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re: kreiss et al.: pneumatosis intestinalis complicating c. difficile pseudomembranous colitis. 200010763988
recurrent clostridium difficile-associated diarrhea and colitis treated with saccharomyces cerevisiae (baker's yeast) in combination with antibiotic therapy: a case report. 200010764197
the small g-protein rac mediates depolarization-induced superoxide formation in human endothelial cells.superoxide anions impair nitric oxide-mediated responses and are involved in the development of hypertensive vascular hypertrophy. the regulation of their production in the vascular system is, however, poorly understood. we investigated whether changes in membrane potential that occur in hypertensive vessels modulate endothelial superoxide production. in cultured human umbilical vein endothelial cells, changes in membrane potential were induced by high potassium buffer, the non-selective potassi ...200010764736
comparison of the tox a/b test to a cell culture cytotoxicity assay for the detection of clostridium difficile in stools.the tox a/b test (techlab, blacksburg, va, usa) was compared to cell culture cytotoxicity assay on 1109 consecutive diarrheal stool samples collected from patients with the presumptive diagnosis of clostridium difficile disease. the tox a/b test is an enzyme immunoassay in a microtiter format that detects both toxins a and b. the procedure used for this study takes approximately 1.5 h to perform. cell culture cytotoxicity was performed by using a fibroblast cell line in a microtiter format read ...200010764962
fecal incontinence in hospitalized patients who are acutely ill.information about fecal incontinence experienced by patients in acute-care settings is lacking. the relationship of fecal incontinence to several well-known nosocomial or iatrogenic causes of diarrhea has not been determined.200010768587
ph-induced conformational changes in clostridium difficile toxin b.toxin b from clostridium difficile is a monoglucosylating toxin that targets substrates within the cytosol of mammalian cells. in this study, we investigated the impact of acidic ph on cytosolic entry and structural changes within toxin b. bafilomycin a1 was used to block endosomal acidification and subsequent toxin b translocation. cytopathic effects could be completely blocked by addition of bafilomycin a1 up to 20 min following toxin treatment. furthermore, providing a low extracellular ph co ...200010768933
p38 map kinase activation by clostridium difficile toxin a mediates monocyte necrosis, il-8 production, and enteritis.clostridium difficile toxin a causes acute neutrophil infiltration and intestinal mucosal injury. in cultured cells, toxin a inactivates rho proteins by monoglucosylation. in monocytes, toxin a induces il-8 production and necrosis by unknown mechanisms. we investigated the role of mitogen-activated protein (map) kinases in these events. in thp-1 monocytic cells, toxin a activated the 3 main map kinase cascades within 1 to 2 minutes. activation of p38 was sustained, whereas stimulation of extrace ...200010772660
systemic vancomycin overexposure in a patient with spinal cord injury who had staphylococcal sepsis and clostridium difficile colitis. 200010774640
acute abdomen and clostridium difficile colitis: still a lethal combination.with the steadily prevalent appropriate and inappropriate use of antimicrobial agents, clostridium difficile colitis has continued to be noticed as a common problem in hospitalized patients. the aim of this communication is to highlight a subset of c. difficile colitis patients who presented with an acute abdomen.200010781981
short-acting general anaesthesia facilitates therapeutic ercp in frail elderly patients with benign extra-hepatic biliary disease.to ascertain whether therapeutic endoscopic retrograde cholangiopancreatography (ercp) for benign biliary disease in frail elderly patients with comorbid conditions can be safely undertaken in a district general hospital, and whether the procedure is facilitated by the use of short-acting general anaesthesia.200010784000
a clostridium difficile gene encoding flagellin.six strains of clostridium difficile examined by electron microscopy were found to carry flagella. the flagella of these strains were extracted and the n-terminal sequences of the flagellin proteins were determined. four of the strains carried the n-terminal sequence mrvntnvsal exhibiting up to 90% identity to numerous flagellins. using degenerate primers based on the n-terminal sequence and the conserved c-terminal sequence of several flagellins, the gene encoding the flagellum subunit (flic) w ...200010784054
epidemiology of antibiotic resistance.three biological processes contribute to the accumulation of bacterial drug resistance: new selection, gene epidemics and strain epidemics. new resistance emerges by (i) the advantaging of entire species, (ii) by mutation, and (iii) by the escape of resistance genes to mobile dna. organisms to have 'benefited' from modern patterns of cephalosporins and quinolone use include enterococci, clostridium difficile, coagulase-negative staphylococci and enterobacter spp. mutational resistance notoriousl ...200010786953
involvement of a conserved tryptophan residue in the udp-glucose binding of large clostridial cytotoxin glycosyltransferases.large clostridial cytotoxins catalyze the glucosylation of rho/ras gtpases using udp-glucose as a cosubstrate. by site-directed mutagenesis of clostridium sordellii lethal toxin and clostridium difficile toxin b fragments, we identified tryptophan 102, which is located in a conserved region within the catalytic domain of all clostridial cytotoxins, to be crucial for udp-glucose binding. exchange of trp-102 with alanine decreased the glucosyltransferase activity by about 1,000-fold and blocked cy ...200010788427
pseudomembranous enteritis after proctocolectomy: report of a case.intestinal pseudomembrane formation, sometimes a manifestation of antibiotic-associated diarrheal illnesses, is typically limited to the colon but rarely may affect the small bowel. a 56-year-old female taking antibiotics, who had undergone proctocolectomy for idiopathic inflammatory bowel disease, presented with septic shock and hypotension. a partial small-bowel resection revealed extensive mucosal pseudomembranes, which were cultured positive for clostridium difficile. intestinal drainage con ...200010789757
persistent clostridium difficile colitis: a possible etiology for the development of collagenous colitis. 200010795766
synchronous occurrence of collagenous colitis and pseudomembranous colitis.synchronous collagenous and pseudomembranous colitis has not been previously reported. a 73-year-old woman presented with chronic watery diarrhea and abdominal cramping of six weeks' duration. biopsies of the colon revealed findings of collagenous colitis involving the endoscopically normal right colon, and superimposed collagenous and pseudomembranous colitis involving the rectosigmoid colon. endoscopically, the left colon revealed discrete ulcerative plaques, and clostridium difficile toxin a ...200010799091
a role for the small molecular weight gtpases, rho and cdc42, in muscarinic receptor signaling to focal adhesion kinase.an enhanced tyrosine phosphorylation of focal adhesion kinase (fak) is elicited during neuronal growth cone remodeling and requires the maintenance of agonist-sensitive pools of phosphatidylinositol 4,5-bisphosphate (pip2). rho family gtpases are putative regulators of both pip2 synthesis and growth cone remodeling, including neurite outgrowth elicited by muscarinic cholinergic receptor (machr) stimulation. in this study, we investigated the interrelationships among rho family gtpases, pip2 synt ...200010800944
production of actin-specific adp-ribosyltransferase (binary toxin) by strains of clostridium difficile.in addition to the two large clostridial cytotoxins (tcda and tcdb) certain strains of clostridium difficile produce an actin-specific adp-ribosyltransferase, or binary toxin. pcr reactions were developed to detect genes encoding the enzymatic (cdta) and binding (cdtb) components of the binary toxin and 170 representative strains were tested to assess the prevalence of the toxin. positive pcr results (n=59) were confirmed by immunoblotting and adp-ribosyltransferase assay. pcr ribotype and toxin ...200010802189
rho proteins and the p38-mapk pathway are important mediators for lps-induced interleukin-8 expression in human endothelial cells.bacterial endotoxin (lipopolysaccharide, or lps) has potent proinflammatory properties by acting on many cell types, including endothelial cells. secretion of the cxc-chemokine interleukin-8 (il-8) by lps-activated endothelial cells contributes substantially to the inflammatory response. using human umbilical vein endothelial cells (huvecs), we analyzed the role of small gtp-binding rho proteins and p38 mitogen-activated protein kinase (mapk) for lps-dependent il-8 expression in endothelial cell ...200010807767
clostridium difficile in patients with renal failure - management of an outbreak using biotherapy. 200010809792
autologous blood and marrow transplantation in patients 60 years and older.although many hematologic malignancies are more common in older patients, autologous blood and marrow transplantation (abmt) has traditionally been restricted to patients younger than 60 years because of concerns that older patients would be either unable to provide a graft or unable to tolerate the therapy. from june 1995 to may 1998, 30 patients > or = 60 years underwent abmt at our institution for low-grade lymphoma (4 patients), relapsed intermediate-grade lymphoma (17 patients), or multiple ...200010816029
enteropathogens in adult patients with diarrhea and healthy control subjects: a 1-year prospective study in a swedish clinic for infectious diseases.a 1-year prospective study was conducted to identify enteropathogens in adults with diarrhea (n=851) and in healthy control subjects (n=203) by use of conventional laboratory methods. virulence factor genes for diarrheagenic escherichia coli were detected by polymerase chain reaction. enteropathogens were identified in 56% of patients and 16% of control subjects. the isolation rate was 65% for patients with symptoms for <1 week and for travelers; >1 pathogen was found in 11% of patients. the mos ...200010816147
toxic megacolon secondary to infective colitis in children.toxic megacolon is a fulminating and potentially lethal complication of severe colitis. toxic megacolon secondary to infective colitis in children is rare. we analyzed the clinical course, pathology, treatment, and outcome of toxic megacolon secondary to infective colitis in children.200010820951
convulsions induced by metronidazole treatment for clostridium difficile-associated disease in chronic renal failure.clostridium difficile-related diarrhea and colitis are common health problems, especially in elderly, frail hospitalized patients. the drug of choice is metronidazole, which can be associated, in long or high doses, with neurotoxic side effects. we report convulsions induced by short-term metronidazole therapy used in conventional doses for clostridium difficile colitis in an elderly patient with chronic renal failure.200010830559
activation of astroglial phospholipase d activity by phorbol ester involves arf and rho proteins.primary cultures of rat cortical astrocytes express phospholipase d (pld) isoforms 1 and 2 as determined by rt-pcr and western blot. basal pld activity was strongly (10-fold) increased by 4beta-phorbol-12beta,13alpha-dibutyrate (pdb) (ec(50): 56 nm), an effect which was inhibited by ro 31-8220 (0.1-1 microm), an inhibitor of protein kinase c (pkc), and by brefeldin a (10-100 microg/ml), an inhibitor of adp-ribosylating factor (arf) activation. pretreatment of the cultures with clostridium diffic ...200010832096
epidemiology of recurrences or reinfections of clostridium difficile-associated diarrhea.approximately 15 to 35% of patients with a first episode of clostridium difficile-associated diarrhea relapse within 2 months. between 1994 and 1997, strains from 93 hospitalized patients with c. difficile recurrences were fingerprinted by using both serotyping and pcr-ribotyping. the results showed that 48.4% of clinical recurrences were, in fact, reinfections with a different strain of c. difficile. rates of clinical recurrences could therefore be reduced by implementing strict isolation preca ...200010835010
characterization of surface layer proteins from different clostridium difficile clinical isolates.in a previous study we suggested that two surface proteins of a clostridium difficile strain were involved in the formation of a regularly assembled surface layer (s-layer) external to the cell wall. in the present paper six c. difficile strains isolated from cases and healthy carriers were studied. by using freeze-etching and negative staining techniques two superimposed structurally different lattices were detected on the cell surface of the different c. difficile strains. in each strain, the ...200010839973
hiv and diarrhea in the era of haart: 1998 new york state hospitalizations.this study reflects an attempt to identify the causes of diarrheal illness in hospitalized hiv patients in light of therapeutic advancements in hiv management.200010840348
inhibition of rho protein stimulates inos expression in rat vascular smooth muscle cells.inducible nitric oxide synthase (inos) in vascular smooth muscle cells (vsmcs) is upregulated in arterial injury and plays a role in regulating vsmc proliferation and restenosis. inflammatory cytokines [e.g., interleukin-1beta (il-1beta)] released during vascular injury induce inos. small gtp-binding proteins of the ras superfamily play a major role in il-1beta-dependent signaling pathways. in this study, we examined the role of rho gtpases in regulating inos expression in vsmcs. treatment of vs ...200010843870
hospital-acquired infections among chronic hemodialysis patients.the epidemiological characteristics of nosocomial infections among patients requiring chronic hemodialysis, a high-risk and rapidly growing population, have not been fully elucidated. during a 30-month cohort study, rates of bloodstream infections (bsis), urinary tract infections (utis), pneumonia, and diarrhea caused by clostridium difficile and the distribution of pathogens among hospitalized chronic hemodialysis patients were compared with hospitalized patients not requiring chronic hemodialy ...200010845821
clostridium difficile-associated diarrhoea in hospitalised patients.the aim of the present study was to evaluate the incidence, risk factors and cost implications of clostridium difficile-associated diarrhoea (cdad) in hospitalized adult patients.200010849187
[diagnosis of clostridium difficile infection in pseudomembranous colitis].c. difficile is known as the main cause of pseudomembranous colitis, however, some individuals may be asymptomatically colonized. in this paper two patients with diarrhoea had three respectively five negative stool cultures. endoscopically, one patient had severe colitis consistent with both pseudomembranous colitis and inflammatory bowel disease. in the other case the endoscopic findings were typical for pseudomembranous colitis. in both cases there were positive cultures for c. difficile from ...200010850214
characterization of the ends and target sites of the novel conjugative transposon tn5397 from clostridium difficile: excision and circularization is mediated by the large resolvase, tndx.tn5397 is a conjugative transposon that was originally isolated from clostridium difficile. previous analysis had shown that the central region of tn5397 was closely related to the conjugative transposon tn916. however, in this work we obtained the dna sequence of the ends of tn5397 and showed that they are completely different to those of tn916. tn5397 did not contain the int and xis genes, which are required for the excision and integration of tn916. instead, the right end of tn5397 contained ...200010850994
confirmation of transmission of the microsporidian parasite enterocytozoon bieneusi in south africa. 200010853401
ras mediates the camp-dependent activation of extracellular signal-regulated kinases (erks) in melanocytes.in melanocytes and melanoma cells, camp activates extracellular signal-regulated kinases (erks) and mek-1 by an unknown mechanism. we demonstrate that b-raf is activated by camp in melanocytes. a dominant-negative mutant of b-raf, but not of raf-1, blocked the camp-induced activation of erk, indicating that b-raf is the mek-1 upstream regulator mediating this camp effect. studies using clostridium sordelii lethal toxin and clostridium difficile toxin b have suggested that rap-1 or ras might tran ...200010856235
in vitro activity of rifaximin, metronidazole and vancomycin against clostridium difficile and the rate of selection of spontaneously resistant mutants against representative anaerobic and aerobic bacteria, including ammonia-producing species.rifaximin is a rifamycin derivative characterized by a wide antibacterial activity. this drug is neither absorbed by the gastrointestinal tract nor inactivated by gastric juices, and exerts its action entirely within the intestinal lumen.200010859431
fmlp-induced arachidonic acid release in db-camp-differentiated hl-60 cells is independent of phosphatidylinositol-4, 5-bisphosphate-specific phospholipase c activation and cytosolic phospholipase a(2) activation.in inflammatory cells, agonist-stimulated arachidonic acid (aa) release is thought to be induced by activation of group iv ca(2+)-dependent cytosolic phospholipase a(2) (cpla(2)) through mitogen-activated protein kinase (map kinase)- and/or protein kinase c (pkc)-mediated phosphorylation and ca(2+)-dependent translocation of the enzyme to the membrane. here we investigated the role of phospholipases in n-formylmethionyl-l-leucyl-l-phenylalanine (fmlp; 1 nm-10 microm)-induced aa release from neut ...200010860542
ileal perforation caused by cytomegalovirus infection in a critically ill adult.cytomegalovirus (cmv) infection of the gastrointestinal (gi) tract is common and is most often seen in patients with acquired immunodeficiency syndrome (aids), inflammatory bowel disease, or those receiving immunosuppressive therapy. cmv infection of the small bowel accounts for only 4.3% of all cmv infections of the gi tract. isolated cases of small bowel perforation due to cmv have been reported in aids patients, and all but one patient has died. this article reports the first case of an ileal ...200010875475
comparison of pcr-ribotyping, arbitrarily primed pcr, and pulsed-field gel electrophoresis for typing clostridium difficile.clostridium difficile is now recognized as the major agent responsible for nosocomial diarrhea in adults. among the genotyping methods available, arbitrarily primed pcr (ap-pcr), pcr-ribotyping, and pulsed-field gel electrophoresis (pfge) have been widely used for investigating outbreaks of c. difficile infections. however, the comparative typing ability, reproducibility, discriminatory power, and efficiency of these methods have not been fully investigated. we compared the results of three meth ...200010878030
characterization of a toxin a-negative, toxin b-positive strain of clostridium difficile responsible for a nosocomial outbreak of clostridium difficile-associated diarrhea.clostridium difficile-associated diarrhea (cad) is a very common nosocomial infection that contributes significantly to patient morbidity and mortality as well as to the cost of hospitalization. previously, strains of toxin a-negative, toxin b-positive c. difficile were not thought to be associated with clinically significant disease. this study reports the characterization of a toxin a-negative, toxin b-positive strain of c. difficile that was responsible for a recently described nosocomial out ...200010878068
pulsed-field gel electrophoresis of degradation-sensitive dnas from clostridium difficile pcr ribotype 1 strains. 200010878091
persistence of an endemic (toxigenic) isolate of clostridium difficile in the environment of a general medicine ward.the epidemiology of clostridium difficile-associated diarrhea (cdad) in an endemic setting was investigated by use of dna typing methods to determine the strain identity of c. difficile isolates. two predominant toxigenic clones were found in the environment and accounted for 29.8% (type 1) and 15.5% (type 2) of cdad cases, respectively. in endemic settings, the environment and cross-transmission may play a role in acquisition of cdad.200010880312
rapidly progressive necrotizing fasciitis and gangrene due to clostridium difficile: case report.a case of rapidly progressive necrotizing fascitis and gas gangrene due to clostridium difficile that responded very well to surgical intervention is described.200010880313
[drug-induced enterocolitis. important differential diagnosis in the investigation of diarrhea and intestinal hemorrhage].this article is a review of the side-effects of drugs affecting the small and large intestines. pseudomembranous colitis is caused by antibiotics facilitating an overgrowth of clostridium difficile. a hemorrhagic colitis, generally self-limiting, can be caused by penicillin, amoxycillin and ampicillin. toxicity of nsaid may induce intestinal ulcers, diaphragm-like strictures, perforation, colitis and relapse of inflammatory bowel disease. drug-induced lymphocytic colitis has been reported due to ...200010881520
local antibiotic guidelines for adult community-acquired pneumonia (cap): a survey of uk hospital practice in 1999.we investigated the guidelines in british hospitals for the management of adults admitted with community-acquired pneumonia (cap). a questionnaire was sent to one consultant respiratory physician in each of the 263 hospitals in the british thoracic society (bts) directory of training posts and services. two hundred and thirteen (81%) responses were received: 178 (84%) had written cap guidelines, of which 123 (69%) printed copies were received. for non-severe cap a single antibiotic (74% of guide ...200010882705
clostridium difficile toxin a causes early damage to mitochondria in cultured cells.the mechanism by which clostridium difficile toxin a causes actin depolymerization and cell rounding involves toxin internalization and subsequent monoglucosylation of the rho family of proteins. this study explored toxin internalization and effects on mitochondrial function before cell rounding.200010889163
the rise of clostridium difficile: the effect of length of stay, patient age and antibiotic use.hospitals in the uk have recently seen a marked increase in c. difficile for reasons which are unclear. reduced standards of hygiene, increasingly elderly patients, greater cephalosporin use and longer hospital stay have been suggested. we retrospectively studied all cases of c. difficile diarrhoea at princess margaret hospital, swindon, over two years. cephalosporins, patient age and los appeared unrelated to the rise in c. difficile; penicillins and macrolides were related. our policy of using ...200010896804
contrasting incidence of clostridium difficile and other enteropathogens in aids patients in london and lusaka. 200010897357
rac is required for constitutive macropinocytosis by dendritic cells but does not control its downregulation.dendritic cells use constitutive macropinocytosis to capture exogenous antigens for presentation on mhc molecules. upon exposure to inflammatory stimuli or bacterial products such as lipopolysaccharide (lps), macropinocytosis is dramatically downregulated as part of a developmental programme leading to dendritic cell maturation, migration and activation of t cells. it is not known, however, how macropinocytosis is sustained in dendritic cells in the absence of exogenous stimuli, nor how it is do ...200010899002
respiratory antibiotic use and clostridium difficile infection: is it the drugs or is it the doctors? 200010899237
[ultrasound diagnosis of pseudomembranous colitis].the diagnosis of pseudomembranous colitis (pmc) is based on the history of exposure to antibiotics, characteristic endoscopic findings and on demonstrating the presence of clostridium difficile toxins in the faeces. this report presents typical sonographic features of pmc.200010902512
[ultrasound diagnosis of penicillin-induced segmental hemorrhagic colitis].penicillin-induced segmental haemorrhagic colitis (shc) is a characteristic and striking but rarely diagnosed clinical entity. bloody diarrhea and abdominal cramps start a few days after the intake of oral penicillin derivatives. we report the ultrasonographic and clinical findings in nine patients with shc and compare the results with the findings in ten patients with antibiotic-related pseudomembranous colitis (pmc).200010902513
[evaluation of four rapid methods for the investigation of the toxigenic capacity of clostridium difficile strains isolated in a selective medium].use of selective clostridium difficile culture as a diagnostic method for c. difficile associated disease requires to prove the toxigenic ability of the isolates. toxin b detection by cell culture assay after growing the microorganism in enriched broth is the standard method, but it delays the final diagnosis for 3-5 days. this study compares retrospectively four rapid techniques for detecting these toxigenic c. difficile strains.200010905010
survival of clostridium difficile and its toxins in equine feces: implications for diagnostic test selection and interpretation.although clostridium difficile is recognized as a cause of enterocolitis in horses and humans, there has been little work published regarding the lability of c. difficile and its toxins in feces. a significant decrease in recovery of c. difficile from inoculated equine fecal samples occurred during storage. recovery after storage in air at 4 degrees c decreased from 76% (37/49) after 24 hours to 67% (33/49) at 48 hours and 29% (14/ 49) after 72 hours. in contrast to aerobic storage, 25 of 26 sam ...200010907862
genetic characterization of toxin a-negative, toxin b-positive clostridium difficile isolates by pcr.toxin-specific enzyme immunoassays, cytotoxicity assays, and pcr were used to analyze 48 toxin a-negative, toxin b-positive clostridium difficile isolates from various geographical sites around the world. all the isolates were negative by the tox-a test and positive by the tox a/b test. a deletion of approximately 1.7 kb was found at the 3' end of the toxa gene for all the isolates, similar to the deletion in toxinotype viii strains (e.g., c. difficile serotype f 1470). additional pcr analysis i ...200010921980
statistical process control geometric q-chart for nosocomial infection surveillance.several authors have proposed the use of statistical process control charting methods for the surveillance of endemic rates of nosocomial infections. the principal goal of such a charting program is to recognize any increase of the endemic rate to an epidemic rate as soon as possible after the change occurs. however, many of the statistical process control charting methods that have been proposed are based on classical charting principles that are effective largely for processes for which suffic ...200010926710
control of cellular phosphatidylinositol 4,5-bisphosphate levels by adhesion signals and rho gtpases in nih 3t3 fibroblasts involvement of both phosphatidylinositol-4-phosphate 5-kinase and phospholipase c.the involvement of small gtpases of the rho family in the control of phosphoinositide metabolism by adhesion signals was examined in nih 3t3 fibroblasts. abrogation of adhesion signals by detachment of cells from their substratum resulted in a time-dependent decrease in the cellular level of ptdins(4,5)p2 by approximately 50%. this effect could be mimicked by treatment of adherent cells with clostridium difficile toxin b and toxin b-1470, which inhibit specific subsets of rho and ras gtpases. de ...200010931209
a chimeric ribozyme in clostridium difficile combines features of group i introns and insertion elements.cdlst1, a dna insertion of 1975 bp, was identified within tcda-c34, the enterotoxin gene of the clostridium difficile isolate c34. located in the catalytic domain a1-c34, cd/st1 combines features of two genetic elements. within the first 434 nt structures characteristic for group i introns were found; encoding the two transposase-like proteins tlpa and tlpb nucleotides 435-1975 represent the remainder of a is605-like insertion element. we show that the entire cdlst1 is accurately spliced from tc ...200010931294
[hyperbaric oxygen as an adjunctive treatment for descending necrotizing mediastinitis: report of a case].we report a case of 59-year-old man of descending necrotizing mediastinitis (dnm) secondary to peritonsillar abscess. a 59-year-old man with diabetes mellitus was admitted to a local hospital because of cervical swelling related to a peritonsillar abscess. despite administration of antibiotics, swelling of the neck, dysphagia and dyspnea deteriorated. therefore he was urgently undergone a tracheotomy and transferred to our hospital by an ambulance. the surgery consisted with neck and anterior me ...200010935394
rho gtpases as targets of bacterial protein toxins.several bacterial toxins target rho gtpases, which constitute molecular switches in several signaling processes and master regulators of the actin cytoskeleton. the biological activities of rho gtpases are blocked by c3-like transferases, which adp-ribosylate rho at asn41, but not rac or cdc42. large clostridial cytotoxins (e. g., clostridium difficile toxin a and b) glucosylate rho gtpases at thr37 (rho) or thr35 (rac/cdc42), thereby inhibiting rho functions by preventing effector coupling. the ...200010937872
clostridium difficile - pathogen or pest? 200020177553
bacterial toxins modifying the actin cytoskeleton.numerous bacterial toxins recognize the actin cytoskeleton as a target. the clostridial binary toxins (iota and c2 families) adp-ribosylate the actin monomers causing the dissociation of the actin filaments. the large clostridial toxins from clostridium difficile, clostridium sordellii and clostridium novyi inactivate, by glucosylation, proteins from the rho family that regulate actin polymerization. in contrast, the cytotoxic necrotic factor from escherichia coli activates rho by deamidation an ...199910943412
[isolation of toxigenic strains of clostridium difficile and enterotoxin producing bacteroides fragilis from fecal specimens of patients suspected of antibiotic associated diarrhoea].fifty faecal samples from patients suspected of aad (antibiotic associated diarrhoea) were studied for clostridium difficile and enterotoxin producing bacteroides fragilis (etbf). using tcd (becton-dickinson) and c. difficile toxin a test (oxoid) in 34% of specimens the presence of toxin a was detected. from all specimens 25 c. difficile strains were isolated. all isolated strains produced toxin b in vitro which was shown in mc coy cytotoxicity test. eighteen strains only were toxin a positive i ...199910865431
toxic megacolon: diagnosis and treatment challenges.in adults, toxic megacolon is a relatively uncommon but potentially lethal complication of inflammatory bowel disease (ibd), infectious colitis, or ischemic colitis caused by cancer chemotherapeutic agents. patients have distension of the colon and signs of toxicity such as elevated temperature, hypotension, decreased level of consciousness and electrolyte imbalances. factors thought to increase the risk include premature discontinuation of ibd medications; procedures that increase colon trauma, ...199910865533
laboratory assessment of five enzyme immunoassay clostridium difficile toxin detection kits. 199910824330
clostridium difficile-associated diarrhea in human immunodeficiency virus infection--a changing scenario. 199910825082
evaluation of different methods for detection of clostridium difficile toxins in poland.the aim of this study was to compare different methods for c. difficile toxins detection. fifty three stool samples taken from patients with antibiotic-associated diarrhoea were studied. tcd toxin a eia (becton dickinson, usa), tox a/b elisa test (techlab, usa), cytotoxicity and neutralization assay on mccoy cells and pcr for detection of both toxin a and b genes were performed in vivo (in stool samples) and in vitro (in isolated strains). reference toxigenic and nontoxigenic and two japanese to ...199910756719
residential care and the elderly: the burden of infection.long term care facilities (ltcfs) include a variety of different types of healthcare settings, each with their own unique infectious disease problems. this report focuses on the epidemiological considerations, risk factors and types of infections that occur in elderly patients institutionalized in nursing home settings. in the us, the number of patients in nursing homes continues to grow as the population ages. today, patients in nursing homes have more complicated medical conditions than they d ...199910658754
bacterial resistance to disinfectants: present knowledge and future problems.bacterial resistance to antibiotics is a long-established, widely-studied problem. increasingly, attention is being directed to the responses of various types of microbes to biocides (antiseptics, disinfectants and preservatives). different groups of bacteria vary in their susceptibility to biocides, with bacterial spores being the most resistant, followed by mycobacteria, then gram-negative organisms, with cocci generally being the most sensitive. there are wide divergencies within this general ...199910658759
epidemiology of nosocomial clostridium difficile diarrhoea.clostridium difficile is a frequent and clinically important cause of diarrhoea that has been strongly but not exclusively associated with the hospital setting. the vast majority of cases of c. difficile diarrhoea are associated with antecedent treatment with antibiotics, of which cephalosporins and clindamycin appear to pose the highest risk. within hospitals and chronic-care facilities, cross-infection of c. difficile has been related to transient carriage on hands of healthcare workers and co ...199910658778
what should we do about patients with clostridium difficile? 199910658800
low prevalence of nosocomial clostridium difficile transmission, as determined by comparison of arbitrarily primed pcr and epidemiological data.an increased prevalence of patients with c. difficile-associated diarrhoea in a hospital setting suggested the possible existence of an endemic occurrence. a study was therefore designed to determine clonal relatedness among 173 isolates of c. difficile, collected consecutively during 1995 from 147 patients (89 inpatients and 58 outpatients) and to estimate the probability of nosocomial transmission. arbitrarily primed pcr (ap-pcr) with three different primers, ap1, ap2 and cld1, was used for fi ...199910658802
incidence of clostridium difficile infection: a prospective study in an indian hospital.clostridium difficile is the commonest cause of hospital-acquired diarrhoea. a prospective study comprising of 156 patients and 54 healthy controls was undertaken to assess c. difficile associated diarrhoea (cdad) incidence in an indian hospital. methods used included c. difficile culture and enzyme linked immunosorbent assay (elisa) for toxin a. attempts were made to type isolates by antibiogram and sds-page. of the 210 stool samples tested, 12 gave positive results in at least one assay. of th ...199910658803
an audit of the use of manual handling equipment and their microbiological flora--implications for infection control.a review of the use of manual handling aids in two hospitals found equipment was employed on a multi-patient basis with inadequate cleaning. sampling with a casella slit sampler demonstrated frequent contamination by methicillin-resistant staphylococcus aureus and clostridium difficile of fabric aids. recommendations for care of equipment are made.199910658808
screening for carriage and nosocomial acquisition of clostridium difficile by culture: a study of 284 admissions of elderly patients to six general hospitals in wales. 199910658811
[clostridium difficile]. 199910635809
pathophysiology, diagnosis and treatment of clostridium difficile infection.clostridium difficile infection has become in recent years an important nosocomial threat. prevention of the spread of c. difficile infection among long term hospitalized patients is a major challenge since c. difficile spores can persist indefinitely in the hospital environment. following antibiotic therapy that disrupts the normal bacterial flora of the colon, c. difficile can colonize the large intestine. the bacteria releases two large protein toxins that bind to colonocytes and mediate an a ...199910638139
isolation of clostridium difficile from the ruminal reservoir of newborn lambs. 199910596876
antibiotics and clostridium difficile.clostridium difficile is now established as a major nosocomial pathogen. c. difficile infection is seen almost exclusively as a complication of antibiotic therapy, and is particularly associated with clindamycin and third-generation cephalosporins. depletion of the indigenous gut microflora by antibiotic therapy has long been established as a major factor in the disease. however, the direct influence of antimicrobials upon virulence mechanisms such as toxin production and adhesion in the bowel, ...199910602670
ifosfamide, carboplatin and etoposide (ice) in metastatic and refractory breast cancer.twenty-five patients with metastatic breast cancer were treated with ice after failure of previous chemotherapy. their median age was 50 years (range 36-73). all but 1 patient had multiple sites of metastases. nineteen (76%) patients had undergone two or more chemotherapy regimens for metastatic disease prior to ice. the performance status (ps) of the patients was eastern cooperative oncology group (ecog) 0:6; 1:12; 2:5; 3:2. ifosfamide 1.25 g/m(2) over 3 h d1-3 along with mesna, etoposide 80 mg ...199910602907
an antibiotic policy associated with reduced risk of clostridium difficile-associated diarrhoea.antibiotic-associated diarrhoea caused by clostridium difficile is increasing in hospitals, and older people are at particular risk.199910604512
[nosocomial infections].glycopeptide resistance: resistance to glycopeptides raises many therapeutic problems when it occurs in strains such as enterococci or staphylococci causing clinical infections. two observations described here exemplify the emergence of such resistance in a metacillin-resistant staphylococcus aureus (mrsa) strain during vancomycin treatment and in a clostridium difficile strain. nasal mrsa in hospital personnel: nasal cavities of hospital personnel is a not well recognized reservoir of mrsa. a s ...199910605463
clostridium difficile-associated disease. implications for midwifery practice.clostridium difficile-associated disease (cdad), a gastrointestinal infection with a wide range of manifestations whose primary symptom is diarrhea, occurs when antibiotic medications, or rarely other drugs or conditions, disrupt the normal colonic microflora, making it susceptible to the growth of toxigenic c difficile. it is a significant nosocomial infection and an increased incidence has been noted in recent years. although infrequently seen in midwifery practices, it does occur and may incr ...199910063221
evaluation of microbicidal activity of a new disinfectant: sterilox 2500 against clostridium difficile spores, helicobacter pylori, vancomycin resistant enterococcus species, candida albicans and several mycobacterium species.the microbicidal activity of a new disinfectant sterilox, a super-oxidized water, containing a mixture of oxidizing substances, was tested against clostridium difficile spores, helicobacter pylori, vancomycin resistant enterococcus species, candida albicans and several mycobacterium species using membrane filters. all tests were performed in duplicate with and without added horse serum at 1% and 5% v/v. distilled water, 0.35% peracetic acid (nu-cidex) and 2% glutaraldehyde were included as contr ...199910063471
rapid detection of toxigenic clostridium difficile from stool samples by a nested pcr of toxin b gene.toxigenic clostridium difficile is the aetiologic agent of most cases of antibiotic-associated diarrhoea and pseudomembranous colitis. the present standard method for c. difficile diagnosis is a cytotoxicity assay, performed on human fibroblast cultures. it is time consuming and requires special facilities. a nested-pcr assay detecting toxin b gene within a few hours was designed. one hundred and two stool samples were collected during four months. all samples were processed for toxin b-pcr, cul ...199910063477
antimicrobial activities of synthetic bismuth compounds against clostridium difficile.clostridium difficile is a major nosocomial pathogen responsible for pseudomembranous colitis and many cases of antibiotic-associated diarrhea. because of potential relapse of disease with current antimicrobial therapy protocols, there is a need for additional and/or alternative antimicrobial agents for the treatment of disease caused by c. difficile. we have synthesized a systematic series of 14 structurally simple bismuth compounds and assessed their biological activities against c. difficile ...199910049270
a novel cytotoxin from clostridium difficile serogroup f is a functional hybrid between two other large clostridial cytotoxins.the large clostridial cytotoxins (lcts) constitute a group of high molecular weight clostridial cytotoxins that inactivate cellular small gtp-binding proteins. we demonstrate that a novel lct (tcdb-1470) from clostridium difficile strain 1470 is a functional hybrid between "reference" tcdb-10463 and clostridium sordellii tcsl-1522. it bound to the same specific receptor as tcdb-10463 but glucosylated the same gtp-binding proteins as tcsl-1522. all three toxins had equal enzymatic potencies but w ...199910196187
antibiotic-associated diarrhea. it can be serious. 199910424198
[five cases of detected fecal clostridium difficile toxin during elemental diet]. 199910434560
prevalence of clostridium perfringens enterotoxin and clostridium difficile toxin a in feces of horses with diarrhea and colic.to determine prevalence of clostridial enterotoxins in feces of horses with diarrhea and colic, and to determine whether an association exists between detection of clostridial enterotoxins in feces and development of diarrhea as a complication of colic.199910434974
successful treatment of cytomegalovirus colitis with ganciclovir in a patient with adult t cell leukemia lymphoma: case report.an 84-year-old patient with adult t cell leukemia lymphoma (atll) developed diarrhea on day 5 of chemotherapy and was diagnosed with cytomegalovirus (cmv) colitis. sigmoidoscopy revealed multiple superficial erosions surrounded by a flare. computed tomography (ct) and ultrasonogram of the abdomen revealed marked thickening of the colonic mucosa. there were 186 cmv antigen-positive leukocytes per 31,000 white blood cells (wbc). a colonic biopsy specimen showed typical cmv nuclear inclusions. immu ...199910435685
transfer of a conjugative transposon, tn5397 in a model oral biofilm.a tetracycline resistance profile was established from a microcosm dental plaque in a constant depth film fermenter. the fermenter was inoculated with a bacillus subtilis strain which contained the conjugative transposon, tn5397, which confers tetracycline resistance upon its host. after 6 hour and 24 hour the tetracycline resistance profile of the biofilm was redetermined and a tetracycline resistant streptococcus species was isolated. a molecular analysis of this strain confirmed that tn5397 w ...199910436923
suppression of toxin production in clostridium difficile vpi 10463 by amino acids.the impact of various growth conditions on the expression of toxins and other proteins by clostridium difficile vpi 10463 was studied. during non-starved conditions, the rate of toxin synthesis paralleled that of total protein during both exponential growth and stationary phase, and in both defined and complex media. biotin limitation reduced growth rate and bulk protein synthesis, whereas toxin expression continued, leading to a 50- to 200-fold increase in intracellular toxin levels. concomitan ...199910439407
prevalence of toxin a negative/b positive clostridium difficile strains. 199910440000
prognosis of adult-onset idiopathic bile acid malabsorption.from 1986 to 1993, 150 patients were investigated with the 75se-homocholic acid taurine (sehcat) test as a late step in the investigation of chronic diarrhoea. on basis of low sehcat values and response to cholestyramine treatment, 33 patients were initially classified as having idiopathic bile acid malabsorption (ibam). the aim was to describe the long-term clinical course of the disease and to assess the reliability of the sehcat test in diagnosing ibam.199910440608
immunological evidence for a bacterial toxin aetiology in sudden infant death syndrome.toxin-specific antibodies to clostridial, enterobacterial and staphylococcal toxins implicated in sudden infant death syndrome were studied in sera from sudden infant death syndrome infants and a comparison group of infants (babies with phenylketonuria). the results indicated a higher proportion of sera from sudden infant death syndrome infants contained iga that bound to clostridial and enterobacterial toxins but a higher proportion of sera from the phenylketonuria comparison group contained ig ...199910443490
evaluation of two rapid assays for detection of clostridium difficile toxin a in stool specimens.rapid laboratory diagnosis of clostridium difficile-associated diarrhea (cdad) is highly desirable in the setting of hospital cost containment. we tested 654 stool specimens to compare the performance of two assays for rapid detection of toxin a, the immunocard toxin a test (meridian diagnostics, inc.) and the culturette brand toxin cd enzyme immunoassay (eia) (becton dickinson microbiology systems), with a cytotoxin assay (cytotoxi test; advanced clinical diagnostics) and culture on cycloserine ...199910449503
detection of glycopeptide-resistant enterococci in routine diagnostic faeces specimens.faeces received in a diagnostic laboratory were screened for glycopeptide-resistant enterococci (gre) on modified lewisham medium, with and without enrichment in enterococcosel broth. colonization by gre was detected in 102/838 patients (12.2%). in 74 (73%) of colonized patients gre were detected by both methods and in 28 (27%) they were detected only after enrichment. the carriage rate in hospitalized patients was 32% (93/289) compared with 2.3% (11/425) in the community (gp patients and food-h ...199910462636
detection of clostridium difficile toxin by an indigenously developed latex agglutination assay.an indigenously developed latex agglutination assay using c. sordelli antitoxin was used to screen 211 stool samples received from hospitalized patients. of 126 samples from patients receiving single to multiple antibiotics for various ailments, 38 (30%) were positive by the toxin assay, whereas only 6/85 (7%) of samples of patients not receiving antibiotics were also positive. thus, of 211 samples a total of 44 (20.8%) were positive by our toxin assay, giving titers ranging from 1 in 5 to 1 in ...199910464446
pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation.pseudomembranous colitis (pmc) is a potentially life-threatening acute infectious colitis caused by one or more toxins produced by an unopposed proliferation of clostridium difficile bacteria. pmc is characterized by the presence of elevated, yellow-white plaques forming pseudomembranes on the colonic mucosa. these plaques can be visualized at both pathologic analysis and endoscopy. plain radiography, contrast enema studies, and computed tomography (ct) are useful in the evaluation of pmc. plain ...199910464797
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