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diarrheal disease due to clostridium difficile in general practice.a total of 288 stool samples from patients attending their general practitioners was examined for the presence of clostridium difficile. c. difficile or its cytotoxin was found in 16 patients (5.5%) and was the most common enteric pathogen detected. most patients had only mild to moderate diarrhea but in the majority of patients the diarrhea was protracted. eleven of the 16 patients had received antimicrobial agents in the 3 mths preceding onset of diarrhea and there was good circumstantial evid ...19911784528
[current status of clostridium difficile: recent advances in diagnostic materials and treatment of colitis and diarrheas associated with antibiotic therapy].clostridium difficile infection covers several clinical pictures which have been identified only recently. the majority are based upon imbalance in the intestinal ecosystem. major advances in recent years concerning this type of infection have involved: a) better knowledge of pathophysiological mechanisms, in particular the demonstration of a 2nd toxin, essential to the understanding of c. difficile infections; b) better codification of the management of these disorders. this is aimed today at t ...19911793250
morphological changes in adherent cells induced by clostridium difficile toxins. 19911794484
detection of clostridium difficile from an enhancement broth by gas-liquid chromatography.gas-liquid chromatography (glc) was used to detect the presence of isocaproic acid produced by clostridium difficile from 54 stool samples grown in cycloserine-cefoxitin broth. isocaproic acid was detected in 12 samples of which 5 were confirmed to be clostridium difficile by culture and biochemical tests. the detection of isocaproic acid by glc together with the presence of presumptive colonies on primary selective culture media provides a more rapid laboratory diagnosis for clostridium diffici ...19911795558
clostridium difficile and its cytotoxin in hospitalized children with acute diarrhea.a total of 498 children, aged 0-14 years, admitted at the b.c. roy memorial hospital for children, calcutta, were investigated for the occurrence of clostridium difficile and its cytotoxin. of the children in the investigation, 369 suffered from acute diarrhea. only 8.4% of these children had c. difficile in fecal samples and in vitro cytotoxin was demonstrated in 7%. in 27 (7.3%) of the patients with acute diarrhea c. difficile was isolated as the only pathogen. in contrast, among 129 control c ...19911797664
comparison of oral cefpodoxime proxetil and penicillin v potassium in the treatment of group a streptococcal pharyngitis/tonsillitis. the cefpodoxime pharyngitis study group.ninety-three patients with a diagnosis of acute pharyngitis/tonsillitis due to streptococcus pyogenes were randomly assigned to receive 100 mg of cefpodoxime proxetil orally with food every 12 hours or 250 mg of penicillin v potassium orally on an empty stomach every six hours. treatment efficacy was evaluated in 30 cefpodoxime-treated and 33 penicillin-treated patients. after 10 days of treatment, s pyogenes was eradicated from the throat culture in 29 of the 30 cefpodoxime-treated patients and ...19911799915
usefulness of semi-quantitative cultures in the diagnosis of clostridium difficile associated disease.semi-quantitative stool cultures on ccfa were compared to cytotoxic assays for the diagnosis of clostridium difficile associated disease (cad). there was a significant correlation between the amount of clostridium difficile growth on ccfa, the presence of cytotoxin and a clinical diagnosis of cad in the 541 initial stool specimens tested.19911810735
clinical manifestation of clostridium difficile enteritis in calcutta.233 cases with acute diarrhoea investigated, clostridium difficile was isolated as a sole pathogen from 17 (7.3%) cases. the major clinical features of these cases were watery diarrhoea (82.4%), bloody stool (17.6%), vomiting (64.8%), fever (17.6%) and abdominal pain (2.5%). fourteen (82.4%) of 17 c difficile isolates were found to produce cytotoxin as detected by verocell assay.19911814901
isolation of a fibroblast mutant resistant to clostridium difficile toxins a and b.a mutant of chinese hamster lung fibroblasts (don cells), resistant against clostridium difficile toxins a and b, was isolated after mutagenization with ethylmethanesulphonate and a two-step selection with toxin b. the mutant, termed cdtr-q, was 10(4) times more resistant to toxin b than wild-type cells and cross-resistant to toxin a (10(3) times more resistant). the resistance was overcome by increasing the dose of toxin. the resistance has been stable after cultivation for 40 generations in th ...19911816487
colonization by clostridium difficile in hospitalized children: risk factors and typification of the isolated strains.the frequency of colonization by clostridium difficile in 273 hospitalized children under 15 years of age was studied. feces were collected from patients attending the infectious disease service at the pediatric hospital imss, during a period of 11 months. no colonization was detected in 16 neonates; whereas 10 of 103 children (9.7%) under one year of age, 7 of 84 children (8.3%) from one to five years and 3 of 70 children (4.2%) from five to 15 years of age were colonized. the use of antibiotic ...19911819972
toxigenicity and adherence in clostridium difficile strains isolated from patients with and without diarrhoea.the mechanisms by which clostridium difficile causes diarrhoea are unknown. the expression of putative virulence factors by 44 clostridium difficile strains isolated from patients with and without diarrhoea was studied. toxins a and b were tested in cho and mrc-5 cells, respectively; adherence was measured in two substrates: hep-2 cells and polystyrene plates. the in vitro expression of toxins a and b by strains isolated from patients with diarrhoea was not significantly different from that by s ...19911819993
in vitro activities of ramoplanin and four glycopeptide antibiotics against clinical isolates of clostridium difficile.seventy strains of clostridium difficile, all isolated from symptomatic patients, were found to be uniformly susceptible to ramoplanin, a new glycolipodepsipeptide antibiotic, and to four glycopeptides (vancomycin, teicoplanin, and two semisynthetic teicoplanin derivatives). ramoplanin is recommended for further evaluation in the treatment of c. difficile-associated disease.19911826593
antibiotic resistance of clostridium difficile isolates.the activity of metronidazole, vancomycin, clindamycin and teicoplanin against clostridium difficile strains isolated from various origins in poland was investigated. mic was determined for metronidazole, clindamycin and teicoplanin. the disc-diffusion method was used for the vancomycin susceptibility test. three out of thirty-eight strains were resistant to vancomycin and twenty-eight were susceptible to teicoplanin. a widespread mic was observed for clindamycin and metronidazole. no correlatio ...19911828756
a family of clostridial and streptococcal ligand-binding proteins with conserved c-terminal repeat sequences.analysis of the derived amino acid sequences of toxins a and b from clostridium difficile has identified an extraordinarily large number of repeat amino acid units in the c-terminal regions of the proteins. nearly one third of each of the proteins consist of repeating units which appear, at least in the case of toxin a, to be responsible for carbohydrate binding. similar repeat units are also found in the c-terminal region of four glucosyltransferases from streptococcus mutans and streptococcus ...19911830357
oral vancomycin-induced rash: case report and review of the literature.disseminated rash and pruritus are described in an 82-year-old woman with chronic renal failure following administration of oral vancomycin hydrochloride 125 mg q6h for the treatment of clostridium difficile colitis. renal function was estimated to be 0.27 ml/s based on a serum creatinine of 177 mumol/l. after eight days of therapy, she developed a slightly raised maculopapular rash on her legs and torso, which spread to her abdomen and arms with continued treatment. vancomycin was discontinued ...19911840008
[generalized toxic symptoms caused by clostridium difficile infection in a patient with wilms' tumor].this case report describes a 15 months-old patient with wilms' tumor, who was treated with radical operation and chemotherapy. during hospitalization the patient suffered from recurrent lung infections, which were treated with appropriate antibiotics. subsequently, the patient developed severe abdominal affection with daily melena, liver and kidney involvement, and generalized edema and hypertension. cl. difficile and its cytotoxin was demonstrated in feces, and the patient was successfully trea ...19911848955
[response of the ird intestinal epithelial cell line to clostridium difficile toxins a and b in rats. effect of saccharomyces boulardii].in vivo, clostridium difficile acts by releasing 2 toxins: toxin a, an enterotoxin, and toxin b, a cytotoxin. this study was performed to determine: a) whether the rat epithelial intestinal cell line ird 98 responds to clostridium difficile toxin a and b; b) whether the yeast saccharomyces boulardii has an effect on this model. evaluation of 3h-thymidine incorporation into ird 98 cells exposed to toxin b revealed that dna synthesis was inhibited for low concentrations (10 ng/ml). for higher conc ...19911849105
clostridium difficile toxin a induces a specific antisecretory factor which protects against intestinal mucosal damage.peroral challenge with toxin a from clostridium difficile induced the formation of antisecretory factor in rats. the animals were given 100 micrograms of the toxin, which was followed by a pronounced diarrhoea and by the appearance of antisecretory factor in the pituitary gland. in electrofocusing, the induced antisecretory factor separated in two peaks (pi 5.4 and 5.0); both fractions showed a lectin-like binding to agarose. the pi 5.4 fraction inhibited cholera toxin as well as toxin a induced ...19911855687
acute abdomen as the first presentation of pseudomembranous colitis.acute abdomen was the presenting manifestation of pseudomembranous colitis in six men who had previously been treated with antibiotics and presented with abdominal distention, pain, fever, and leukocytosis with absent or mild diarrhea. plain abdominal radiographs revealed megacolon in two, combined small and large bowel dilation in three, with one of them showing volvuluslike pattern, and isolated small bowel ileus in one. emergency colonoscopy was performed successfully in all patients and reve ...19911860633
newly documented antimicrobial activity of quinolones.the improved antimicrobial activity of newer fluoroquinolones and novel applications recently found for the drugs already marketed are reviewed. several new compounds are more active against gram-positive bacteria than the presently marketed fluoroquinolones. win 57273, the most potent compound in vitro on a weight basis, is 16 to 128 times more active than ciprofloxacin against various staphylococci, streptococci, enterococcus spp., corynebacterium spp., listeria monocytogenes and bacillus spp. ...19911864284
prevalence of clostridium difficile in hospitalised patients with acute diarrhoea in calcutta.during a 12-month period, clostridium difficile was isolated from 38 (11.1%) of 341 hospitalised patients suffering from acute diarrhoea and from five (3%) of 172 patients as control who were admitted with illnesses other than diarrhoea. it was the sole bacterial pathogen in 31 cases. 87% of the isolates obtained from patients with diarrhoea produced neutralisable cytotoxin. none of these patients had any history of previous treatment using antibiotics. no age or gender-specific high incidence w ...19911869797
[pseudomembranous colitis: a clinical analysis and review of literatures].clostridium difficile has been well known to be a pathogen of pseudomembranous colitis. it is characterized by the formation of elevated plaques and pseudomembranes which result in varying degree of diarrhea. this series analysed 20 cases of pseudomembranous colitis diagnosed at chang gung memorial hospital between january 1985 and december 1989. the male to female ratio was 1:3. their ages ranged between 13 and 81 years, with a mean of 53.7 years. sixteen of our patients claimed to have taken a ...19911878812
[clostridium difficile: a typing method for epidemiological studies].one hundred and twenty two strains of clostridium difficile were studied: 33 strains were isolated from stools of neonates or children, 89 cases of antibiotic associated diarrhea. the strains were identified by biochemical tests and gaz liquid chromatography of the fermentation products. a typing scheme for clostridium difficile were proposed by using a polyacrylamide gel electrophoresis of whole cell proteins. we studied the correlation between this typing and the serogrouping scheme based on s ...19911881693
[secondary penetration of a ventriculo-peritoneal shunt into the intestines. possible cause of a recurring sepsis?].we present a 28-year-old-patient with a severe head injury: skull fractures, epidural hematoma, subarachnoid hemorrhage, glasgow coma score 7, and aspiration following a motorbike accident. a systemic infection with symptoms of shock and staphylococcus aureus in blood culture specimens developed a few days after admission (later staphylococcus epidermidis was also cultured). a posttraumatic hydrocephalus was treated by a ventriculo-peritoneal shunt inserted at mini-laparotomy. in multiple microb ...19911883061
development and application of a multiple typing system for clostridium difficile.a combination of bacteriocin, bacteriophage, and plasmid typing techniques was used to differentiate strains of clostridium difficile. a typing set of 20 bacteriocin-producing strains was established after 400 isolates of c. difficile were screened for the ability to produce bacteriocin. these strains were used to type a collection of 114 isolates of c. difficile. forty-six (40%) of the 114 isolates were typeable, and 31 typing patterns were distinguishable. plasmid typing of the same 114 isolat ...19911892377
[bacterial enterotoxins: structure, mode of action].the enterotoxins are macro-proteins, produced by enterotoxic bacterial strains acting in the human or animal intestine during digestive infections. in most cases, they induce diarrhoea (associated or not with tissue damage). these molecules differ in their structure and mechanism of action. some of them (cholera toxin, escherichia coli lt) activate a cyclase system (adenylate or guanylate cyclase), inducing water and electrolyte flux in the gut. conversely, others (toxins a and b, clostridium di ...19911897866
protection against experimental pseudomembranous colitis in gnotobiotic mice by use of monoclonal antibodies against clostridium difficile toxin a.the pathogenicity of clostridium difficile is due to the production of two toxins (toxins a and b). we prepared monoclonal antibodies against toxin a and determined whether axenic mice passively immunized with the monoclonal antibodies were protected against c. difficile disease. the mice were kept in an isolator and were given ascites fluid intravenously prior to challenge with a toxinogenic strain of c. difficile. control mice and mice receiving ascites fluid devoid of toxin antibody died with ...19911900059
travelers' diarrhea among united states military personnel during joint american-egyptian armed forces exercises in cairo, egypt.a study was conducted of travelers' diarrhea in a united states military population on deployment in cairo, egypt, during july and august 1987. acute diarrhea requiring medical attention developed in 183 (4%) of 4,500 troops. a possible etiologic agent was identified in 49% of all diarrhea cases. enteric pathogens associated with cases of diarrhea included: enterotoxigenic escherichia coli (17% st-producers, 13% lt-producers, and 3% lt/st-producers); shigella (9%); campylobacter spp. (2%); salmo ...19911900113
[antibiotic associated recurrent diarrhea cured with fecal streptococci]. 19911900554
binding kinetics of clostridium difficile toxins a and b to intestinal brush border membranes from infant and adult hamsters.this study was undertaken to determine if the relative resistance of neonates and infants to clostridium difficile-associated intestinal disease can be related to age-dependent differences in intestinal receptors for c. difficile toxins a and b. brush border membranes (bbms) from the small intestines of adult and infant hamsters were examined for their ability to bind radiolabeled toxins a and b. [125i]toxin a bound to both infant and adult hamster bbms at physiological temperature, whereas [125 ...19911900806
treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by clostridium difficile toxin.we tested the hypothesis that children with chronic relapsing colitis induced by clostridium difficile toxin have defective antibody responses to c. difficile toxins as a cause of their underlying illness. six such children were tested for serum igg and iga antibody to c. difficile toxin a. these six children had lower igg anti-toxin a levels than 24 healthy children (p = 0.026) and 18 healthy adults (p = 0.0008). five patients treated with 400 mg intravenously administered gamma-globulin per ki ...19911901084
purification and characterization of s layer proteins from clostridium difficile gai 0714.the s layer of clostridium difficile gai0714 was shown to be composed of two proteins, of 32 kda and 45 kda, as determined by sds-page. the two proteins were extracted with 8 m-urea (ph 8.3) from a cell wall preparation and purified by deae-sepharose cl-6b chromatography followed by hplc gel filtration. when solubilized in 0.1 m-urea, both proteins appeared to exhibit dimeric forms, with respective molecular masses of about 61 kda and 99 kda, upon hplc. although the amino acid compositions of th ...19911901902
molecular screening of clostridium difficile toxins a and b genetic determinants and identification of mutant strains.three separate sets of polymerase chain reaction primers were designed to specifically detect the presence of a toxin a gene fragment, a toxin b gene fragment, and the entire toxin b gene. in addition toxin gene fragments that were amplified from well characterized toxic strains were tagged fluorescently and used as hybridization probes to screen c. difficile strains. a survey of 37 toxic strains and 10 non-toxic strains demonstrated that toxic strains normally contain the genetic composition fo ...19911903351
characterization of rabbit ileal receptors for clostridium difficile toxin a. evidence for a receptor-coupled g protein.the purpose of this study was to characterize the surface receptor for toxin a, the enterotoxin from clostridium difficile, on rabbit intestinal brush borders (bb) and on rat basophilic leukemia (rbl) cells. purified toxin a was radiolabeled using a modified bolton-hunter method to sp act 2 microci/micrograms, with retention of full biologic activity. 3h-toxin a bound specifically to a single class of receptors on rabbit bb and on rbl cells with dissociation constants of 5.4 x 10(-8) and 3.5 x 1 ...19911905325
purification and characterisation of toxin b from a strain of clostridium difficile that does not produce toxin a.most toxigenic strains of clostridium difficile produce both toxin a and toxin b. the toxin produced by c. difficile strain 8864 was characterised and compared with those produced by c. difficile strain 10463. toxin a was not detected by immunoassay in cultures from strain 8864 and all the cytotoxic activity produced by this strain was neutralised by antiserum to toxin b. toxin b from strain 8864 was purified and compared with toxin b from strain 10463. the size of the purified subunits of toxin ...19911906544
enhancement of cell-mediated cytotoxicity by clostridium difficile toxin a: an in vitro study.cells from the immune system exhibiting cytotoxic activity are able to kill tumor or infected cells in a major histocompatibility complex-restricted (cytotoxic lymphocytes) or non-restricted (natural killer cells) manner. in order to exert such a cytotoxicity they have to bind the target cell and release cytotoxic factors able to induce target cell death. treatment of human peripheral blood mononuclear cells with toxin a from clostridium difficile induced an enhancement of the cytotoxic efficien ...19911907410
cytokine response by human monocytes to clostridium difficile toxin a and toxin b.clostridium difficile toxins a and b isolated from strain vpi 10463 were tested for induction of cytokine release by human monocytes. toxin b at 10(-12) m activated human monocytes as measured by release of interleukin-1 (il-1), tumor necrosis factor (tnf), or il-6. these effects of toxin b were heat labile (51 degrees c, 30 min). toxin b was as effective as bacterial lipopolysaccharides in inducing il-1 beta but less effective in inducing tnf or il-6. toxin b and lipopolysaccharides were synerg ...19911910012
modulation of clostridium difficile induced mortality as a function of the dose and the viability of the saccharomyces boulardii used as a preventative agent in gnotobiotic mice.the ability of viable and nonviable saccharomyces boulardii to protect gnotobiotic mice from clostridium difficile induced mortality was tested. with the exception of irradiated s. boulardii, which retained some activity, only viable yeast protected the mice from lethality. the survival of c. difficile infected mice was dependent on the dose of the yeast provided in the drinking water.19911913342
new clostridium difficile serotypes in poland.polish isolates of clostridium difficile strains of different origin were studied. all strains were serotyped according to the delmee scheme. twenty-one strains remained untypeable. by typing them with antisera against 5 polish strains we observed 5 new serotypes.19911915796
production of monoclonal antibody to clostridium difficile toxin a which neutralizes enterotoxicity but not haemagglutination activity.nine monoclonal antibodies (mab) to clostridium difficile toxin a were produced. the isotype of one mab (37b5) was igg2b, kappa, and that of the other eight mabs was igm, kappa. immunoblot analysis after non-denatured page showed that with the exception of one mab (112g6) all mabs gave a positive reaction with the 540 kda band of toxin a. immunoblot analysis showed that four mabs (2e15, 3b4, 37b5 and 49c4) gave a positive reaction with the 240 kda major band of toxin a. in neutralisation tests w ...19911916231
clostridium difficile in inflammatory bowel disease relapse.stools of 65 patients with exacerbation of symptoms of inflammatory bowel disease were examined for the presence of enteric pathogens and clostridium difficile. ten (16%) had c. difficile toxin. symptoms in all patients cleared after therapy, with improvement correlating with elimination of toxin from the stool.19911919950
[the norrköping study. cephalosporins are often the implicating factors in clostridium difficile infections].in a retrospective study carried out at norrköping central hospital, the incidence of clostridium difficile-associated diarrhoea and colitis was found to be correlated to in-patient consumption (in terms of defined daily doses) of the implicated anti-microbial agents. the third generation cephalosporin, cefotaxime, was implicated 38 times more often than small spectrum penicillins. in general, the cephalosporins were predominantly responsible, accounting for 46 per cent (67/147) of the episodes ...19911921624
life-threatening complications of empiric ceftriaxone therapy for 'seronegative lyme disease'.lyme disease, now the most common tick-borne illness in the united states, has recently received much media attention, due in part to its potentially serious sequelae in untreated patients. because a rare patient with late illness may lack antibodies to the etiologic agent, borrelia burgdorferi, physicians may be tempted to give empiric antibiotics for illnesses that may not be lyme disease. we have described a patient who, despite negative laboratory evidence for late lyme disease, was treated ...19911925730
[antibiotic-associated colitis--the dark side of antibiotic therapy].intestinal side effects after antibiotic therapy are frequent. mostly, harmless diarrhea disappears after cessation of therapy without inducing colitis; however, changing of the intestinal flora sometimes leads to colonization of the colon by toxin-producing strains of clostridium difficile, inducing sometimes severe pseudomembranous colitis. a rapid correct diagnosis by anamnesis, clinical signs, endoscopical aspect and demonstration of toxin in the stool allows an efficient treatment. the ther ...19911926012
clostridium difficile toxin a and its effects on cells.clostridium difficile toxin a in its native form is a high molecular weight (520-540 k) aggregate with five major biological activities. it is lethal, enterotoxic, cytotoxic and cytotonic, and induces hemagglutination of rabbit red blood cells. possibly these activities are contained in separate components. a major subunit of c. 230-310 k has been defined but lower molecular weight components cannot be excluded. the major component has been cloned, and sequence analysis indicated a complicated p ...19911926159
a comparative biochemical, pharmacological and immunological study of clostridium novyi alpha-toxin, c. difficile toxin b and c. sordellii lethal toxin.the three clostridial cytotoxins, i.e. alpha-toxin of c. novyi (tox alpha-nov), toxin b of c. difficile (toxb-dif) and lethal toxin of c. sordellii (lt-sor) consist of single peptide chains of about 200,000 (tox alpha-nov), 250,000 (lt-sor) and 275,000 (toxb-dif) mol. wts. toxb-dif and lt-sor but not tox alpha-nov cross-reacted with rabbit polyclonal antibodies. toxicity upon i.v. injection in mice was similar (ld50, 100 hr, 50-200 ng/kg) and was characterized by a slowly developing fluid loss i ...19911926186
the chemotactic response of human granulocytes to clostridium difficile toxin a is age dependent.elderly patients are at high risk for developing diarrhea and colitis as a complication of antimicrobial therapy. clostridium difficile, the causative agent of antibiotic-associated diarrhea and colitis produces an enterotoxin (toxin a) and a cytotoxin (toxin b). of these two exotoxins, toxin a appears to be largely responsible for the inflammatory phenomena of c. difficile colitis, because it produces secretion, pronounced granulocytic infiltration, and epithelial cell necrosis and ulceration i ...19911928037
control of nosocomial transmission of clostridium difficile based on sporadic case surveillance.the recognition of a cluster of antibiotic-associated nosocomial clostridium difficile disease (ncdd) caused by serotype c in a surgical ward led to a hospital-wide ncdd surveillance and control program. the initial step included: (a) gas-liquid chromatography screening of inpatients' diarrheal stools; (b) enteric isolation precautions, cohorting and terminal room disinfection in wards with a cluster of two or more ncdd cases per month. during a 12-month period, the quarterly incidence of ncdd r ...19911928155
in vitro and in vivo evaluation of tiacumicins b and c against clostridium difficile.tiacumicins b and c are members of a novel group of 18-membered macrolide antibiotics with in vitro activity against clostridium difficile. the mics against 15 strains of c. difficile were 0.12 to 0.25 microgram/ml for tiacumicin b, 0.25 to 1 microgram/ml for tiacumicin c, and 0.5 to 1 microgram/ml for vancomycin. the resistance frequency for both compounds against c. difficile was less than 2.8 x 10(-8) at four and eight times the mic. the in vivo activities of the tiacumicins against two strai ...19911929250
nucleotide sequence and phylogeny of a chloramphenicol acetyltransferase encoded by the plasmid pscs7 from staphylococcus aureus.the nucleotide sequence of the chloramphenicol acetyltransferase gene (cat) and its regulatory region, encoded by the plasmid pscs7 from staphylococcus aureus, was determined. the structural cat gene encoded a protein of 209 amino acids, which represented one monomer of the enzyme chloramphenicol acetyltransferase (cat). comparisons between the amino acid sequences of the pscs7-encoded cat from s. aureus and the previously sequenced cat variants from s. aureus, staphylococcus intermedius, staphy ...19911929326
the clinical significance of antibiotic-associated pseudomembranous colitis in the 1990s.antibiotic-associated pseudomembranous colitis is an uncommon but potentially serious adverse reaction, resulting in acute diarrhoea and characterised by colonic pseudomembranes. a direct relationship between the disease, recent antibiotic therapy and proliferation of clostridium difficile in the colonic lumen was established in the late 1970s. it is thought that antibiotic therapy may alter the enteric flora, enabling c. difficile to proliferate and produce toxins with cytopathic (toxin b or cy ...19911930740
[relation between isolation of bacteriophages from clostridium difficile and cytotoxicity of the strains].we studied the possible relationship between the presence of bacteriophages and cytotoxicity of clostridium difficile strains from multiple origin. a total of 143 strains were studied, 38.46% showed lysogenic activity to at least one of control strains and 85.3% produces cytopathic effects on mccoy cells, that were neutralized by c. sordellii antitoxin. all bacteriophages seen on electron microscopy showed similar shape and size (hexagonal head shape and flexible tail ended in a basal plate). ac ...19911954265
bacteriotherapy for clostridium difficile diarrhoea. 19901967389
rapid identification of toxigenic clostridium difficile by polymerase chain reaction. 19901968161
clostridium difficile carriage after infection. 19901968608
false-positive clostridium difficile latex agglutination tests. 19901972242
nosocomial clostridium difficile colonisation and disease.to assess the risk of acquiring clostridium difficile diarrhoea or colitis in patients colonised with c difficile, rectal swabs taken weekly for 9 weeks from patients with long-term (at least 7 days) hospital stays on three wards were cultured for c difficile. 60 (21%) of 282 patients were culture-positive for c difficile during their hospital stay, of whom 51 were symptom-free faecal excretors. c difficile diarrhoea developed in the other 9 patients; 2 were culture-positive for c difficile and ...19901975332
pseudomembranous colitis associated with ciprofloxacin. 19901976960
ciprofloxacin and clostridium difficile infection. 19901978050
ciprofloxacin and pseudomembranous colitis. 19901979116
construction and expression of the complete clostridium difficile toxin a gene in escherichia coli.cloned fragments constituting the 8.1-kb toxin a gene of clostridium difficile were used to reconstruct the intact gene. the recombinant toxin expressed in escherichia coli was cytotoxic, enterotoxic, and lethal. in addition, toxic lysate caused hemagglutination of rabbit erythrocytes. the toxic activities were inhibited by antibody specific for toxin a. our findings demonstrate that the biological activities exhibited by native toxin a are functions of a single protein encoded by the 8.1-kb tox ...19911987027
molecular detection of persistent borrelia burgdorferi in the urine of patients with active lyme disease.current diagnostic tests for lyme disease (ld) are dependent upon the host serologic response and are insensitive early in infection and, possibly, following antibiotic therapy. we cloned a library of borrelia burgdorferi 297 dna and studied one clone, ly-1, for its potential in diagnostic and pathogenic studies. using pulsed-field electrophoresis, we demonstrated that ly-1 is of chromosomal origin and estimated that the b. burgdorferi chromosome is approximately 1,100 kb in size. the 3.7-kb ly- ...19911987041
[the problems of rapid diagnosis of clostridium difficile as causative agent of antibiotic-associated pseudomembranous colitis].this paper compares three common methods for the detection of clostridium difficile, i.e. latex agglutination, culture and cytotoxic activity. the sensitivity of the latex agglutination test alone is 70%, of the culture 100% and of the cytotoxin test 66%. specificities are 93, 96 and 100%, respectively. the latex agglutination has positive and negative predictive values of 58 and 96%; the respective values for the culture are 77 and 100%, for the cytotoxin assay 100 and 96%. whereas all tests ar ...19911990415
clostridium difficile disease in a department of surgery. the significance of prophylactic antibiotics.a clustering of clostridium difficile-associated disease in a department of surgery prompted a program of infection control and the evaluation of contributing factors. fifty patients had diarrhea and positive assays for c difficile cytotoxin during the study period. twenty-one of the 36 cases that developed among patients admitted to the surgical services occurred on two adjacent general surgery wards that shared attending surgeons and house staff. perioperative prophylactic antibiotics predated ...19911992999
identification of toxigenic clostridium difficile by the polymerase chain reaction.toxigenic strains of clostridium difficile are causative agents of pseudomembranous colitis and antimicrobial agent-associated diarrhea and colitis. the toxigenicity is routinely assayed by using highly sensitive cell cultures. we used a simple and rapid polymerase chain reaction (pcr) assay to differentiate toxigenic and nontoxigenic strains of c. difficile. two sets of oligonucleotide primer pairs derived from nonrepeating sequences of the toxin a gene were used to amplify 546- and 252-bp dna ...19911993763
adp-ribosylation in clostridium difficile toxin-treated cells is not related to cytopathogenicity of toxin b.adp-ribosylation of a protein in human fibroblasts treated with partially purified clostridium difficile toxin b was previously reported. here we show that the same protein was adp-ribosylated also in human fibroblasts exposed to supernatant from a c. difficile strain producing neither toxin a nor toxin b. furthermore, in chinese hamster ovary and in vero cells, showing toxin b-induced cytopathogenic effect, the protein was not significantly adp-ribosylated. the results indicate that the adp-rib ...19911995067
clostridium difficile--a common and costly colitis.clostridium difficile infection manifests as a self-limiting diarrhea, protracted colitis, or toxic pseudomembranous colitis. the incidence of c. difficile in a 514-bed community hospital was studied retrospectively; 155 patients of a total 18,262 admitted during 1988 were identified with c. difficile as an admitting or subsequent diagnosis. the method of diagnosis, mode of therapy, and related costs were analyzed. we have determined that education, with an emphasis on pathogenesis and preventio ...19911999131
comparison of traditional gas chromatography (gc), headspace gc, and the microbial identification library gc system for the identification of clostridium difficile.three gas chromatography (gc) methods were compared for the identification of 52 clinical clostridium difficile isolates, as well as 17 non-c. difficile clostridium isolates. headspace gc and microbial identification system (mis) gc, an automated system which utilizes a software library developed at the virginia polytechnic institute to identify organisms based on the fatty acids extracted from the bacterial cell wall, were compared against the reference method of traditional gc. headspace gc an ...19912007632
comparative antimicrobial spectrum and activity of ceftibuten against clinical isolates from west germany.the in vitro activity of a new oral cephalosporin, ceftibuten, was determined against 837 clinical isolates by agar dilution technique and compared with that of the oral cephalosporins, cefaclor, cefuroxime, cefixime, cefpodoxime, and cefprozil. against enterobacteriaceae, ceftibuten was the most active of the compounds. ceftibuten mic90s were less than or equal to 0.25 micrograms/ml for most members of the family enterobacteriaceae, 0.13 microgram/ml for haemophilus influenzae, 4 micrograms/ml ...19912013211
influence of fosfomycin on the intestinal and pharyngeal flora of man.the influence of 5 g fosfomycin i.v. every 12 hours on the intestinal and pharyngeal flora was studied in eight healthy, male volunteers. the escherichia coli counts were markedly reduced during application and returned to normal in all subjects within a maximum period of 12 days. the total count of enterococci was reduced by one to two decimal potencies under medication. there was no change in the counts of bacteroides and anaerobic lactobacteria. no selection of clostridium difficile was obser ...19912013503
prospective study of clostridium difficile intestinal colonization and disease following single-dose antibiotic prophylaxis in surgery.a total of 108 volunteers undergoing an elective surgical procedure were randomly given a single 2-g intravenous prophylactic dose of either a cephalosporin or mezlocillin. stool samples were cultured for clostridium difficile the day before the operation and later on postoperative days 4, 7, and 14. c. difficile was detected in 23.0% of patients who received a cephalosporin (cefoxitin, 8.3%; cefazolin, 14.3%; cefotetan, 20.0%; ceftriaxone, 25.0%; cefoperazone, 43.7%), in 3.3% of patients given ...19912014978
risk factors for clostridium difficile cytotoxin-positive diarrhea after control for horizontal transmission.this study identifies risk factors that predispose hospitalized patients to diarrhea caused by clostridium difficile.19912016508
high activity of inclusion bodies formed in escherichia coli overproducing clostridium thermocellum endoglucanase d.the formation of cytoplasmic inclusion bodies by escherichia coli overproducing clostridium thermocellum endoglucanase d (egd) was investigated. egd was found in inclusion bodies as a 68 kda form, whereas the size of the cytoplasmic form was 65 kda. upon solubilization with urea followed by dialysis, the 68 kda form was converted to the 65 kda species. proteolysis occurred within the cooh-terminal, reiterated region of the 68 kda form, which is conserved among most c. thermocellum endoglucanases ...19912026260
electron microscopic investigation of lysogeny of clostridium difficile strains isolated from antibiotic-associated diarrhea cases and from healthy carriers.an electron microscopic investigation was performed on 28 clostridium difficile strains isolated from 15 antibiotic-associated diarrhea cases and from 13 healthy infants. through the use of supernatants of the cultures induced by mitomycin c (1 or 3 micrograms/ml), 18 of the 28 c. difficile strains proved to harbor phage particles with a different morphology and size. most of the phages revealed belonged in phage group b1 with a non-contractile tail. seven of the 11 toxin-producing, lysogenic c. ...19912036214
passive immunization of hamsters against disease caused by clostridium difficile by use of bovine immunoglobulin g concentrate.gestating holstein cows were vaccinated with clostridium difficile toxoid prepared from the culture filtrate of a strain that produces high levels of toxins a and b and other antigens. a bovine immunoglobulin g (igg) concentrate was prepared from colostrum collected at parturition. the results of our studies showed that hamsters treated prophylactically with the hyperimmune bovine igg concentrate were protected against c. difficile disease. these results suggest that orally administered hyperimm ...19912037383
positive role of clostridium difficile infection in diarrhea in infants and children.a retrospective review of children with clostridium difficile infection and diarrhea identified 43 patients. fifteen (35%) had immunoglobulins below the normal range for age, and typified those with transient hypogammaglobulinemia of infancy, because all increased their levels over the following 12 months. the age of those with hypogammaglobulinemia was significantly younger (p less than 0.01), averaging 18.8 months, than those with normal immunoglobulins who had a mean age of 4.6 yr. the number ...19912038989
in vitro synergy studies with clostridium difficile.agar dilution anaerobic susceptibility studies using rifampin, vancomycin, metronidazole, and bacitracin individually and in combination were performed with clostridium difficile. fifty-five strains of c. difficile were studied. eighty-five percent of strains tested (29 of 34) were synergistically inhibited by the combination of bacitracin and rifampin (fractional inhibitory concentration, less than or equal to 0.50).19912039211
[the influence of cefpirome on intestinal bacterial flora].cefpirome (cpr, hr810), a new parenteral cephalosporin antibiotic, was studied for its effect on the intestinal bacterial flora in pediatric patients. the subjects were children admitted for infections (6 males and 3 females, 1 month to 5 years 1 month old, weighted 3.94 to 21.0 kg). cpr was intravenously administered at a dose between 19.0 to 40.0 mg/kg, 3 to 4 doses daily over 6 to 12 days. the feces from these children were collected before, during, and after administration, and bacteria were ...19912041149
[refractory clostridium difficile infection. untraditional treatment of antibiotic-induced colitis].intestinal clostridium difficile infections are treated successfully with antibiotics. relapses can be a problem. we describe a patient who suffered seven relapses after treatment with all the medicaments reported to be efficacious. she was cured only after treatment with faeces administered by duodenal tube.19912042156
exacerbation of ulcerative colitis. 19912044913
[clostridium difficile and its toxins]. 19912047717
correlation of immunoblot type, enterotoxin production, and cytotoxin production with clinical manifestations of clostridium difficile infection in a cohort of hospitalized patients.to determine whether strain-specific differences in immunoblot type, enterotoxin production, or cytotoxin production correlated with clinical presentation of clostridium difficile infection, we evaluated isolates obtained from 428 prospectively studied hospitalized patients. of 99 isolates available for immunoblot typing, 61 were recovered from asymptomatic carriers and 38 were from patients with c. difficile-associated diarrhea. of 17 immunoblot types, the seven types comprising the majority of ...19912050409
treatment of acute uncomplicated urinary tract infection with ceftibuten.ceftibuten is an orally active third generation cephalosporin with increased potency against members of the enterobacteriaceae. in this study, 74 women with acute uncomplicated urinary tract infection (uti) were enrolled in an open study to evaluate the safety and efficacy of this new antibiotic. patients were treated with 400 mg ceftibuten once daily for seven days and followed for four to six weeks after cessation of therapy. all pathogens were eradicated during treatment, including five coagu ...19912050421
time-dependent killing of clostridium difficile by metronidazole and vancomycin.killing of clostridium difficile by metronidazole and vancomycin was studied with a batch culture method. pre-reduced 50 ml volumes of brain heart infusion broth containing one of a range of concentrations of either vancomycin or metronidazole were inoculated with approximately 10(6) cfu/ml of c. difficile. the cultures were incubated anaerobically at 35 degrees c for 24 h. total viable counts and spore counts were performed with a modified miles and misra technique. concentrations of metronidaz ...19912050597
[what is your diagnosis? bacterial diarrhea. culture for clostridium difficile and toxin determination]. 19912052818
enzyme profiles of clostridium difficile strains isolated from children.clostridium difficile isolates from children with haematological malignancies, diarrhoea and healthy neonates as well as standard strains were examined by api zym (standard test) system and api zym research kit for glucosidases and peptidases. the results of expanded enzymatic characterization are presented.19912060317
[physiopathology of clostridium difficile-related intestinal disease. role of the colonic ecosystem]. 19912060744
diarrhea: a neglected nosocomial hazard? 19912071876
risk factors for the development of clostridium difficile-associated diarrhea during a hospital outbreak.to evaluate the risk factors associated with a nosocomial outbreak of clostridium difficile-associated diarrhea.19912071877
ciprofloxacin and clostridium difficile-associated diarrhoea. 19912071919
clostridium difficile in the elderly. 19912071922
clostridium difficile associated disease in thailand.over a twenty-six month period 383 fecal specimens from 269 diarrheal patients and 114 control patients were examined for clostridium difficile and its cytotoxin. c. difficile was isolated from 13 (4.8%) of overall age group of diarrheal patients and from 3 (2.6%) of controls. fecal cytotoxin was detected in 106 (52.5%) of 203 diarrheal patients and in 17 (22.4%) of 76 controls. sixty-one percent of antibiotic-associated diarrheal patients (less than 3 years) and 51% of non-antibiotic associated ...19902075479
clostridium difficile-associated diarrhea. 19902076119
microfilament-disrupting clostridium difficile toxin b causes multinucleation of transformed cells but does not block capping of membrane ig.the effects of clostridium difficile toxin b on some actin-dependent cellular functions were studied. a three-day incubation of intoxicated b-lymphocytes and transformed 3t3 fibroblasts resulted in dose-dependent multinucleation. using vimentin-negative daudi cells we showed that this effect of toxin b does not involve vimentin. as dna and protein syntheses are not impaired in the cells used, the results suggest that toxin b has an effect on the actin-containing contractile ring during mitosis, ...19902081549
cloning of clostridium difficile toxin b gene and demonstration of high n-terminal homology between toxin a and b.high titered clostridium sordellii lethal toxin antiserum, cross-reactive with c. difficile cytotoxin b (toxb), was used to isolate toxb fragments from a c. difficile expression library. recombinant clones containing toxb fragments of the 5' and 3' end were isolate. a 2.5-kb hincii fragment of chromosomal dna overlaps both groups of clones. a partial restriction map of the total toxb gene is presented. the gene is positioned upstream of utxa and toxa, toxb has a size of 6.9 kb, corresponding to ...19902082160
[value of microbiologic studies for diagnosis of post-enteritis reactive arthritis].reactive arthritis may develop within a period of some days until upto 3 weeks after infections with yersinia enterocolitica, yersinia pseudotuberculosis, campylobacter jejuni/coli, shigella and salmonella. intestinal infections with klebsiella pneumoniae, clostridium perfringens, clostridium difficile, cryptosporidium, strongyloides stercoralis, taenia saginata and schistosoma mansoni are, in some cases, considered to be responsible for reactive arthritis. detection of pathogenic bacteria in fe ...19902085058
[occurrence of clostridium difficile in feces of children with dysfunction of the digestive tract and other disorders].thousand and six hundred ninety two fecal samples from children of few weeks old up to over ten years were tested for the presence of clostridium difficile. most of them were treated with antibiotics and showed diarrhea symptoms. hundred and twenty three strains of c-difficile were submitted to serological typing and their sensitivity to 10 selected antibiotics and chemotherapeutic agents was determined. among 109 strains of c. difficile tested for enterotoxin production by latex test 82 strains ...19902087130
incidence of cytotoxin producing isolates of clostridium difficile in faeces of neonates and children in nigeria.one hundred and fifty six (156) confirmed isolates of clostridium difficile from faeces of neonates and children in parts of anambra state, nigeria were screened and assayed for cytotoxin production by the tissue culture technique and the frequency of occurrence estimated. twenty three out of 156 isolates were found to be cytotoxin positive isolates representing a frequency of 14.8%. there was no difference between the frequency of occurrence of cytotoxin positive isolates in neonates and childr ...19902087200
[reactive arthritis].the term reactive arthritis was introduced to describe an acute non-purulent arthritis complicating an infection elsewhere in the body. reactive arthritis can also be classified into hla-b27 associated and non-associated forms. rheumatic fever is an example of the hla-b27 non-associated forms with genetic factors other than hla-b27 involved. hla-b27 associated reactive arthritis includes enteric, urogenic and idiopathic arthritides. the bacteria known to trigger post-enteritic reactive arthritis ...19902087418
actin and lamin comprised filaments in the nuclei of chinese hamster ovary cells affected with clostridium difficile enterotoxin a.the major change in the ultrastructure of chinese hamster ovary (cho) cells treated with clostridium difficile enterotoxin a was the formation of bundles of filaments in the nucleoplasm. the filaments appeared after 2.5 h and disappeared by the fourth hour of incubation with the toxin. to partially characterize these filaments, laser diffractometry and ultrastructural immunocytochemistry were employed. the bundles consist of coiled filaments of about 11 nm and 16 nm diameter and a main long axia ...19902090392
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