Publications

[susceptibility of clostridium difficile to metronidazole using the e-test: effect of the culture medium].	the treatment of intestinal clostridium difficile infections rests on administration of either a glycopeptide or metronidazole. given the current shifts in resistance patterns of anaerobes to antimicrobials, a study of the susceptibility of c. difficile to metronidazole was timely. the objective of this study was to evaluate the influence of the culture medium on the minimal inhibitory concentration (mic) of metronidazole as determined using the e-test. thirty-one strains were grown on three dif ...	1999	10418031
the actin-based motility of intracellular listeria monocytogenes is not controlled by small gtp-binding proteins of the rho- and ras-subfamilies.	in this study, we analyzed whether the actin-based motility of intracellular listeria monocytogenes is controlled by the small gtp-binding proteins of the rho- and ras-subfamilies. these signalling proteins are key regulatory elements in the control of actin dynamics and their activity is essential for the maintenance of most cellular microfilament structures. we used the clostridium difficile toxins tcdb-10463 and tcdb-1470 to specifically inactivate these gtp-binding proteins. treatment of euk ...	1999	10418138
nosocomial diarrhoea.	toroviruses have been reported as a new cause of nosocomial viral diarrhoea, and the role of astroviruses has been further elucidated. polymerase chain reaction methods promise to improve the diagnosis and understanding of the aetiology and control of hospital-acquired viral gastroenteritis. a clearer picture of the impact and extent of clostridium difficile diarrhoea has emerged, and several control measures have been described. an epidemic clostridium difficile strain and toxin a-deficient str ...	1999	17035796
should all stool specimens be routinely tested for clostridium difficile?	objective: to determine the frequency with which clostridium difficile was detected in stool specimens from outpatients and patients hospitalized for less than 4 days to assess the usefulness of routine laboratory screening for detecting this enteric pathogen. methods: seven hundred and forty-one specimens from 398 patients were cultured over a 6-month period for salmonella, shigella, yersinia, escherichia coli o157:h7, campylobacter and clostridium difficile. clostridium difficile culture-posit ...	1999	11856253
antimicrobial susceptibility of clostridium difficile by e test.	the in vitro inhibitory activity of 11 antimicrobials against 44 clinical isolates of clostridium difficile was investigated. minimum inhibitory concentrations (mics) were determined using e test. metronidazole (mic90 0.38 microg/ml), teicoplanin (mic90 0.75 microg/ml) and vancomycin (mic90 1.0 microg/ml) were very active against the isolates examined, whereas, resistance to imipenem, cefoxitin, clindamycin and ciprofloxacin was found in most of the tested strains. we concluded that teicoplanin ...	1999	11561576
antibacterial activity of aristolochia paucinervis pomel.	several fractions of the methanolic extract of the rhizome or the leaves of aristolochia paucinervis pomel were screened for antibacterial activity using the agar dilution method against fourteen reference bacterial strains. only three fractions (defatted chloroformic rhizome fraction: aprc, rhizome ethyl acetate fraction: apre and leaf chloroform fraction: aplc) showed an activity against at least one of the microorganisms tested. the minimum inhibitory concentration (mic) determination showed ...	1999	10616964
a severe case of post-antibiotic clostridium difficile colitis.		1999	10687784
infectious enteritis.	initial management of acute infectious enteritis should focus on fluid and electrolyte repletion and symptomatic care. a decision to prescribe empiric antibiotic therapy should rest on clinical or epidemiologic features of the illness that suggest a treatable bacterial origin or a high-risk host. this decision should be reinforced by the detection of leukocytes or blood in the stool. if empiric therapy is indicated, a quinolone is generally the best initial choice. a stool culture yielding an en ...	1999	11096582
update on gastrointestinal infections: clostridium difficile and other bugs.		1999	10980973
fulminant clostridium difficile colitis associated with paclitaxel and carboplatin chemotherapy.	resnik e, lefevre ca. fulminant clostridium difficile colitis associated with paclitaxel and carboplatin chemotherapy. pseudomembranous colitis is commonly associated with the use of antibiotics. some antineoplastic agents even without associated antibiotic use can predispose patients to developing infection with clostridium difficile. the infection is usually mild; however, in rare cases severe forms of pseudomembranous colitis may be encountered. a 66 year-old female with stage iiic suboptimal ...	1999	11240821
statistical inference for serial dilution assay data.	serial dilution assays are widely employed for estimating substance concentrations and minimum inhibitory concentrations. the poisson-bernoulli model for such assays is appropriate for count data but not for continuous measurements that are encountered in applications involving substance concentrations. this paper presents practical inference methods based on a log-normal model and illustrates these methods using a case application involving bacterial toxins.	1999	11315070
[pseudomembranous colitis]	objective: to alert about the pseudomembranous colitis in children, a consequence of the use of antibiotics. methods: this report is the result of the clinical follow-up of a patient with chronic diarrhea after the use of several antibiotics. the bibliography was obtained through medline system. results: case report of a girl two years and seven months old, previously healthy, with a clinical picture of chronic diarrhea with dysenteric characteristics after the use of antibiotics, associated wit ...	1999	14685502
small intestinal pathology.	during the past year, important studies on various mechanisms of small bowel disease have been reported. the section on enterocyte function evaluates studies on hypoxia and apoptosis. many of the studies of small intestinal epithelia use as models t84 cells. when these cells are referred to as intestinal cells, it may be in a general sense. this may be of relevance in permeability studies because the transepithelial resistance of t84 cells is on the order of 1000 to 2000 ohm.cm, much higher than ...	1999	17023934
differential yield of pathogens from stool testing of nosocomial versus community-acquired paediatric diarrhea.	to evaluate the role of routine stool examination for all pathogens in paediatric nosocomial diarrhea (nad) and community-acquired diarrhea (cad) over a two-year period at alberta children's hospital and current practices in other canadian hospitals. a secondary objective was to characterize features that may predict nad or cad etiology.	1999	22346400
diarrhea recurrence in patients with clostridium difficile-associated diarrhea: role of concurrent antibiotics.	to monitor prospectively patients with clostridium difficile-associated diarrhea (cad) in a six hundred bed tertiary care hospital to determine which factors influenced the recurrence of the diarrhea.	1999	22346388
empyema caused by clostridium difficile.	extraintestinal infections of clostridium difficile are rare and often associated with underlying disorders. a case of empyema caused by aspiration of c difficile in a patient with carcinoid syndrome and c difficile colitis is described.	1999	22346383
[hospital load of bacterial intestinal infections].	infectious diarrhea is a worldwide problem, with differences from country to country, and it is an important cause of infant morbidity and mortality in the underdeveloped countries.	1998	16495887
the effect of an enhanced infection-control policy on the incidence of clostridium difficile infection and methicillin-resistant staphyloccocus aureus colonization in acute elderly medical patients.	clostridium difficile (cd) infection and methicillin-resistant staphylococcus aureus (mrsa) colonization are increasingly common in elderly patients, are associated with cephalosporin or prolonged aminopenicillin courses and can be transmitted by direct contact. management is by side-room isolation. ward closure may be required to control outbreaks.	1998	12675094
antianaerobic activity of a cecropin---melittin peptide.	objective: several small, 15-residue peptides that contain portions of the amino acid sequences of both cecropin a and melittin have previously been shown to have broad-spectrum antibacterial activities against aerobic microorganisms, with no undesirable hemolytic properties. it would also be useful to know what effect these hybrid peptides have on anaerobic bacteria. methods: the minimum inhibitory concentrations of one hybrid, ca(1--7)m(2--9)nh2, were compared with those of seven other antimic ...	1998	11864323
modulation between aerobic and anaerobic metabolism in the mutant cell line cdtr-q.	it has recently been shown that the cell line don q obtained by mutagenesis of wild type chinese hamster lung fibroblasts (don wt), presents a point mutation in the gene coding for udp-glucose pyrophosphorylase. the persistent low level of udp-glucose makes don q clone resistant to clostridium difficile toxin b. starting from the observation that don q cells exhibit many large hydrophobic cytoplasmic inclusions, that we have found to be made of neutral lipids, the aerobic metabolism of the two c ...	1998	10874983
nerves and intestinal mast cells modulate responses to enterotoxins.	experiments in intact animals exposed to enterotoxins demonstrate that neurons and immune cells of the lamina propria regulate toxin-induced diarrhea and tissue damage. clostridium difficile toxins cause profound diarrhea and acute inflammation by activating a complex cascade initiated by toxin binding to enterocyte receptors.	1998	11390763
bacterial infections of the gut (excluding enteric fever).	bacterial enteric infections are still a major cause of morbidity and mortality, and many challenges lie ahead in understanding and managing these conditions. clostridium difficile remains the most important nosocomial infection. antibiotic resistance makes the treatment of shigella infections increasingly difficult. molecular and cellular techniques are, however, rapidly expanding our understanding of the complexity of the pathogenesis of established and newly recognized pathogens.	1998	17033424
isolation from the rumen of a new acetogenic bacterium phylogenetically closely related to clostridium difficile.	five strains of filamentous acetogenic bacterium were isolated from high dilutions of ruminal content of newborn lambs. these gram-positive spore-forming bacteria grew either chemolithotrophically with h2+ co2 or chemo-organotrophically with glucose, cellobiose, fructose, maltose, mannose and syringic acid. the dna base composition of the five strains were between 29.1 and 31.3 mol% g + c. their temperature and ph optimum for growth were 35-40 degrees c and 6.5-7.0, respectively. the full 16s rr ...	1998	16887627
prospects for a vaccine for clostridium difficile.	clostridium difficile diarrhoea and colitis is a new disease that is attributable to broad spectrum antibiotic therapy. during the past 2 decades c. difficile has become one of the most common nosocomial pathogens in the developed world. as changing demographics create an increasingly elderly population and the use of broad spectrum antimicrobials continues to expand, c. difficile is likely to become increasingly problematic. disease caused by this organism is caused by the inflammatory actions ...	1998	18020593
[acute infectious diarrheal disease in romania: 1993-1998].	the decrease of morbidity-mortality caused by gastroenteritis is in relation to the factors largely responsible for the fall in infant mortality and mortality from communicable diseases in developing countries. nevertheless, diarrhea is still a considerable public health problem in these countries, especially among children under 5 years old. 98% of all deaths in children younger than 15 years are in the developing world. five of the ten leading killers are communicable, perinatal, and nutrition ...	1998	10422319
clostridium difficile-associated diarrhea in acute and long-term care facilities.	this report presents an overview of the epidemiology, diagnosis, complications, and treatment of clostridium difficile-associated diarrhea in acute and long-term care facilities. more studies are needed to understand the epidemiology of this disease in long-term care facilities, to identify the risk factors for its recurrence, and to evaluate new treatment modalities.	1998	10099071
human diseases caused by exotoxins produced by anaerobes and their rapid detection.	major human diseases caused by exotoxins produced by anaerobes include botulisms, tetanus, foodborne illness caused by enterotoxin-producing clostridium perfringens, and diarrhea/colitis caused by toxigenic clostridium difficile. recently, enterotoxigenic bacteroides fragilis (etbf) has been recognized, that may be related to childhood diarrheal disease. detection test of botulinal neurotoxin is hardly performed at clinical laboratories since the most reliable means of detection and identificati ...	1998	10036379
recognizing and managing clostridium difficile-associated diarrhea.	clostridium difficile-associated diarrhea poses a significant physical risk and cost to the recovery of hospitalized older adults. c. difficile is responsible for 75% or more of the diarrhea-associated enteric infections acquired during a hospital stay (gerding, johnson, peterson, mulligan, & silva, 1995). c. difficile is easily spread by direct or indirect contact, therefore placing other patients at great risk for contamination by this organism. nursing plays a significant role in early identi ...	1998	10036439
a double-blind, placebo-controlled, parallel group study of oral trovafloxacin on bowel microflora in healthy male volunteers.	treatment with oral antibiotic drugs generally influences normal fecal flora. these changes can be both beneficial (eg, elimination of aerobic, gram-negative bacilli) and detrimental (eg, the appearance of resistant pathogenic micro-organisms). trovafloxacin, a new fluoroquinolone with in vitro activity against anaerobes, and gram-negative, gram-positive, and atypical pathogens, is a potentially beneficial antimicrobial for bowel sterilization. this double-blind trial investigated the effect of ...	1998	9935254
[resistance of respiratory and enteral bacteria to antibiotics].		1998	9927887
comparative anti-anaerobic activity of men 10700, a penem antibiotic.	the in vitro activity of men 10700, a new penem, has been compared with that of metronidazole, clindamycin, ciprofloxacin, co-amoxiclav, imipenem and three third generation cephalosporins against 120 strains of anaerobes. the organisms tested comprised clostridium perfringens, clostridium difficile, bacteroides fragilis and speciated members of the genera fusobacterium, veillonella and peptostreptococcus. men 10700 showed activity similar to that of imipenem, and was more potent than metronidazo ...	1998	9916909
reactive oligoarthritis in a patient with clostridium difficile pseudomembranous colitis. review of the literature.	a 57-year-old man developed oligoarthritis of the right sacroiliac joint, knee and elbow in the wake of clostridium difficile pseudomembranous colitis. he was hla b27-positive and had a history of reiter's syndrome. his joint manifestations resolved after a course of nonsteroidal antiinflammatory drug therapy and injection of the right knee with triamcinolone acetonide. clostridium difficile should be recognized as a rare cause of reactive arthritis.	1998	9923050
multicentre evaluation of a commercial test for the rapid diagnosis of clostridium difficile-mediated antibiotic-associated diarrhoea.	an immunoassay for the detection of clostridium difficile toxin a in stool samples (clearview c. diff a; unipath, uk) was evaluated against the cell cytotoxicity assay using 407 stool samples from patients suspected to have, or considered at risk of, antibiotic-associated diarrhoea. of the samples tested, 98 were positive and 280 were negative by both tests (sensitivity 83.1%, specificity 96.9%). following resolution of the 29 discrepant results, the sensitivity and specificity of the immunoassa ...	1998	9923521
[molecular epidemiology and pathogenicity of clostridium difficile].		1998	9865068
increasing hospitalization and death possibly due to clostridium difficile diarrheal disease.	this study calculated yearly estimated national hospital discharge (1985 to 1994) and age-adjusted death rates (1980 to 1992) due to bacterial, viral, protozoal, and ill-defined enteric pathogens. infant and young child hospitalization (but not death) rates in each category increased more than 50% during 1990 to 1994. age-adjusted death and hospitalization rates due to enteric bacterial infections and hospitalizations due to enteric viral infections have increased since 1988. the increases in ho ...	1998	9866738
acquisition of clostridium difficile and clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding.	clostridium difficile is the most common infectious cause of nosocomial diarrhea, but its role in diarrhea associated with tube feeding has not been rigorously investigated.	1998	9867755
clostridium difficile diarrhea after use of tacrolimus following renal transplantation.		1998	9868682
community-acquired pneumonia.		1998	9872273
regulation of phospholipase d activity in synaptosomes permeabilized with staphylococcus aureus alpha-toxin.	in order to investigate the regulation of presynaptic phospholipase d (pld) activity by calcium and g proteins, we established a permeabilization procedure for rat cortical synaptosomes using staphylococcus aureus alpha-toxin (30-100 microg/ml). in permeabilized synaptosomes, pld activity was significantly stimulated when the concentration of free calcium was increased from 0.1 microm to 1 microm. this activation was inhibited in the presence of kn-62 (1 microm), an inhibitor of calcium/calmodul ...	1998	9872388
clostridial pathogenicity in experimental necrotising enterocolitis in gnotobiotic quails and protective role of bifidobacteria.	the pathogenesis of neonatal necrotising enterocolitis (nec) remains unclear. gnotobiotic quails fed a lactose diet have been used to investigate the role of clostridial strains originating from faecal specimens of neonates through the intestinal lesions, the changes in microflora balance and the production of bacterial metabolites, i.e., short-chain fatty acids and hydrogen. bifidobacteria are thought to exert various beneficial effects on host health, including interaction with the colonic mic ...	1998	9879939
pcr-ribotyping and pyrolysis mass spectrometry fingerprinting of environmental and hospital isolates of clostridium difficile.	the relationships between environmental isolates of clostridium difficile were examined by two typing methods, pcr ribotyping and pyrolysis mass spectrometry (pyms). the 184 isolates were divided into 23 different pcr ribotypes, 13 of which were producers of toxins a and b; the remaining 10 types did not produce either toxin a or b. pyms analysis resolved 31 groups with 60 (32.5%) isolates in one group (group 9). in both methods most of the isolates showed similar clustering. pcr ribotypes of th ...	1998	9879953
prospective study of the risk of clostridium difficile diarrhoea in elderly patients following treatment with cefotaxime or piperacillin-tazobactam.	rates of clostridium difficile diarrhoea have recently been rising, with the elderly being at highest risk.	1998	9882029
silver sulfadiazine induced clostridium difficile toxic megacolon in a burn patient: case report.	a 53 yr old diabetic male presented with a 34% total body surface area (tbsa) deep partial- and full-thickness burns. on post burn days 4 and 9, all of his burns were excised and grafted. although he had only been treated with topical antibiotics, he developed clostridium difficile colitis after his second surgery that progressed to toxic megacolon and perforation. the incidence and treatment of toxic megacolon secondary to c. difficile is reviewed. early diagnosis and treatment with colonoscopi ...	1998	9882070
effectiveness of antibiotic prophylaxis in critically ill patients. antibiotic prophylaxis can lead to contamination with clostridium difficile.		1998	9882129
inhibition of small g proteins by clostridium sordellii lethal toxin activates cdc2 and map kinase in xenopus oocytes.	the lethal toxin (lt) from clostridium sordellii is a glucosyltransferase that modifies and inhibits small g proteins of the ras family, ras and rap, as well as rac proteins. lt induces cdc2 kinase activation and germinal vesicle breakdown (gvbd) when microinjected into full-grown xenopus oocytes. toxin b from clostridium difficile, that glucosylates and inactivates rac proteins, does not induce cdc2 activation, indicating that proteins of the ras family, ras and/or rap, negatively regulate cdc2 ...	1998	9882492
nosocomial infections in hand surgery.	the active and experienced hand surgeon should have enough knowledge to recognize both common and uncommon hand infections. control of hospital-acquired infections, including surgical site infections, requires a knowledge of potential personal risk factors and ongoing surveillance systems to aid in prevention and early detection. current national trends may soon require that surgical-site infections be diagnosed by specific criteria that will allow comparisons of data from various locations. alt ...	1998	9884892
reduction in vancomycin-resistant enterococcus and clostridium difficile infections following change to tympanic thermometers.	to contain a nosocomial outbreak of vancomycin-resistant enterococcus (vre).	1998	9613694
inhibition of rho is required for camp-induced melanoma cell differentiation.	up-regulation of the camp pathway by forskolin or alpha-melanocyte stimulating hormone induces melanocyte and melanoma cell differentiation characterized by stimulation of melanin synthesis and dendrite development. here we show that forskolin-induced dendricity is associated to a disassembly of actin stress fibers. since rho controls actin organization, we studied the role of this guanosine triphosphate (gtp)-binding protein in camp-induced dendrite formation. clostridium botulinum c3 exotransf ...	1998	9614180
increased incidence of clostridium difficile infection.		1998	9617691
detection of bacteroides fragilis enterotoxin gene by pcr.	bacteroides fragilis constitutes about 1% of the bacterial flora in intestines of normal humans. enterotoxigenic strains of b. fragilis have been associated with diarrheal diseases in humans and animals. the enterotoxin produced by these isolates induces fluid changes in ligated intestinal loops and an in vitro cytotoxic response in ht-29 cells. we developed a nested pcr to detect the enterotoxin gene of b. fragilis in stool specimens. after dna extraction, a 367-bp fragment was amplified with t ...	1998	9620408
[clostridium difficile-associated diarrhea treated with homologous feces].		1998	9621767
community-acquired clostridium difficile-associated diarrhoea in a patient with colonic carcinoma.	in the vast majority of cases, clostridium difficile-associated diarrhoea and pseudomembranous colitis develop following the use of antibiotics. we report a case in which c. difficile-associated diarrhoea was diagnosed in the absence of previously reported predisposing factors. it transpired that the patient had a colonic carcinoma. we suggest that a diagnosis of c. difficile-associated diarrhoea in the absence of a history of antibiotics or other established causes should prompt a colonoscopy t ...	1998	9624800
the cause of diarrhea in hospitalized patients.		1998	9625156
hospital-wide restriction of clindamycin: effect on the incidence of clostridium difficile-associated diarrhea and cost.	widespread antibiotic use has been associated with increases in both bacterial resistance and nosocomial infection.	1998	9625685
clostridium difficile colitis associated with a 'triple' regimen, containing clarithromycin and metronidazole, to eradicate helicobacter pylori.	we describe a 54-year-old man with helicobacter pylori (+) duodenal ulcer who developed clostridium difficile associated colitis, 5 days after commencing a 'triple' regimen consisting of omeprazole 20 mg b.d., metronidazole 500 mg b.d. and clarithromycin 500 mg b.d., to eradicate h. pylori. despite the fact that oral metronidazole did not prevent the disease, the patient did well after treatment with oral metronidazole plus a yeast preparation (saccharomyces bulardii). no relapse occurred.	1998	9627163
differentiating ischemic colitis from other colitides.		1998	9630187
clostridium difficile--setting the scene.		1998	9630368
clinical impact and associated costs of clostridium difficile-associated disease.	toxin-producing clostridium difficile is the commonest cause of nosocomial diarrhoea and, as such, poses a major problem in our hospitals. the main population susceptible to disease is the elderly, for reasons that remain unclear. by contrast, carriage rates in neonates are high, but disease is low. the organism also has a major clinical impact in the immunosuppressed host, patients undergoing surgery (especially gastrointestinal) and those with severe underlying disease and longer hospital stay ...	1998	9630369
pathogenesis of clostridium difficile infection.	clostridium difficile produces two major toxins referred to as toxins a and b. these are thought to be primarily responsible for the virulence of the bacterium and the major contributors to the pathogenesis of antibiotic-associated gastrointestinal disease. the molecular organization and control of expression of toxins a and b is now starting to be understood, and the cellular mechanism of action of both toxins, glucosylation of rho family proteins, has been discovered. other factors, such as pr ...	1998	9630370
the role of antimicrobial agents in the aetiology of clostridium difficile-associated disease.	high clostridium difficile disease rates were originally associated with clindamycin use, but this association has declined in recent years following the decline in the clinical use of clindamycin, and disease is now particularly associated with the use of broad-spectrum antibiotics, especially the cephalosporins. there are now sufficient reports in the literature to merit the discontinuation of the widespread use of cephalosporins, especially in the elderly, by the substitution, wherever possib ...	1998	9630371
the diagnosis of clostridium difficile-associated disease.	there are well-documented risk factors associated with the development of antibiotic-associated diarrhoea; knowledge of these and of the typical signs and symptoms should alert the clinician to the possibility of clostridium difficile-associated diarrhoea (cdad). it is therefore common practice in large general hospitals for clinicians to request, and for laboratories to include, investigations for c. difficile on in-patient stool specimens to confirm a diagnosis of cdad. the laboratory methods ...	1998	9630372
treatment of clostridium difficile infection.	the treatment options for clostridium difficile infection remain limited, although promising agents are currently being assessed. metronidazole is the first-line drug of choice for those patients requiring specific anti-c. difficile treatment. much of the interest in alternative therapies has centred on the difficult management issues posed by patients with multiple symptomatic recurrences of c. difficile infection. however, it is now clear that the majority of these episodes are due to reinfect ...	1998	9630373
the epidemiology and typing of clostridium difficile.	clostridium difficile is normally a harmless environmental bacterium but, under certain circumstances, it can cause hospital outbreaks of disease. to understand the disease epidemiology, outbreaks have been investigated by many different methods. the phenotypic and genotypic approaches to typing are reviewed here and the epidemiology of c. difficile-associated disease is elucidated in light of recent information.	1998	9630374
infection control and prevention of clostridium difficile infection.	clostridium difficile has become a major problem as a nosocomial pathogen that is associated with the use of antibiotics. in the prevention and control of c. difficile disease it is important that programmes are directed at primary and secondary prevention. the three main elements of prevention are: (i) restricted use of antibiotics; (ii) strict enteric precautions when looking after patients with diarrhoea; and (iii) meticulous cleaning of clinical areas. although poor handwashing is known to p ...	1998	9630375
clostridium difficile infections of the gut: the unanswered questions.		1998	9630376
clostridium difficile infection: appendix.		1998	9630377
clostridium difficile toxins a and b are cation-dependent udp-glucose hydrolases with differing catalytic activities.	toxins a and b of clostridium difficile are udp-glucose glucosyltransferases that exert their cellular toxicity primarily through their abilities to monoglucosylate, and thereby inactivate, rho family small gtpases. toxin a also hydrolyzes udp-glucose, although this activity is not well characterized. in this study, we measured the kinetics of udp-glucose hydrolysis by toxins a and b and found significant differences in the catalytic activities of these two structurally homologous toxins. the to ...	1998	9632652
case records of the massachusetts general hospital. weekly clinicopathological exercises. case 19-1998. a 70-year-old man with diarrhea, polyarthritis, and a history of reiter's syndrome.		1998	9634361
clostridium difficile toxin a stimulates macrophage-inflammatory protein-2 production in rat intestinal epithelial cells.	neutrophil infiltration of the colonic mucosa is a hallmark of clostridium difficile toxin a-mediated enterocolitis. macrophage-inflammatory protein-2 (mip-2) is a potent neutrophil chemoattractant secreted by rat macrophages and epithelial cells in response to inflammatory stimuli. in this work, we report that administration of toxin a into rat ileal loops increased mucosal levels of mip-2 before the onset of fluid secretion and mucosal neutrophil infiltration. administration of rabbit anti-mip ...	1998	9637520
effect of isoleucine on toxin production by clostridium difficile in a defined medium.	supplementation of a carbohydrate-free minimal medium with a high level (100 mm) of histidine, methionine, valine, isoleucine, proline and leucine, in particular isoleucine, markedly increased toxin production by clostridium difficile vpi 10463. the effect of isoleucine was further examined. increasing the concentration of isoleucine from 20 to 100 mm remarkably increased toxin production, while bacterial growth decreased gradually. amino acid analysis of the culture revealed that, at 100 mm iso ...	1998	9638867
genetic rearrangements in the pathogenicity locus of clostridium difficile strain 8864--implications for transcription, expression and enzymatic activity of toxins a and b.	the pathogenicity locus (paloc) of clostridium difficile isolate 8864 was investigated to locate genetic rearrangements that would explain the exceptional pathogenicity of this particular isolate. two major changes were defined: an insertion of 1.1 kb between the two genes tcda and tcde, coding for the enterotoxin and an accessory protein of unknown function, respectively, and a deletion of 5.9 kb encompassing the 3' ends of tcda and tcdc. transcription of the tcda-e genes is severely affected b ...	1998	9645428
brewer's yeast and saccharomyces boulardii both attenuate clostridium difficile-induced colonic secretion in the rat.	saccharomyces boulardii (sb), a nonpathogenic yeast, has been used to prevent recurrences of clostridium difficile (c.diff) -associated diarrhea. a single report suggested that treatment with saccharomyces cerevisiae (sc), commonly called brewer's yeast (by), facilitates treatment of persistent c.diff infection. we conducted this experiment to determine whether c.diff toxin a-induced colonic secretion in the rat is blunted by pretreatment with either sb or by. we employed closed cecal pouches in ...	1998	9753273
implementation of sequential therapy programs--a microbiologist's view.	sequential antimicrobial therapy is not new, but confusion about the timing and nature of the switch often negates perceived advantages. a common problem is the choice of oral antibiotic to follow empirical administration of an intravenous second or third generation cephalosporin. where guidelines do not exist, particularly when data are lacking as the the best option, the delphi technique of obtaining a consensus agreement by review of a series of case histories is recommended. majority verdict ...	1998	9756370
in vitro effects of clostridium difficile toxins on hepatocytes.	clostridium difficile infections are associated with development of the systemic inflammatory response, including the production of hepatic acute phase proteins. lipopolysaccharide (lps) directly stimulates the production of at least one of these proteins, a 23-kda acute phase protein (the lps-induced protein, or lip) by murine hepatocytes in vitro. the aim of the present study was to determine if c. difficile toxins also stimulated the synthesis of this protein in vitro.	1998	9758734
[clostridium difficile pseudo-membranous colitic secondary to taking diclofenac].		1998	9762175
coordinate activation of activator protein 1 and inflammatory cytokines in response to neisseria gonorrhoeae epithelial cell contact involves stress response kinases.	neisseria gonorrhoeae (ngo), the etiologic agent of gonorrhea, induce a number of proinflammatory cytokines by contact to epithelial cells. cytokine genes and a variety of other immune response genes are activated as a result of the regulatory function of immediate early response transcription factors including activator protein 1 (ap-1). since it is established that phosphorylation of c-jun, the central component of ap-1, by the stress-activated c-jun nh2-terminal kinase (jnk) increases the tra ...	1998	9763607
adenovirus endocytosis requires actin cytoskeleton reorganization mediated by rho family gtpases.	adenovirus (ad) endocytosis via alphav integrins requires activation of the lipid kinase phosphatidylinositol-3-oh kinase (pi3k). previous studies have linked pi3k activity to both the ras and rho signaling cascades, each of which has the capacity to alter the host cell actin cytoskeleton. ad interaction with cells also stimulates reorganization of cortical actin filaments and the formation of membrane ruffles (lamellipodia). we demonstrate here that members of the rho family of small gtp bindin ...	1998	9765425
[emergence of gram-positive bacteria in nosocomial transmission].		1998	9767768
review article: the use of biotherapeutic agents in the prevention and treatment of gastrointestinal disease.	there is presently a lack of well conducted clinical trials demonstrating any significant benefits of probiotics in humans. with the exception of diarrhoea due to rotavirus infection in children there is little evidence from randomized, double-blind, placebo-controlled studies that bacterial probiotics have a significant beneficial action in preventing diarrhoea of any cause. the yeast saccharomyces boulardii has been shown to be of benefit in the prevention of antibiotic-associated diarrhoea bu ...	1998	9768523
[systematic detection of toxigenic strains of clostridium difficile--is it useful?].	the incidence of clostridium difficile (cd) infection is rising and cd in fact is now endemic in many hospitals. during the past 4 years we analyzed our data concerning diarrhea caused by cd in our 700 beds hospital. a positive case was defined as a cd cytotoxine positive with or without positive culture for cd. in the present study 120 episodes of cd associated diarrhea occurred in 102 patients. 1101 stools were cultured from 921 patients. since 1995 we choose to systematically evaluate cd in d ...	1998	9769867
diarrhea and clostridium difficile infection in latin american patients with aids. working group on aids in peru.	diarrhea and wasting are among the most debilitating and deadly manifestations of aids, yet only limited information is available regarding the etiology, clinical consequences, and immunologic effects of infection with diarrheal agents. peruvian aids patients presenting with and without diarrhea were followed prospectively to examine the relations among diarrheal pathogens, clinical presentations, cd4 lymphocyte count, weight loss, and survival. patients with chronic diarrhea had lower cd4 lymph ...	1998	9770145
the bcl-2 gene is differentially regulated by il-2 and il-4: role of the transcription factor nf-at.	the murine ts1alphabeta t cell line expresses the anti-apoptotic protein bcl-2 upon il-2 stimulation, whereas il-4-mediated growth of this cell line proceeds in the absence of bcl-2 expression. in addition, il-4 stimulation inhibits bcl-2 expression and modulates its mrna level. il-2-induced dna binding activity for these transcription factors is sensitive to phosphatidylinositol 3 kinase inhibitor wortmannin and to rho inhibitor clostridium difficile toxin b, which inhibit il-2-induced bcl-2 ex ...	1998	9771966
clostridium difficile colitis: factors influencing treatment failure and relapse--a prospective evaluation.	the aim of this study was to identify patient related factors that may influence the treatment response and relapse following clostridium difficile (c. difficile) colitis.	1998	9772047
[choose preparations that affect the intestinal ecosystem as little as possible!].	the administration of antimicrobials often causes ecological disturbances in the normal microflora, such as decreased colonisation resistance which may result in overgrowth of potentially pathogenic micro-organisms such as yeasts and clostridium difficile. another possible consequence is the establishment of resistant strains which may spread within the host, or from person to person, causing infection. resistant bacteria can also transfer resistance genes to their own or other species. the arti ...	1998	9772776
risk factors for clostridium difficile infection.	a systematic review of the literature to identify risk factors associated with clostridium difficile infection was conducted. two main outcomes were considered: c. difficile diarrhoea and c. difficile carriage. a qualitative assessment, based on a set of defined and consistently applied criteria, appeared to be the best approach for risk factors other than antibiotic use, as an approach based on meta-analysis would have utilized only the information provided by a minority of the studies. risk fa ...	1998	9777516
[drug-associated hemorrhagic enteritis].	drug-associated hemorrhagic colitis are divided into antibiotic associated hemorrhagic colitis (aahc) and other drug associated hemorrhagic colitis. aahc are mainly caused by oral usage of ampicillin and its derivatives (85%). initially aahc are believed to be caused by klebsiella oxytoca overgrowth. however, these organisum has no exotoxin like clostridium difficile and pathogenesis of aahc are still unresolved. typical aahc are diagnosed by colonoscopy with diffuse hemorrhage and edema mainly ...	1998	9780724
human enteric pathogens identified in a london teaching hospital and a rural public health laboratory: 1994.	two microbiology laboratories, one serving an inner city hospital and one a rural public health laboratory, collected data on the outcome of examining faecal specimens in 1994. overall, 6.7% of the investigations were positive, but the rates were lower for hospital inpatients, for recently described pathogens, and in the absence of relevant clinical details; rates were higher for patients with a history of foreign travel. no benefit was gained by examining more than two specimens from any patien ...	1998	9782627
gastrointestinal toxicity and clostridium difficile diarrhea in patients treated with paclitaxel-containing chemotherapy regimens.	the objective of this study was to determine the incidence of grade 3 and 4 gastrointestinal toxicity and the prevalence of clostridium difficile-associated diarrhea (cdad) in patients with gynecologic malignancies treated with paclitaxel-based chemotherapy regimens.	1998	9784328
activation of rho gtpases by escherichia coli cytotoxic necrotizing factor 1 increases intestinal permeability in caco-2 cells.	the cytotoxic necrotizing factor 1 (cnf1) activates rho gtpases by deamidation of glutamine-63 and thereby induces redistribution of the actin cytoskeleton and formation of stress fibers. here, we have studied the effects of cnf1 on the transepithelial resistance of caco-2 cells, a human intestinal epithelial cell line, in comparison with the rho-inactivating toxin b of clostridium difficile. whereas toxin b decreased the transepithelial resistance of caco-2 cells by about 80% after 4 h, cnf1 re ...	1998	9784513
effect of clostridium difficile toxin a on human colonic lamina propria cells: early loss of macrophages followed by t-cell apoptosis.	we have previously shown that clostridium difficile toxin a induces detachment of human colonic epithelial cells from the basement membrane and subsequent cell death by apoptosis. because these cells require adhesion-dependent signalling from the extracellular matrix for survival, their detachment from the basement membrane by other means also induces apoptosis. the role of toxin a in the induction of apoptosis therefore remains to be determined. in addition, sensitivities to c. difficile toxin ...	1998	9784558
extraintestinal clostridium difficile: 10 years' experience at a tertiary-care hospital.	to determine the clinical characteristics of patients with extraintestinal clostridium difficile (ecd).	1998	9787741
binding of clostridium difficile toxin a to human milk secretory component.	toxigenic clostridium difficile is isolated from a majority of healthy human infants. the exact mechanism of asymptomatic colonisation is unclear; however, previous studies in this laboratory have shown that components of both the immunoglobulin and non-immunoglobulin fractions of human milk bind to toxin a and prevent its interaction with hamster intestinal brush border membranes (bbms). secretory iga (siga) is the primary immunoglobulin found in human milk. as siga resists digestion in the inf ...	1998	9788811
mechanisms of drug-induced diarrhoea in the elderly.	in the rapidly increasing elderly population, diarrhoea as a result of drug therapy is an important consideration. the elderly consume a disproportionately large number of drugs for multiple acute and chronic diseases. drugs can compromise both immune and nonimmune responses. aging decreases the quality and proportion of t cells which in turn reduces the production of secretory iga, the primary immune response of the gut. acid production in the stomach decreases with increasing age and this comp ...	1998	9789728
the enzymatic domain of clostridium difficile toxin a is located within its n-terminal region.	clostridium difficile, an anaerobic pathogen encountered in human enteric disease, produces two major virulence factors, toxins a and b, which are members of a clostridial family of large cytotoxins. these are glucosyltransferases, which use a udp-sugar as co-substrate to glucosylate and inactivate small gtpases of the rho or ras families, culminating in cytotoxicity. clinically, toxin a is perhaps the most important family member, because it causes major tissue damage in the course of disease, ...	1998	9790914
neutropenic enterocolitis.		1998	9798019
mechanisms and management of antibiotic-associated diarrhea.	only 10%-20% of all cases of antibiotic-associated diarrhea (aad) are caused by infection with clostridium difficile. other infectious organisms causing aad include clostridium perfringens, staphylococcus aureus, klebsiella oxytoca, candida species, and salmonella species. most of the clinically mild aad cases are due to functional disturbances of intestinal carbohydrate or bile acid metabolism, to allergic and toxic effects of antibiotics on intestinal mucosa, or to pharmacological effects on m ...	1998	9798020
fc receptor-mediated phagocytosis requires cdc42 and rac1.	at the surface of phagocytes, antibody-opsonized particles are recognized by surface receptors for the fc portion of immunoglobulins (fcrs) that mediate their capture by an actin-driven process called phagocytosis which is poorly defined. we have analyzed the function of the rho proteins rac1 and cdc42 in the high affinity receptor for ige (fcepsilonri)-mediated phagocytosis using transfected rat basophil leukemia (rbl-2h3) mast cells expressing dominant inhibitory forms of cdc42 and rac1. bindi ...	1998	9799231
prevention of iatrogenic illness: adverse drug reactions and nosocomial infections in hospitalized older adults.	adverse drug reactions and nosocomial infections are two important aspects of iatrogenesis in hospitalized older adults. adverse drug reactions are related to changes in pharmacodynamics and pharmacokinetics that occur with aging as well as polypharmacy. strategies for limiting iatrogenesis due to medications are discussed. nosocomial infections continue to complicate older inpatients' care despite advances in understanding and treating institutional infections. in particular, urinary tract infe ...	1998	9799474
clostridium difficile infection in patients with reactive arthritis of undetermined etiology.	in this study clostridium difficile infection, which has been reported to induce reactive arthritis (rea), was investigated in patients with rea of undetermined etiology. one hundred patients with acute arthritis were included to in the study. the diagnosis of arthritis and/or infectious agents that are capable of causing rea were determined in 69 of them. the remaining 31 patients (study group) with rea of undetermined etiology were further investigated for c. difficile toxin a (cdta). the cont ...	1998	9808399
isolation and characterization of two bacteriocins of lactobacillus acidophilus lf221.	lactobacillus acidophilus lf221 produced bacteriocin-like activity against different bacteria including some pathogenic and food-spoilage species. besides some lactic acid bacteria, the following species were inhibited: bacillus cereus, clostridium sp., listeria innocua, staphylococcus aureus, streptococcus d. l. acidophilus lf221 produced at least two bacteriocins, acidocin lf221 a and acidocin lf221 b, which were purified by ammonium sulphate precipitation, ion-exchange chromatography, hydroph ...	1998	9650259