features compatible with pseudomembranous colitis were seen at sigmoidos ...	2000	10696903
isolation and molecular characterization of clostridium difficile strains from patients and the hospital environment in belarus.	toxigenic clostridium difficile is the most common etiologic agent of hospital-acquired diarrhea in developed countries. the role of this pathogen in nosocomial diarrhea in eastern europe has not been clearly established. the goal of this study was to determine the prevalence of c. difficile in patients and the hospital environment in belarus and to characterize these isolates as to the presence of toxin genes and their molecular type. c. difficile was isolated from 9 of 509 (1.8%) patients anal ...	2000	10699022
reactive arthritis after helicobacter pylori eradication.		2000	10703805
rho and rac exert antagonistic functions on spreading of macrophage-derived multinucleated cells and are not required for actin fiber formation.	multinucleated giant cells (mngc) derived from avian blood monocytes present, like osteoclasts, an unusual cytoskeletal organization characterized by (1) cortical rings of actin filaments, (2) unique adhesion structures called podosomes and (3) vinculin containing focal complexes which are not visibly connected to f-actin structures. the rho family of small gtpases plays an essential role in the regulation and organization of cellular cytoskeletal structures including f-actin and vinculin associ ...	2000	10704369
factors associated with nosocomial diarrhea and clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital.	a prospective survey of the adult inpatient population of an urban tertiary care hospital was conducted to determine factors associated with the development of nosocomial diarrhea and the acquisition of clostridium difficile-associated disease. during the 3-month survey, 98 patients with nosocomial diarrhea were enrolled, and 38 controls were recruited. the controls were patients without diarrhea lying in beds adjacent to the affected patients. factors significantly associated with nosocomial di ...	2000	10706173
clostridium difficile splenic abscess.		2000	10711482
the p42/p44 map kinase pathway prevents apoptosis induced by anchorage and serum removal.	anchorage removal like growth factor removal induces apoptosis. in the present study we have characterized signaling pathways that can prevent this cell death using a highly growth factor- and anchorage-dependent line of lung fibroblasts (ccl39). after anchorage removal from exponentially growing cells, annexin v-fitc labeling can be detected after 8 h. apoptosis was confirmed by analysis of sub-g1 dna content and western blotting of the caspase substrate poly (adp-ribose) polymerase. growth fac ...	2000	10712523
a rho-related gtpase is involved in ca(2+)-dependent neurotransmitter exocytosis.	rho, rac, and cdc42 monomeric gtpases are well known regulators of the actin cytoskeleton and phosphoinositide metabolism and have been implicated in hormone secretion in endocrine cells. here, we examine their possible implication in ca(2+)-dependent exocytosis of neurotransmitters. using subcellular fractionation procedures, we found that rhoa, rhob, rac1, and cdc42 are present in rat brain synaptosomes; however, only rac1 was associated with highly purified synaptic vesicles. to determine the ...	2000	10713089
divergent roles for ras and rap in the activation of p38 mitogen-activated protein kinase by interleukin-1.	we have found that lethal toxin from clostridium sordellii, which specifically inactivates the low molecular weight g proteins ras, rap, and rac, inhibits the activation of p38 mitogen-activated protein kinase (mapk) by interleukin-1 (il-1) in el4.nob-1 cells and primary fibroblasts. the target protein involved appeared to be ras, because transient transfections with dominant negative rasn17 inhibited p38 mapk activation by il-1. furthermore, transfections of cells with constitutively active ras ...	2000	10713096
clostridium difficile toxin a excites enteric neurones and suppresses sympathetic neurotransmission in the guinea pig.	evidence suggests that the intestinal actions of clostridium difficile toxin a-stimulation of secretion and motility, and an acute inflammatory response-have a neurally mediated component.	2000	10716676
the role of probiotic cultures in the control of gastrointestinal health.	the use of probiotics to enhance intestinal health has been proposed for many years. probiotics are traditionally defined as viable microorganisms that have a beneficial effect in the prevention and treatment of specific pathologic conditions when they are ingested. there is a relatively large volume of literature that supports the use of probiotics to prevent or treat intestinal disorders. however, the scientific basis of probiotic use has been firmly established only recently, and sound clinic ...	2000	10721914
epidemiology of nosocomial infection and resistant organisms in patients admitted for the first time to an acute rehabilitation unit.	the objectives of this study were to define the epidemiology of nosocomial bacterial colonization and infection and to define predictors of nosocomial infection among a cohort (n=423) of admissions to an acute rehabilitation unit. overall, methicillin-resistant staphylococcus aureus (mrsa) and enterococci were the most commonly identified colonizing organisms. escherichia coli and pseudomonas aeruginosa were the most commonly identified colonizing gram-negative bacilli. during 70 (16.5%) of the ...	2000	10722423
clostridium difficile recombinant toxin a repeating units as a carrier protein for conjugate vaccines: studies of pneumococcal type 14, escherichia coli k1, and shigella flexneri type 2a polysaccharides in mice.	unlike the native protein, a nontoxic peptide (repeating unit of the native toxin designated raru) from clostridium difficile toxin a (cdta) afforded an antigen that could be bound covalently to the surface polysaccharides of pneumococcus type 14, shigella flexneri type 2a, and escherichia coli k1. the yields of these polysaccharide-protein conjugates were significantly increased by prior treatment of raru with succinic anhydride. conjugates, prepared with raru or succinylated (rarusucc), were a ...	2000	10722615
evaluation of the clinical usefulness of c. difficile toxin testing in hospitalized patients with diarrhea.	although numerous studies have evaluated the sensitivity and specificity of different assays for clostridium difficile toxin, none has evaluated how physicians utilize these tests or respond to test results. therefore, we assessed patient characteristics, clinical findings, and physician responses to positive and negative assay results at two university-affiliated hospitals, one of which used a cell cytotoxicity assay to test for c. difficile toxin and the other of which used an enzyme immunoass ...	2000	10729659
rho family proteins modulate rapid apoptosis induced by cytotoxic t lymphocytes and fas.	little is known about the role of rho proteins in apoptosis produced by stimuli evolved specifically to produce apoptosis, such as granzymes from cytotoxic t lymphocytes (ctls) and fas. here we demonstrate that all three rho family members are involved in ctl- and fas-induced killing. dominant-negative mutants of each rho family member and clostridium difficile toxin b, an inhibitor of all family members, strongly inhibited the susceptibility of cells to ctl- and fas-induced apoptosis. fas-induc ...	2000	10734125
control of nosocomial clostridium difficile transmission in bone marrow transplant patients.	this is a report of six cases of clostridium difficile-associated diarrhea (cdad) that occurred among cancer patients undergoing bone marrow transplantation in a tertiary-care cancer hospital. specific infection control measures that were taken to minimize the nosocomial spread of cdad also are discussed.	2000	10738997
[joint manifestations related to clostridium difficile].	reactional joint disease subsequent to digestive tract infections have been well studied for salmonella, shigella, yersinia and campylobacter. association with hla b27 is well documented. a review of the literature since 1976 disclosed 23 cases of articular and extra-articular inflammatory reactions following pseudomembranous clostridium difficile infection.	2000	10745937
pseudomembranous colitis caused by a toxin a(-) b(+) strain of clostridium difficile.	we report a case of severe pseudomembranous colitis due to a toxin a(-) b(+) strain of clostridium difficile in an immunosuppressed patient and discuss the implications for diagnostic testing in suspected c. difficile-associated diarrhea.	2000	10747174
in vitro antibacterial spectrum of a new broad-spectrum 8-methoxy fluoroquinolone, gatifloxacin.	the in vitro antibacterial spectrum of gatifloxacin was compared with those of ciprofloxacin and ofloxacin. gatifloxacin was two- to four-fold more potent than comparator quinolones against staphylococci, streptococci, pneumococci and enterococci (gatifloxacin mic90s, < or =1 mg/l, except 4 mg/l against methicillin-resistant staphylococcus aureus and enterococcus faecium). gatifloxacin was two-fold less potent than ciprofloxacin, and the same as or two-fold more potent than ofloxacin against ent ...	2000	10747819
pseudomembranous colitis in a patient treated with paclitaxel for carcinoma of the breast: a case report.	the concomitant antimicrobial properties of antineoplastic agents may play a role in causing pseudomembranous colitis, which has been documented for cisplatin, cyclophosphamide and 5-fluorouracil.	2000	10748982
intestinal colonization leading to fecal urobilinoid excretion may play a role in the pathogenesis of neonatal jaundice.	neonatal hyperbilirubinemia remains of concern because of the potential danger for the central nervous system. because urobilinogen is a nontoxic derivative of bilirubin, the current study was conducted to examine the fecal excretion of urobilinoids and bilirubin in healthy newborns and infants, as well as their intestinal bacteria capable of reducing bilirubin, to assess a possible relation to serum bilirubin levels during the first weeks of life.	2000	10749414
inhibition of calcium release-activated calcium current by rac/cdc42-inactivating clostridial cytotoxins in rbl cells.	using large clostridial cytotoxins as tools, the role of rho gtpases in activation of rbl 2h3 hm1 cells was studied. clostridium difficile toxin b, which glucosylates rho, rac, and cdc42 and clostridium sordellii lethal toxin, which glucosylates rac and cdc42 but not rho, inhibited the release of hexosaminidase from rbl cells mediated by the high affinity antigen receptor (fcepsilonri). additionally, toxin b and lethal toxin inhibited the intracellular ca(2+) mobilization induced by fcepsilonri- ...	2000	10749865
gastric acid suppression does not promote clostridial diarrhoea in the elderly.	gastric acid prevents bacterial colonization of the stomach and suppression of its secretion might predispose to clostridium difficile (cd) diarrhoea. we retrospectively studied elderly patients admitted to medical wards of an acute hospital to determine whether the incidence of cd diarrhoea was greater among those previously treated with gastric acid suppressants. from records of stool cd toxin tests undertaken in 1995 and 1996, we found 126 cases with positive results, and selected 126 control ...	2000	10751237
re: clinical characteristics and antibiotic utilization in surgical patients with clostridium difficile-associated diarrhea.		2000	10759208