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clostridium difficile associated diarrhoea in hospitalised patients: onset in the community and hospital and role of flexible sigmoidoscopy.clostridium difficile associated diarrhoea (cdad) is a hospital acquired infection in which optimal methods for diagnosis and the scale of the problem in the community remain to be determined. in hospitalised patients with cdad, we aimed to (i) study patients in whom the onset of diarrhoea was in the community and (ii) investigate the role of bedside flexible sigmoidoscopy in diagnosis.200415082585
radiology quiz case 2. cervical necrotizing fasciitis (cnf), odontogenic origin. 200415096437
factors associated with failure of metronidazole in clostridium difficile-associated disease.to identify patients likely to fail metronidazole as initial treatment of c. difficile infection.200415100520
clostridium difficile toxin a carboxyl-terminus peptide lacking adp-ribosyltransferase activity acts as a mucosal adjuvant.the receptor binding domains of the most potent mucosal adjuvants, bacterial toxins and plant lectins, are organized in repeat units to recognize specific sugar residues. the lectin-like structure of the c-terminal region of clostridium difficile toxin a prompted us to investigate the mucosal adjuvant properties of a nontoxigenic peptide corresponding to amino acids 2394 to 2706 (txa(c314)). we compared txa(c314) adjuvant activity to those of cholera toxin (ct) and escherichia coli heat-labile e ...200415102793
the host cell chaperone hsp90 is necessary for cytotoxic action of the binary iota-like toxins.the heat shock protein hsp90 is essential for uptake of the binary actin adp-ribosylating toxins clostridium perfringens iota-toxin and clostridium difficile transferase into eukaryotic cells. inhibition of hsp90 by its specific inhibitor radicicol delayed intoxication of vero cells by these toxins. a common hsp90-dependent mechanism for their translocation is discussed.200415102823
leukemoid reaction due to clostridium dificile infection in acquired immunodeficiency syndrome: two case reports and a review of the literature.the clinical presentation of colitis associated with clostridium difficile infection in immunosuppressed patients with acquired immunodeficiency syndrome (aids) has not been completely characterized. previous reports suggest that these patients present with low blood leukocyte counts, consistent with the impaired myelopoiesis that can occur with human immunodeficiency virus (hiv) infection. in contrast, we describe the cases of two patients with colitis associated with c difficile infection who ...200415108834
provision of alcohol hand rub at the hospital bedside: a case study.a pilot study was performed on a 28-bed acute hospital ward, promoting hand disinfection by providing sterillium alcohol hand rub at the bedside. bottles of sterillium with pump dispensers were attached to the end of each patient's bed, next to the observation charts. posters promoting the use of the product were prominently displayed and several ward staff attended a presentation on the effectiveness of sterillium. although this was a small study, alert organism rates during the three-month tri ...200415110116
clinical manifestations and outcome of pseudomembranous colitis in an elderly population in israel.pseudomembranous colitis is a well-recognized cause of diarrhea in patients receiving antibiotics and has significant consequences in terms of morbidity, mortality and cost. clostridium difficile infection is the single most important infectious cause of pmc. pmc is frequently nosocomial, with an increased risk of spread among institutionalized patients, both in hospitals and nursing homes.200415115256
secular trends in hospital-acquired clostridium difficile disease in the united states, 1987-2001.we reviewed clostridium difficile-associated disease (cdad) data from the intensive care unit (icu) and hospital-wide surveillance components of the national nosocomial infections surveillance system hospitals during 1987-2001. icu cdad rates increased significantly only in hospitals with >500 beds (p<.01) and correlated with the duration of icu stay (r=0.82; p<.05). hospital-wide (non-icu) rates increased only in hospitals with <250 beds (p<.01) and in general medicine patients versus surgery p ...200415116293
microbial-gut interactions in health and disease. antibiotic-associated diarrhoea.most cases of antibiotic-associated diarrhoea (aad) are directly or indirectly due to the alteration of gut microflora by antibiotics. 'functional' diarrhoea, usually limited to a mild and brief change in stool frequency, is considered as the most frequent pattern of aad. reduced carbohydrate fermentation and impaired metabolism of bile acids have been claimed as the potential causes of this transient digestive discomfort but a critical analysis of the data supporting these theories is necessary ...200415123074
microbial-gut interactions in health and disease. mucosal immune responses.the host gastrointestinal tract is exposed to countless numbers of foreign antigens and has embedded a unique and complex network of immunological and non-immunological mechanisms, often termed the gastrointestinal 'mucosal barrier', to protect the host from potentially harmful pathogens while at the same time 'tolerating' other resident microbes to allow absorption and utilization of nutrients. of the many important roles of this barrier, it is the distinct responsibility of the mucosal immune ...200415123077
phosphatidylinositol 4,5-bisphosphate regulates adipocyte actin dynamics and glut4 vesicle recycling.to investigate the potential role of phosphatidylinositol 4, 5-bisphosphate (pi(4,5)p2) in the regulation of actin polymerization and glut4 translocation, the type i phosphatidylinositol 4-phosphate 5-kinases (pip5ks) were expressed in 3t3l1 adipocytes. in preadipocytes (fibroblasts) pip5k expression promoted actin polymerization on membrane-bound vesicles to form motile actin comets. in contrast, expression of pip5k in differentiated 3t3l1 adipocytes resulted in the formation of enlarged vacuol ...200415123724
"collateral damage" from cephalosporin or quinolone antibiotic therapy."collateral damage" is a term used to refer to ecological adverse effects of antibiotic therapy; namely, the selection of drug-resistant organisms and the unwanted development of colonization or infection with multidrug-resistant organisms. the risk of such damage can be assessed for different antibiotic classes by a variety of epidemiologic studies. cephalosporin use has been linked to subsequent infection with vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing klebsie ...200415127367
minimizing the threat of c. difficile.learn the signs and symptoms of clostridium difficile-associated diarrhea (cdad), outline infection control measures to help stop its spread and review treatment regimens.200015127529
national clostridium difficile standards group: report to the department of health. 200415129935
prevalence and characterization of a binary toxin (actin-specific adp-ribosyltransferase) from clostridium difficile.in addition to the two large clostridial cytotoxins (tcda and tcdb), some strains of clostridium difficile also produce an actin-specific adp-ribosyltransferase, called binary toxin cdt. we used a pcr method and southern blotting for the detection of genes encoding the enzymatic (cdta) and binding (cdtb) components of the binary toxin in 369 strains isolated from patients with suspected c. difficile-associated diarrhea or colitis. twenty-two strains (a prevalence of 6%) harbored both genes. when ...200415131151
getting "c diff" under control. 200415132050
attenuation regulation of amino acid biosynthetic operons in proteobacteria: comparative genomics analysis.candidate attenuators were identified that regulate operons responsible for biosynthesis of branched amino acids, histidine, threonine, tryptophan, and phenylalanine in gamma- and alpha-proteobacteria, and in some cases in low-gc gram-positive bacteria, thermotogales and bacteroidetes/chlorobi. this allowed us not only to describe the evolutionary dynamics of regulation by attenuation of transcription, but also to annotate a number of hypothetical genes. in particular, orthologs of ygea of esche ...200415135544
microbial contamination of drinking water and disease outcomes in developing regions.drinking water is a major source of microbial pathogens in developing regions, although poor sanitation and food sources are integral to enteric pathogen exposure. gastrointestinal disease outcomes are also more severe, due to under-nutrition and lack of intervention strategies in these regions. poor water quality, sanitation and hygiene account for some 1.7 million deaths a year world-wide (3.1% of all deaths and 3.7% of all daly's), mainly through infectious diarrhoea. nine out of 10 such deat ...200415138046
antimicrobial susceptibility of equine and environmental isolates of clostridium difficile.the antimicrobial susceptibility of 50 clostridium difficile isolates, 36 of them from horse feces and 14 from environmental sites, was determined by broth microdilution. the antimicrobial agents tested were avilamycin, cephalothin, chloramphenicol, clindamycin, erythromycin, gentamicin, neomycin, oxacillin, oxytetracycline, penicillin, spiramycin, streptomycin, trimethoprim/sulfamethoxazole, vancomycin, and virginiamycin. all isolates were susceptible to vancomycin (mic </=1 microg/ml). the mic ...200415140395
differential effects of varying concentrations of clostridium difficile toxin a on epithelial barrier function and expression of cytokines.presentation after clostridium difficile infection may depend on the level of epithelial exposure to toxins. we investigated epithelial barrier function and expression of interleukin (il)-8 and transforming growth factor (tgf)-beta in response to varying concentrations of c. difficile toxin a.200415143480
cytosol-derived proteins are sufficient for arp2/3 recruitment and arf/coatomer-dependent actin polymerization on golgi membranes.the actin cytoskeleton has been implicated in protein trafficking at the golgi apparatus and in golgi orientation and morphology. actin dynamics at the golgi are regulated in part by recruiting cdc42 or rac to the membrane through a binding interaction with the coatomer-coated (copi)-vesicle coat protein, coatomer. this leads to actin polymerization through the effector, n-wasp and the arp2/3 complex. here, we have used reconstitution of vesicle budding to test whether arp2/3 is recruited to mem ...200415147909
treatment of clostridium difficile infection.with the introduction of broad-spectrum antibiotics into clinical practice, clostridium difficile infection has become the most common cause of infectious diarrhea in hospitalized patients. although mild cases may resolve by discontinuing antibiotics, thus allowing re-establishment of colonic microflora, oral metronidazole or vancomycin is indicated if the process is more severe. metronidazole may be given intravenously, with intracolonic therapeutic levels achieved by excretion of drug into bil ...200415149585
inhibition of clostridium difficile strains by intestinal lactobacillus species.indigenous intestinal microflora (including lactobacilli) has an important role in protection against clostridium difficile infection. to assess in vitro interaction between lactobacilli and c. difficile, antagonistic activity of 50 intestinal lactobacillus spp. strains against 23 pathogenic c. difficile strains was determined. phenotypic properties of c. difficile strains [production of short-chain fatty acids (scfas) and toxin a, and antimicrobial susceptibility] and lactobacilli (production o ...200415150337
subunit composition of the glycyl radical enzyme p-hydroxyphenylacetate decarboxylase. a small subunit, hpdc, is essential for catalytic activity.p-hydroxyphenylacetate decarboxylase from clostridium difficile catalyses the decarboxylation of p-hydroxyphenylacetate to yield the cytotoxic compound p-cresol. the three genes encoding two subunits of the glycyl-radical enzyme and the activating enzyme have been cloned and expressed in escherichia coli. the recombinant enzymes were used to reconstitute a catalytically functional system in vitro. in contrast with the decarboxylase purified from c. difficile, which was an almost inactive homo-di ...200415153112
efficacy of oral ramoplanin for inhibition of intestinal colonization by vancomycin-resistant enterococci in mice.ramoplanin is a glycolipodepsipeptide antibiotic with activity against gram-positive bacteria that is in clinical trials for prevention of vancomycin-resistant enterococcus (vre) bloodstream infections and treatment of clostridium difficile diarrhea. orally administered ramoplanin suppresses vre intestinal colonization, but recurrences after discontinuation of treatment have frequently been observed. we used a mouse model to examine the efficacy of ramoplanin for inhibition of vre colonization a ...200415155213
in vitro activities of the new semisynthetic glycopeptide telavancin (td-6424), vancomycin, daptomycin, linezolid, and four comparator agents against anaerobic gram-positive species and corynebacterium spp.telavancin is a new semisynthetic glycopeptide anti-infective with multiple mechanisms of action, including inhibition of bacterial membrane phospholipid synthesis and inhibition of bacterial cell wall synthesis. we determined the in vitro activities of telavancin, vancomycin, daptomycin, linezolid, quinupristin-dalfopristin, imipenem, piperacillin-tazobactam, and ampicillin against 268 clinical isolates of anaerobic gram-positive organisms and 31 corynebacterium strains using agar dilution meth ...200415155214
in vitro activity of opt-80 against clostridium difficile.clostridium difficile remains the major cause of nosocomial diarrhea. reports on impaired susceptibility of c. difficile to metronidazole and vancomycin and frequent relapses of patients after therapy necessitate the search for new substances. with this study, the activity of opt-80, a new macrocycle, against 207 c. difficile strains and against other obligately anaerobic bacteria was tested. opt-80 showed high in vitro activity against all c. difficile strains tested.200415155234
corticotropin-releasing hormone (crh) requirement in clostridium difficile toxin a-mediated intestinal inflammation.clostridium difficile, the causative agent of antibiotic-associated colitis, mediates inflammatory diarrhea by releasing toxin a, a potent 308-kda enterotoxin. toxin a-induced inflammatory diarrhea involves many steps, including mucosal release of substance p (sp) corticotropin-releasing hormone (crh) and neutrophil transmigration. here we demonstrate that, compared with wild type, mice genetically deficient in crh (crh(-/-)) have dramatically reduced ileal fluid secretion, epithelial cell damag ...200415159534
competitive inhibition of adherence of enterotoxigenic escherichia coli, enteropathogenic escherichia coli and clostridium difficile to intestinal epithelial cell line lovo by purified adhesin of bifidobacterium adolescentis 1027.to observe competitive inhibition of adherence of enterotoxigenic escherichia coli (etec), enteropathogenic escherichia coli (epec) and clostridium difficile (c. difficile) to intestinal epithelial cell line lovo by purified adhesin of bifidobacterium adolescentis 1027 (b. ado 1027).200415162538
a double-blind randomized controlled trial of fusidic acid and metronidazole for treatment of an initial episode of clostridium difficile-associated diarrhoea.few treatment options are currently available to treat patients suffering from an initial episode of clostridium difficile-associated diarrhoea (cdad).200415163651
long-term surveillance of cefotaxime and piperacillin-tazobactam prescribing and incidence of clostridium difficile diarrhoea.we followed the effects of changes to a new antibiotic policy favouring a ureidopenicillin as opposed to a third-generation cephalosporin on the long-term incidence of clostridium difficile diarrhoea (cdd) and antibiotic utilization in a large elderly medicine unit.200415163654
[a nosocomial outbreak of diarrhea caused by toxin a-negative, toxin b-positive clostridium difficile in a cancer center hospital].between february and july 2001, 15 patients were diagnosed as clostridium difficile-associated diarrhea in a ward of hematological neoplasm and lung cancer in a cancer center hospital. of these 15 patients, 10 had malignant lymphoma, and 12 and 11 had exposure to antimicrobial agents and cancer chemotherapy, respectively, before the onset of diarrhea. toxin a-positive, toxin b-positive (a+ b+) c. difficile was recovered from five patients and the remaining 10 patients suffered from diarrhea caus ...200415176235
clostridium difficile pilot study: effects of probiotic supplementation on the incidence of c. difficile diarrhoea.colonic infection with clostridium difficile, leading to pseudomembranous colitis, is a common complication of antibiotic therapy, especially in elderly patients. it has been suggested that non-pathogenic probiotic bacteria might prevent the development and recurrence of c. difficile infection. this double-blind, placebo-controlled study examines the role of probiotic administration in the prevention of c. difficile-associated diarrhoea (cdad) in elderly patients receiving antibiotic therapy. co ...200415179608
the effect of perasafe and sodium dichloroisocyanurate (nadcc) against spores of clostridium difficile and bacillus atrophaeus on stainless steel and polyvinyl chloride surfaces.clostridium difficile is an important cause of nosocomial diarrhoea. the aim of this study was to evaluate the potential for perasafe, a recently introduced biocide, to contribute to control of c. difficile spores in the patient environment, in comparison with the chlorine-releasing agent sodium dichloroisocyanurate (nadcc). these agents were evaluated against a water control, in a surface test on stainless steel and polyvinyl chloride (pvc) floor covering, materials commonly found in the hospit ...200415183245
multilocus sequence typing analysis of human and animal clostridium difficile isolates of various toxigenic types.a multilocus sequence typing (mlst) scheme was developed to study the genetic relationships and population structure of 72 clostridium difficile isolates from various hosts, geographic sources, pcr ribotypes, and toxigenic types (determined by pcr targeting tcda and tcdb genes). mlst was performed by dna sequence analysis of seven housekeeping genes (aroe, ddl, duta, tpi, reca, gmk, and soda). the number of alleles ranged from five (duta and ddl) to eleven (reca). allelic profiles allowed the de ...200415184441
intestinal microecology and quality of life in irritable bowel syndrome patients.it has been noticed that gastroenteritis or dysentery plays a role in pathogenesis of irritable bowel syndrome (ibs), and antibiotics can increase functional abdominal symptoms, both of which may be partly due to intestinal flora disorders. this study was to determine the change of gut flora of ibs, a cluster of abdominal symptoms. because of the chronic course and frequent occurrence of the disease, ibs patients suffered much from it. so the quality of life (qol) of ibs patients was also evalua ...200415188510
do infection control measures work for methicillin-resistant staphylococcus aureus?to review evidence regarding the effectiveness of control measures in reducing transmission of methicillin-resistant staphylococcus aureus (mrsa) in hospitals.200415188845
failure to develop vancomycin-resistant enterococcus with oral vancomycin treatment of clostridium difficile.oral vancomycin therapy has been a risk factor for turning culture positive for vancomycin-resistant enterococcus (vre). vre colonization status was reviewed for all patients who received oral vancomycin and underwent prospective cultures.200415188848
[preparation and characterization of monoclonal antibody against clostridium difficile toxin a].to prepare monoclonal antibodies (mabs) against clostridium difficile toxin a and identify their properties.200415193243
commentary: bartlett jg, onderdonk ab, cisneros rl, kasper dl. clindamycin-associated colitis due to a toxin-producing species of clostridium in hamsters. j infect dis 1977; 136:701. 200415195263
human antibody response to surface layer proteins in clostridium difficile infection.clostridium difficile is a major cause of infectious diarrhoea in hospitalised patients. surface layer proteins (slps) are the most abundant surface localised proteins expressed by c. difficile. the aim of this study was to examine the humoral immune response to c. difficile slps and its potential role in protection from c. difficile associated diarrhoea (cdad). serum antibodies to slps from c. difficile were measured by elisa in a cohort of 146 patients (55 patients with cdad, 34 asymptomatic c ...200415196573
antibiotic prescribing policy and clostridium difficile diarrhoea.broad-spectrum antibiotics, particularly intravenous cephalosporins, are associated with clostridium difficile diarrhoea. diarrhoea due to c. difficile is a growing problem in hospitals, especially among elderly patients.200415208430
clostridium difficile colitis: the challenge continues. 200315212054
in-vitro activity of nisin against clinical isolates of clostridium difficile.nisin is a cationic peptide produced by lactococcus lactis. its activity against clinical isolates of clostridium difficile was compared to that of vancomycin and metronidazole by minimum inhibitory concentration (mic), minimum bactericidal concentration (mbc) and time-kill studies. nisin was more active than the other agents, with a mic90 of 0.256 mg/l and strong bactericidal activity. nisin may be a promising agent for the management of c. difficile associated diarrhea.200415216943
bacillus clausii probiotic strains: antimicrobial and immunomodulatory activities.the clinical benefits observed with probiotic use are mainly attributed to the antimicrobial substances produced by probiotic strains and to their immunomodulatory effects. currently, the best-documented probiotic bacteria used in human therapy are lactic acid bacteria. in contrast, studies aiming to characterize the mechanisms responsible for the probiotic beneficial effects of bacillus are rare. the current work seeks to contribute to such characterization by evaluating the antimicrobial and i ...200415220667
bacteriotherapy using fecal flora: toying with human motions.the intestinal flora may play a key role in the pathogenesis of certain gastrointestinal (gi) diseases. components of bowel flora such as lactobacillus acidophilus and bifidobacterium bifidus have long been used empirically as therapeutic agents for gi disorders. more complex combinations of probiotics for therapeutic bacteriotherapy have also recently become available, however the most elaborate mix of human-derived probiotic bacteria is, by definition, the entire fecal flora. fecal bacteriothe ...200415220681
clostridium difficile colitis in patients after kidney and pancreas-kidney transplantation.limited data exist about clostridium difficile colitis (cdc) in solid organ transplant patients. between 1/1/99 and 12/31/02, 600 kidney and 102 pancreas-kidney allograft recipients were transplanted. thirty-nine (5.5%) of these patients had cdc on the basis of clinical and laboratory findings. of these 39 patients, 35 have information available for review. cdc developed at a median of 30 days after transplantation, and the patients undergoing pancreas-kidney transplantation had a slightly highe ...200415225221
large clostridial cytotoxins: cellular biology of rho/ras-glucosylating toxins.mono-o-glycosylation of eukaryotic target proteins is the molecular mechanism of bacterial protein toxins of the family of large clostridial cytotoxins. this toxin family encompasses several high molecular mass proteins (>250 kda) of various clostridia species that are implicated in severe human diseases. toxin a and toxin b from clostridium difficile are the causative agents of pseudomembranous colitis and antibiotic-associated diarrhea. lethal toxin and hemorrhagic toxin from clostridium sorde ...200415238250
first, the bad news... 200415238469
hospitals battling outbreaks of c. difficile. 200415238481
clostridium difficile infection in hospitals: a brewing storm. 200415238490
risk of clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies.antibiotic disruption of the normal intestinal flora is a well-known risk factor for clostridium difficile-associated diarrhea. reduced gastric acidity has been suggested as a risk factor, and we hypothesized that proton pump inhibitors, because of their potency, may be an independent risk factor for this problem.200415238493
clostridium difficile infection in hospitals: risk factors and responses. 200415238495
clostridium difficile: a formidable foe. 200415238496
clostridium difficile-associated diarrhea in adults.clostridium difficile is the most important cause of nosocomial diarrhea in adults. illness may range from mild watery diarrhea to life-threatening colitis. an antecedent disruption of the normal colonic flora followed by exposure to a toxigenic strain of c. difficile are necessary first steps in the pathogenesis of disease. diagnosis is based primarily on the detection of c. difficile toxin a or toxin b. first-line treatment is with oral metronidazole therapy. treatment with oral vancomycin the ...200415238498
toxin binding of tolevamer, a polyanionic drug that protects against antibiotic-associated diarrhea.tolevamer, (gt160-246), is a sodium salt of styrene sulfonate polymer that is under development for the treatment of diarrhea caused by infection with clostridium difficile. pulsed ultrafiltration binding experiments in phosphate buffer containing 0.15 m na(+) provide per polymer chain dissociation constants of 133 nm and 8.7 microm for the binding of tolevamer to c. difficile toxins a and b, respectively. at 0.05 m na(+), the binding of toxin a to tolevamer is irreversible, whereas the dissocia ...200415240486
nosocomial diarrhoea due to clostridium difficile.the purpose of this review is to summarize recent developments in the diagnosis, epidemiology, treatment and prevention of nosocomial diarrhoea due to clostridium difficile.200415241076
metalloproteinase-dependent transforming growth factor-alpha release mediates neurotensin-stimulated map kinase activation in human colonic epithelial cells.expression of the neuropeptide neurotensin (nt) and its high affinity receptor (ntr1) is increased during the course of clostridium difficile toxin a-induced acute colitis, and ntr1 antagonism attenuates the severity of toxin a-induced inflammation. we recently demonstrated in non-transformed human colonic epithelial ncm460 cells that nt treatment caused activation of a ras-mediated map kinase pathway that significantly contributes to nt-induced interleukin-8 (il-8) secretion. here we used ncm46 ...200415247267
interactions between lactobacilli and antibiotic-associated diarrhea. 200415251283
clostridium difficile and acute respiratory distress syndrome. 200415252417
enteric infection in relapse of inflammatory bowel disease: importance of microbiological examination of stool.previous reports have suggested that diarrhoeal relapses of inflammatory bowel disease (ibd) may be associated or confused with enteric infection, and that treatment of such infections with appropriate antibiotics may be beneficial. to re-evaluate the suggestion that enteric infection is rare and microbiological testing of stool not routinely necessary in patients presenting with relapse of ibd, we have reviewed the incidence of concurrent infection in patients presenting in relapse over a recen ...200415256979
quebec strikes committee on clostridium difficile. 200415262874
cloning and expression of clostridium difficile toxin a gene (tcda) by pcr amplification and use of an expression vector.toxigenic clostridium difficile isolates harbor a 19 kb pathogenicity locus that encodes the genes for toxins a and b. toxins a and b are among the largest known bacterial toxins expressing potent cytotoxicity and enterotoxicity, and thus the major virulence factors in c. difficile associated diarrhea. cloning and sequencing of toxin genes is of interest for studies of molecular pathogenesis. we report the amplification and cloning of the complete toxin a gene into an escherichia coli expression ...200415271388
clostridium difficile diarrhoea in the immunosuppressed patient--update on prevention and management. 200415280518
probiotics in relapsing and chronic diarrhea.diarrhea is common in oncology patients; if it becomes chronic and relapsing, it can be debilitating, hinder planned management, and be difficult to treat. the authors describe two patients, one with leukemia who developed recurrent clostridium difficile colitis and another who developed chronic diarrhea after bone marrow transplantation. in both patients, administration of antibiotics was suspected as the cause. in one patient, relapsing diarrhea resolved after probiotics were given with a 2-da ...200415284590
clinical application of polymerase chain reaction to diagnose clostridium difficile in hospitalized patients with diarrhea.clostridium difficile is a common cause of diarrhea in hospitalized patients and is associated with significant morbidity and cost. the current diagnostic standard, enzyme immunoassay (eia), has low sensitivity, leading to duplicate testing and empiric treatment. we sought to show the usefulness and potential cost effectiveness of polymerase chain reaction (pcr) amplification of toxin b gene for diagnosis of c. difficile-induced diarrhea.200415290659
[six years evaluation of clostridium difficile associated diarrhea].this study was aimed to detect the presence of clostridium difficile toxin in the stool samples of patients with antibiotic-associated diarrhea or pseudomembranous colitis, and to relate its presence with the clinical findings of the patients. between january 1997-april 2003, a total of 726 stool samples were investigated for c. difficile toxin a and/or b by enzyme immunoassay. of them, 68 (9.4%) were found positive for c. difficile toxin (62 were toxin a, 6 were toxin b). c. difficile associate ...200415293901
lysophospholipids increase icam-1 expression in huvec through a gi- and nf-kappab-dependent mechanism.lysophosphatidic acid (lpa) and sphingosine 1-phosphate (s-1-p) are both low molecular weight lysophospholipid (lpl) ligands that are recognized by the edg family of g protein-coupled receptors. in endothelial cells, these two ligands activate edg receptors, resulting in cell proliferation and cell migration. the intercellular adhesion molecule-1 (icam-1, cd54) is one of many cell adhesion molecules belonging to the immunoglobulin superfamily. this study showed that lpa and s-1-p enhance icam-1 ...200415294853
molecular epidemiology of hospital-associated and community-acquired clostridium difficile infection in a swedish county.all episodes of clostridium difficile associated diarrhea (cdad) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. the annual cdad incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. the incidence among hospitalized individuals was 1,300-f ...200415297509
multicenter evaluation of a new screening test that detects clostridium difficile in fecal specimens.clostridium difficile causes approximately 25% of nosocomial antibiotic-associated diarrheas and most cases of pseudomembranous colitis. we evaluated c. diff chek, a new screening test that detects glutamate dehydrogenase of c. difficile. our results showed that this test was comparable to pcr in sensitivity and specificity and outperformed bacterial culture.200415297543
elemental diet modulates the growth of clostridium difficile in the gut flora.tube feeding is regarded as a risk factor for clostridium difficile-associated diarrhoea. recently, we reported that c. difficile toxin was frequently found in patients receiving an elemental diet. the present study was conducted to clarify whether elemental diets are associated with the growth of c. difficile in the gut flora.200415298621
hyperosmotic stress induces rapid focal adhesion kinase phosphorylation at tyrosines 397 and 577. role of src family kinases and rho family gtpases.hyperosmotic stress induced by treatment of swiss 3t3 cells with the non-permeant solutes sucrose or sorbitol, rapidly and robustly stimulated endogenous focal adhesion kinase (fak) phosphorylation at tyr-397, the major autophosphorylation site, and at tyr-577, within the kinase activation loop. hyperosmotic stress-stimulated fak phosphorylation at tyr-397 occurred via a src-independent pathway, whereas tyr-577 phosphorylation was completely blocked by exposure to the src family kinase inhibitor ...200415302877
the role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens.the intestinal tract provides an important reservoir for many nosocomial pathogens, including enterococcus species, enterobacteriaciae, clostridium difficile, and candida species. these organisms share several common risk factors and often coexist in the intestinal tract. disruption of normal barriers, such as gastric acidity and the indigenous microflora of the colon, facilitates overgrowth of pathogens. factors such as fecal incontinence and diarrhea contribute to the subsequent dissemination ...200415307031
antibiotic agents in the elderly.diagnosis and treatment of infections in the elderly is challenging and complicated because of age-related physiologic changes and lack of classical clinical symptoms. elderly patients are more vulnerable to infections because of their underlying diseases. this article reviews the pharmacologic issues in treating the elderly with antibiotics, the most frequently encountered infections in this patient population, and the suggested antibiotic regimens. the discussion also includes the special chal ...200415308275
development of an elisa kit using monoclonal antibody to clostridium difficile toxin a.to establish an elisa kit using monoclonal antibodies against clostridium difficile (c. difficile) toxin a.200415309733
simplified purification method for clostridium difficile toxin a.to establish the purification method for clostridium difficile (c. difficile) toxin a.200415309736
informing the public. 200415313968
distribution of clostridium difficile variant toxinotypes and strains with binary toxin genes among clinical isolates in an american hospital.genetic variants of clostridium difficile have been reported with increasing frequency, but their true incidence is unknown. c. difficile strains have been classified into variant toxinotypes according to variations in the pathogenicity locus encoding the major virulence factors, toxins a and b. some strains produce an additional toxin, binary toxin cdt. this survey of clinical isolates (153) from patients in a single hospital set out to ascertain the distribution of variant toxinotypes and stra ...200415314196
[clostridium difficile, nosocomial enteropathogen: phylogeny and virulence].clostridium difficile is recognized as a potentially nosocomial enteric pathogen. it induces diarrhea or pseudomembranous colitis in patients whose digestive flora has been altered by antibiotic treatment and thus allows the colonization with a strain producing toxin a (enterotoxin) and toxin b (cytotoxin) (a+b+, sometimes a-b+ strains). we studied the phylogeny of c. difficile by developing multilocus sequence typing (mlst) analysis, which reports allelic polymorphism of housekeeping genes thro ...200415314577
the prevention of clostridium difficile associated diarrhoea in hospital.the number of health care-associated infections has increased over the years and generated a lot of interest and concern. the attention tends to be focused on methicillin-resistant staphylococcus aureus (mrsa), but the less publicised clostridium difficile is a growing problem. it increases length of hospital stay, causes significant morbidity in patients, affects nurses' workloads, adds to the cost of cleaning, laundry and disposables, and can lead to ward closures. all nhs trusts in england ar ...200415318695
prevalence of clostridium difficile-associated diarrhoea among hospitalized jordanian patients.we investigated stool specimens of 400 patients at jordan university hospital (300 patients with clinical diarrhoea and 100 controls without diarrhoea) for the presence of clostridium difficile or its toxin. we found a 9.7% prevalence rate of c. difficile or its toxin in stools of patients with diarrhoea. the prevalence of other potential enteric pathogens, such as salmonella spp. (2.3%), shigella spp. (1.0%) and entamoeba histolytica (2.7%), was significantly less. prevalence of c. difficile or ...200115332775
colonic iga producing cells and macrophages are reduced in recurrent and non-recurrent clostridium difficile associated diarrhoea.in clostridium difficile associated diarrhoea (cdad), histological changes in the colonic mucosa range from minimal inflammation to pseudomembranous colitis (pmc). the disease also recurs in a considerable proportion of patients.200415333661
the cme gene of clostridium difficile confers multidrug resistance in enterococcus faecalis.antibiotic resistance in c. difficile by efflux has been previously suggested. the genome of c. difficile 630 was screened for sequences encoding putative proteins homologous to nora from staphylococcus aureus. four orfs homologous to efflux genes were cloned into the pat79 shuttle vector under the control of transcription and translation signals of gram-positive bacteria and expressed in enterococcus faecalis jh2-2 and s. aureus rn4220. one of these sequences, designated cme conferred resistanc ...200415336408
nosocomial infections: what needs to be done? 200415337706
c. difficile hits sherbrooke, que., hospital: 100 deaths. 200415337714
clostridium difficile-associated diarrhea in a region of quebec from 1991 to 2003: a changing pattern of disease severity.recent reports suggest that clostridium difficile colitis may be evolving into a more severe disease. during the second half of 2002 we noted an increase in the number of patients with severe c. difficile-associated diarrhea (cdad) in our institution. we describe cases of cdad at our institution over a 13-year period and investigate changes in illness severity.200415337727
clostridium difficile associated with acute colitis in mature horses treated with antibiotics.clostridium (c.) difficile, or its cytoxin, was demonstrated in faecal samples from 10 of 25 (40%) mature horses investigated with acute colitis treated primarily with antibiotics for disorders other than diarrhoea. c. difficile was not found in faecal samples from 140 horses without signs of enteric disorders, from 21 nondiarrhoeic horses treated with antibiotics, nor from 22 horses with colitis untreated with antibiotics. except for c. difficile neither salmonella nor any other investigated in ...199715338908
the association of erythromycin ethylsuccinate with acute colitis in horses in sweden.in sweden there are several reports of mares developing acute colitis while their foals were being treated orally for rhodococcus equi pneumonia with the combination of erythromycin and rifampicin. in this study 6 adult horses were given low oral dosages of these antibiotics, singly or in combination. within 3 days post administration of erythromycin, in one case in combination with rifampicin, 2 horses developed severe colitis (one fatal). clostridium difficile was isolated from one of the hors ...199715338913
staphylococcus aureus and clostridium difficile cause distinct pseudomembranous intestinal diseases.we report simultaneous infections with clostridium difficile and methicillin-resistant staphylococcus aureus (mrsa) in a patient with discrete colonic pseudomembranes typical of c. difficile infection, as well as confluent, loosely adherent pseudomembranes in the small bowel. identification of mrsa in the small bowel pseudomembrane by polymerase chain reaction supports s. aureus as an enteric pathogen.200415356793
effectiveness of environmental and infection control programs to reduce transmission of clostridium difficile. 200415356835
the incidence of clostridium difficile-associated and non-c. difficile-associated diarrhea after use of gatifloxacin and levofloxacin in an acute-care facility. 200415356836
community-acquired clostridium difficile diarrhea caused by binary toxin, toxin a, and toxin b gene-positive isolates in hungary.the aim of this work was to study the toxin types of clostridium difficile isolates originating from different parts of hungary. a pcr method was used for amplification of the two major toxin genes and the binary toxin gene and to detect the deletion or insertion in the 3' end of the toxin a gene. the findings were compared with the results of cytotoxicity assays on the hela cell line. one hundred twelve isolates were tested; the toxin a and toxin b genes were detected in 79 strains by the pcr m ...200415365032
the diagnostic yield of stool pathogen studies during relapses of inflammatory bowel disease.we sought to determine the yield of stool analysis for bacterial culture, ova and parasites, and clostridium difficile toxin in suspected relapses of inflammatory bowel disease (ibd).200415365403
[antibiotic-associated diarrhea]. 200415368187
early cytoskeletal rearrangement during dendritic cell maturation enhances synapse formation and ca(2+) signaling in cd8(+) t cells.the interplay between dendritic cells (dc) and t cells is a dynamic process critically depending on dc maturation. ca(2+) influx is one of the initial events occurring during dc/t cell contacts. to determine how dc maturation influences dc/t cell contacts, time-lapse video microscopy was established using tcr-transgenic cd8(+) t cells from p14 mice. dc maturation shifted dc/t cell contacts from short-lived interactions with transient ca(2+) influx in t cells to long-lasting interactions and sust ...200415368287
clostridium difficile infection in a geriatric ward.in a prospective, longitudinal study we searched for the presence of clostridium difficile in the stools of 100 consecutively hospitalized elderly patients (mean age: 82; sd: 9.5 years). c. difficile was found on admission in 6 patients, 3 of whom were asymptomatic carriers. ten patients acquired c. difficile during hospitalization. four different types of c. difficile were isolated. the various types were clustered in time, indicating that the infection was acquired from the environment.199115374418
dehydration of (r)-2-hydroxyacyl-coa to enoyl-coa in the fermentation of alpha-amino acids by anaerobic bacteria.several clostridia and fusobacteria ferment alpha-amino acids via (r)-2-hydroxyacyl-coa, which is dehydrated to enoyl-coa by syn-elimination. this reaction is of great mechanistic interest, since the beta-hydrogen, to be eliminated as proton, is not activated (pk 40-50). a mechanism has been proposed, in which one high-energy electron acts as cofactor and transiently reduces the electrophilic thiol ester carbonyl to a nucleophilic ketyl radical anion. the 2-hydroxyacyl-coa dehydratases are two-c ...200415374661
colitis in patients with breast carcinoma treated with taxane-based chemotherapy.colitis is a rare but serious gastrointestinal complication associated with taxane-based chemotherapy in patients with cancer. the incidence, clinical presentation, and outcome of colitis in patients with breast carcinoma treated with taxane-based chemotherapy is not known.200415378497
diarrhea in elderly patients due to clostridium difficile associated with salmonella and shigella infection.clostridium difficile is the main cause of nosocomial diarrhea mainly in elderly hospitalized patients and in nursing homes, but less common in the community. we report three elderly patients living in the community, one frail and two in reasonable good health who recently developed diarrhea due to c. difficile associated with salmonella group c in two cases and shigella flexneri in the other. the association with shigella has not previously been reported and there have only been a few cases wit ...200415381346
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