effect of environmental stress on clostridium difficile toxin levels during continuous cultivation.a method for the continuous culture of clostridium difficile has been described. it has been shown that subjecting continuous cultures of this microorganism to environmental stress results in increased levels of toxin in culture medium. factors found to cause this release include alteration of the eh from --360 to +100 mv or increasing the temperature from 37 to 45 degrees c. the increased toxin levels were not associated with a change in viable cell density or the numbers of spores present. add ...197944176
clostridium defficiel in the urogenital tract of males and females.a study of the occurrence of clostridium difficile in the urogenital tract of males and females revealed higher isolation-rates in patients attending the special (venereal-disease) clinic than in patients attending family-planning and urological clinics. the presence of cl. difficile in patients with venereal diseases is being investigated to see if the organism is simply an opportunist infecting a urethra disturbed by some antecedent disease, or if it is perhaps a primary cuase of disease.197548610
clostridium difficile.seventy-five meconium samples were examined for the presence of cl. difficile; 3 strains were isolated. additionally 45 laboratory animal faeces specimens were tested for the same purpose, a further 2 cases were isolated. these five suspicious strains were identified as cl. difficle according to the tests mentioned in the previous paragraphs. the organisms isolated here showed the same characteristics as five of the strains received and also as the organisms isolated from the inoculated animals ...197560044
clostridium difficile and the aetiology of pseudomembranous colitis.bacterial isolates from 5 patients with pseudomembranous colitis (p.m.c.) were screened for toxin production. strains of clostridium from 4 patients produced in vitro a toxin similar to that found in p.m.c. faecal suspension. these were identified as c. difficile. use of the strains from 2 patients induced a fatal enterocolitis when inoculated orally into hamsters pretreated with vancomycin. the c. difficile that produced the toxin in vitro was then re-isolated from hamster caecal contents. thes ...197877366
diarrhoea and pseudomembranous colitis after gastrointestinal operations. a prospective study.241 patients who had gastrointestinal operations were studied prospectively. postoperative diarrhoea occurred in 58 patients (24%) and was significantly more common after exposure to antibiotics. 9 patients (4%) had high titres of a neutralisable faecal toxin characteristic of pseudomembranous colitis. toxigenic clostridium difficile strains were isolated from the stools of all patients with neutralisable faecal toxin. if pseudomembranous colitis is defined as the presence of neutralisable faeca ...197882138
aetiology of antimicrobial-agent-associated colitis.clostridium difficile was isolated from the faeces of a patient with clindamycin-associated pseudomembranous colitis (p.m.c.). the presence of a preformed faecal toxin and the toxigenicity of both the faecal isolate of c. difficile and a reference strain of c. difficile were demonstrated by tissue-culture assay. the toxin of both strains of c. difficile and that in the patient's faeces were neutralised by heating and by incubation with antitoxin to c. sordellii, but not by incubation with antito ...197885818
[initiation of germination of clostridium difficile spores by lysozyme].the germination rate of spores of c. difficile which is usually lower than 10(-5) is raised to about 5.10(-3) in presence of lysozyme. all spores are initiated by lysozyme when previously treated by sodium thioglycolate. these spores are indeed lysozyme-dependent for germination.1978103645
effect of phenoxymethylpenicillin and clindamycin on the oral, throat and faecal microflora of man.phenoxymethylpenicillin in capsules was given orally in doses of 800 mg twice daily for 7 days to 10 subjects. saliva, throat and faecal specimens were taken up to 29 days for cultivation of aerobic and anaerobic bacteria. no changes in the normal flora in saliva, throat or faeces were noticed during the observation period. clindamycin was given orally in doses of 150 mg 4 times daily to 10 other subjects. no changes in the aerobic oral flora were observed, while a significant decrease in the nu ...1979118526
experimental reproduction of neonatal diarrhea in young gnotobiotic hares simultaneously associated with clostridium difficile and other clostridium strains.clostridium difficile, c. perfringens, and c. tertium are very often present simultaneously in the feces of conventional diarrheic young hares, whereas these three bacterial species are rarely encountered and never present simultaneously in the feces of healthy young hares. when a strain of each of the three bacterial species was monoassociated with axenic young hares, the appearance of pathological disorders was only observed in animals monoassociated with c. difficile, when the number of c. di ...1979222683
diarrhea and colitis associated with antimicrobial therapy in man and animals.antimicrobial agent-induced ileocecitis of laboratory animals and colitis of man share common features. the significance of a newly described toxin in these two entities, the apparent source of the toxin (clostridium difficile) and characteristics of the toxin are reviewed. methods of toxin detection, isolation and rapid identification of c. difficile, and possible modes of therapy for antimicrobial agent-associated colitis of man are discussed.1979367148
selective and differential medium for isolation of clostridium difficile.clostridium difficile is a recognized cause of pseudomembranous (antimicrobial agent-associated) colitis and may be one of the causes of antimicrobial agent-induced diarrhea. a selective and differential agar medium that contains cycloserine, cefoxitin, fructose, and egg yolk (ccfa) was developed to facilitate the isolation of c. difficile from fecal specimens. quantitative cultures of 16 stock strains of c. difficile on this medium (and on a medium containing cycloserine, fructose, and egg yolk ...1979429542
[a case of antibiotic-associated diarrhea caused by clostridium difficile and treated with vancomycin]. 1979449466
ultrastructural changes of cultured human amnion cells by clostridiu difficile toxin.the ultrastructure of the surface of primary human amnion monolayer cells undergoing cytopathology induced by clostridium difficile toxin was examined by scanning electron microscopy. our observations indicated that the type and distribution of cell surface projections were altered dramatically by this toxin. the patterns of such surface changes were specific for the two different types of cells found in this cell culture. cells with demarcated borders showed rearrangement of microvilli into glo ...1979457259
oral metronidazole in clostridium difficile colitis. 1979466143
oral metronidazole in clostridium difficile colitis. 1979476461
purification and characterization of clostridium difficile toxin.recent evidence indicates that toxigenic clostridium difficile strains are a major cause of antimicrobial-associated ileocecitis in laboratory animals and pseudomembranous colitis in humans. c. difficile atcc 9689 was cultivated in a synthetic medium to which 3% ultrafiltrated proteose peptone was added. purification of the toxin from broth filtrate was accomplished through ultrafiltration (100,000 nominal-molecular-weight-limit membrane), precipitation with 75% (nh4)2so4, and chromatographic se ...1979478634
antibiotic susceptibility of clostridium difficile. 1979479065
[antibiotic-induced pseudomembranous clostridium difficile colitis. a new etiopathogenetically definable infectious disease].pseudomembranous colitis has been recognized as a complication of antimicrobial therapy since 1952. most recently, evidence has been accumulated showing that a heat labile toxin is involved. though little is known so far about the normal ecology of c. difficile and the host factors of potential importance in the development of colitis by this anaerobe, antimicrobial agent-induced suppression of the normal gut flora seems to be a major factor leading to the intestinal proliferation of resistant t ...1979488887
cephalosporin-associated pseudomembranous colitis due to clostridium difficile. 1979501864
antibiotic-associated colitis--a review of 66 cases.we have reviewed 66 cases of antibiotic-associated colitis since march 1975, which have been associated with a 27 per cent mortality. we believe antibiotics may predispose patients to this condition which is caused by a toxin produced by clostridium difficile. although the disease is rare, it is more common than previously reported. the presentation, methods of diagnosis and treatment are discussed.1979509051
cultures for clostridium difficile in stools containing a cytotoxin neutralized by clostridium sordellii antitoxin.stools from patients with antibiotic-associated diarrhea or colitis were cultured to detect the presence of clostridium difficile. all specimens contained a cytotoxin which was neutralized by clostridium sordellii antitoxin. initial testing employed several methods with comparative merits in recovering this organism. these included the use of nonselective media, antibiotic-incorporated media, alcohol shock, and paracresol-containing broth. optimal results were achieved with primary plating of se ...1979521486
clostridium difficile-associated colitis after neomycin treated with metronidazole. 1979526821
colitis induced by clostridium difficile.clostridium difficile has been implicated as the major cause of antibiotic-associated pseudomembranous colitis. the current laboratory diagnostic test of choice is a tissue culture assay that demonstrates the presence of a cytopathic toxin neutralized by antitoxin to clostridium sordellii. this toxin was found in stools from 42 of 43 patients with antibiotic-associated pseudomembranous colitis and in stools from 12 of 78 patients with antibiotic-associated diarrhea. specimens from patients with ...1979549188
partial purification and characterization of a cytotoxin from clostridium difficile.a trypsin-sensitive, heat-labile cytotoxin was purified from the supernatant of a culture of clostridium difficile by a procedure that included ultrafiltration, precipitation with (nh4)2so4, gel filtration, and ion-exchange chromatography. the procedure resulted in recovery of 20% of the cytotoxin and an estimated 1,500-fold increase in cytotoxic activity. the minimal amount of protein required to give an actinomorphic response in wi-38 cell cultures was 1.4 ng/ml. the estimated molecular weight ...1979549189
antibiotic-associated colitis: effects of antibiotics on clostridium difficile and the disease in hamsters.fifteen isolates of clostridium difficile from hamsters and human patients were inhibited or killed by low concentrations of metronidazole, vancomycin, penicillin, and ampicillin; the isolates were often reesistant to tetracycline, cephalosporins, trimethoprim-sulfamethoxazole, clindamycin, erythromycin, and aminoglycosides. antibiotics to which c. difficile was susceptible were able to prevent or postpone the colitis caused by clindamycin in hamsters. colitis could be produced by treatment of ...1979549190
induction of colitis in hamsters by topical application of antibiotics.syrian hamsters are exquisitely sensitive to clindamycin; as little as 1 mg/kg of clindamycin given systemically causes a fatal colitis. clindamycin and erythromycin were applied topically daily to the shaved backs of syrian hamsters in a hydroalcoholic vehicle. a daily dose of 0.1 mg of clindamycin was lethal to more than half the hamsters and 1 mg to all the animals. the antibiotic-associated toxin from clostridium difficile was present in their cecal material. based on body surface areas and ...1979571698
identification of clostridium difficile as a cause of pseudomembranous colitis. 1978630301
clindamycin-induced enterocolitis in hamsters.a lethal enterocolitis was induced in hamsters by oral or parenteral administration of clindamycin in amounts comparable to those used in treatment of humans. the intestinal lesions were characterized histologically as an acute inflammatory reaction with pseudomembrane formation and resembled the lesions seen in humans with antibiotic-induced colitis. results of quantitative stool cultures showed the numbers of peptostreptococcus and corynebacterium decreased in animals with colitis after challe ...1978649990
clostridium difficile toxin and antimicrobial agent-induced diarrhea. 1978659927
clindamycin-induced enterocolitis in hamsters as a model of pseudomembranous colitis in patients.stools from a patient with antibiotic-associated colitis and cecal contents from a hamster with clindamycin-induced enterocolitis were compared in a cytotoxicity assay to determine common properties. both specimens produced actinomorphic changes in human amnion cells at 10(-7) dilutions. the toxin was acid labile, heat labile, nonether extractable, non-dialyzable, and produced maximum activity at 60% with ammonium sulfate precipitation. cytotoxicity was neutralized with clostridial antitoxin but ...1978669810
antibiotic-induced lethal enterocolitis in hamsters: studies with eleven agents and evidence to support the pathogenic role of toxin-producing clostridia.clindamycin-induced enterocolitis in hamsters was studied, using a tissue culture assay to detect clostridial toxin. it was found that animals with lethal enterocolitis had a cytopathogenic substance in cecal contents and blood that was neutralized by clostridial antitoxins. cultures of the cecal flora yielded numerous species of clostridia, but only 1 organism was detected which produced a toxin which was cytopathic in tissue culture. this organism, clostridium difficile, was consistently prese ...1978697162
role of clostridium difficile in antibiotic-associated pseudomembranous colitis.tissue cultures were performed on stools from 189 patients to detect a cytopathic toxin which is neutralized by clostridium sordellii antitoxin. specimens satisfying these criteria were considered positive in the tissue culture assay. stools from 26 of 27 patients with antibiotic-associated pseudomembranous colitis were positive and 16 of these specimens showed toxin titers of 10(-3) dilutions or greater. the tissue culture assay was positive with specimens from 9 of 63 patients with antibiotic- ...1978700321
neutralization of clostridium difficile toxin by clostridium sordellii antitoxins.neutralization of clostridium difficile toxin by clostridium sordellii antitoxin was studied by cytotoxicity assay in tissue culture. the sources of toxin were stools from two patients with pseudomembranous colitis and a culture filtrate of c. difficile isolated from one of the patients. c. sordellii antitoxin was available either in monovalent form or as gas gangrene polyvalent antitoxin. the potency of antitoxins against c. difficile determined by cytotoxicity assay did not correlate with the ...1978730363
prevention of clindamycin-induced colitis in hamsters by clostridium sordellii antitoxin.toxins produced by clostridium difficile have been implicated in the etiology of antibiotic-induced colitis. clostridium difficile antitoxin is not available, but recent studies have shown that toxins present in the feces of patients with this disease are neutralized by clostridium sordellii antitoxin. we found that c. sordellii antitoxin neutralized toxins produced in broth cultures of either c. sordellii or c. difficile and that passive immunization with c. sordellii antitoxin before challenge ...1979759263
clindamycin-induced colitis.the hamster model of enterocolitis after the administration of clindamycin was used to study various drugs used in treatment of the disease in humans. current evidence strongly suggests toxigenic, clindamycin-resistant clostridium difficile is a cause of the disease in hamster and man. this organism is susceptible to vancomycin and metronidazole, and the disease could be prevented in the hamster so long as the antibiotics were given orally. a fatal colitis almost invariably ensued once they were ...1979760500
competitive effects of intestinal microflora on vibrio cholerae in gnotobiotic mice.the coexistence of vibrio cholerae and several intestinal bacteria was determined in gnotobiotic mice. the bacteria tested included a bacteroides sp, clostridium difficile, clostridium perfringens type a, 2 separate isolates of escherichia coli, 2 different lactobacilli, 2 separate isolates of proteus mirabilis, pseudomonas maltophilia, and streptococcus faecalis. each species of bacteria became established and was recovered repeatedly from the stools during the studies. no single strain or spec ...1975807775
clostridium difficile: isolation and characteristics.clostridium difficile can be grown readily in reinforced clostridial medium (rcm) containing 0-1-0-4% of o-, m- or p-cresol, or phenol. we recommend 0-2% of phenol or p-cresol in rcm for the isolation of this organism. the characteristic "cornfield" growth in rcm in 25-ml universal containers is described. glucose, fructose, galactose, mannose, raffinose, aesculin and mannitol are fermented with production of acid and gas; maltose, sucrose, glycogen, soluble starch and sorbitol are fermented wit ...1976933146
surveillance of clostridium difficile infection. 19921285121
clostridium difficile infection in manchester. 19921285174
clostridium difficile in london and staffordshire. 19921285182
transmission of clostridium difficile. 19921289395
clindamycin versus phenoxymethylpenicillin in the treatment of acute orofacial infections.the efficacy of clindamycin and phenoxymethylpenicillin in the treatment of orofacial infections was compared in a randomised study in 60 patients: 30 patients received clindamycin 150 mg every 6 h for seven days, and 30 received phenoxymethylpenicillin 1 g every 12 h for seven days. where indicated incision and drainage were carried out. all patients but one in each group responded satisfactorily to treatment. although the clindamycin group had a shorter duration of pain, swelling and fever and ...19921291309
[typing system for clostridium difficile by western blotting using antisera against ten different serogroup strains].western blotting using antisera against each of reference ten serogroups was evaluated as a typing system for clostridium difficile. a total of 164 isolates of c. difficile (114 epidemiologically unrelated and 50 isolates from a hospital outbreak in new york) were tested. blotting patterns for the ten reference strains showed serogroup-specific bands located in the 30-60 kda when each homologous antiserum was used. at greater than 60 kda, variations in each serogroups were observed; these variat ...19921294652
in vitro self-assembly of the s layer subunits from clostridium difficile gai 0714 into tetragonal arrays.regularly arrayed surface component (s layer) of clostridium difficile strain gai 0714 was isolated with 4 m guanidine hydrochloride from the cell wall of the organism, and examined for self-assembly in vitro. the s layer was composed of two different protein subunits with molecular weights of 32 kda and 45 kda. optical diffraction analysis revealed that the morphological units of both native and self-assembled s layer were essentially identical and composed of a rhombus possessing each side of ...19921295134
epidemiological aspects of infections caused by bacteroides fragilis and clostridium difficile.bacteroides fragilis and clostridium difficile are two of the most common anaerobes associated with human disease. studies on the epidemiology of bacteroides fragilis are limited and are based predominantly on serogrouping, which suggests intraspecies differences. further studies using newer techniques for typing are required to elucidate the epidemiological characteristics of this important pathogen. by contrast, numerous phenotypic, immunological and molecular methods have been developed for t ...19921295758
[occurrence of clostridium difficile in the digestive system of dogs].this study was aimed at seeking strains of clostridium difficile in feces and investigation of influence of antibiotics application on frequency of isolation and detection of toxing in vivo produced by this microorganism. samples of feces were obtained from experimental dogs consisting of two groups. to groups i belonged 150 healthy dogs. group ii consisted of samples of feces received from four dogs before and after application of various antibiotics. clostridium difficile was not isolated from ...19921297034
purification and characterization of an immunodominant 36 kda antigen present on the cell surface of clostridium difficile.the 36 kda antigen represents the major edta-extracted protein of clostridium difficile strains belonging to electrophoretic group 2. antibodies to this antigen are found in sera of patients with c. difficile-associated diarrhoea. the 36 kda antigen was extracted from c. difficile c253 by edta and purified by gel filtration (sephacryl s300) and ion exchange chromatography (deae-trisacryl m). the molecular weight of the purified protein was 36 kda as determined by sds-page, also in non-reducing c ...19921298866
contributions to the taxonomy and biology of clostridium difficile.clostridium difficile was incriminated by hughes and jarvis (1987) as a cause of intestinal infections in usa in the 1980-1984 period in 45 p. 100 of cases, whereas salmonellae only in 12 p. 100. four strains of this organism are studied in this paper in comparison with ten strains of c. bifermentans and six of c. sordellii, because the three species share a common antigen and have other common characteristics, as well. however, spores of c. difficile swell the bacteria and those of other bacter ...19921304829
evidence for a modular structure of the homologous repetitive c-terminal carbohydrate-binding sites of clostridium difficile toxins and streptococcus mutans glucosyltransferases.the homologous c-terminal repeats of clostridium difficile toxins (toxa and toxb) and streptococcal glucosyltransferases appear to mediate protein-carbohydrate interactions at cellular binding sites with sugar moieties as substrates. a consensus sequence of 134 repeating units from gram-positive bacteria indicates that these repeats have a modular design with (i) a stretch of aromatic amino acids proposed to be involved in the primary carbohydrate-protein interaction, (ii) an amplification of th ...19921307487
[preliminary epidemiological study of carriers of clostridium difficile].171 samples have been taken from stools of sick persons in three departments of university and hospital centres of algiers (c.h.u.a.): the department of maternity (c.h.u parnet), the department of breast diseases (cpmc), the department of women's surgery (cpmc), 13 samples of c. difficile have been isolated with a frequency of 7.6 per 100 of cases. the rate of conveyance seems more important in adults in hospitals and often concerns sick persons enduring digestive cancer (10.25 per 100) or newbo ...19921309135
human colonic aspirates containing immunoglobulin a antibody to clostridium difficile toxin a inhibit toxin a-receptor binding.clostridium difficile toxin a, a 308-kilodalton protein exotoxin, is the principal causative agent of antibiotic-associated, c. difficile-induced colitis. in the current study, the prevalence of specific human serum and secretory antibody to toxin a and the possible protective effect of secretory, intestinal anti-toxin a antibody are examined. serum (n = 35), colonic aspirates (n = 35), and duodenal aspirates (n = 20) were collected from adults at diagnostic endoscopy. patients with evidence of ...19921309359
susceptibility of anaerobic bacteria to pd 131628.the in vitro activity of pd 131628 against anaerobic cocci, propionibacterium acnes, clostridium perfringens, clostridium difficile, bacteroides fragilis, bacteroides spp. and fusobacteria was determined by the agar dilution method. this activity was compared with that of ciprofloxacin, piperacillin, cefoxitin, imipenem, clindamycin, metronidazole and chloramphenicol. pd 131628, imipenem, clindamycin, metronidazole and chloramphenicol were the most active agents tested.19921314176
lvg syrian hamsters developed a syndrome of chronic enteritis associated with clostridium difficile infection. 19921316508
treatment of asymptomatic clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. a randomized, placebo-controlled compare the efficacy of vancomycin and metronidazole for eradication of asymptomatic clostridium difficile fecal excretion as a means of controlling nosocomial outbreaks of c. difficile diarrhea.19921322075
effect of piperacillin/tazobactam therapy on intestinal microflora.the effect of piperacillin/tazobactam treatment upon the intestinal microflora was studied in 20 patients with intraabdominal infections. the patients received piperacillin 4 g combined with tazobactam 500 mg q 8 h by intravenous injection for 4-8 days. stool specimens were collected before, during and after therapy for cultivation of aerobic and anaerobic microorganisms. six patients had measurable concentrations of piperacillin (1.2-276 mg/kg/faeces) and 4 patients tazobactam concentrations (0 ...19921322559
acquisition of clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection.the frequency of introduction and spread of specific clostridium difficile strains among hospitalized patients were assessed by serial cultures of patients admitted to a medical-surgical ward with endemic c. difficile-associated diarrhea. stool cultures were obtained from 634 (94%) of 678 consecutive admissions to the ward (ward admissions), and all c. difficile isolates were typed by restriction endonuclease analysis. sixty-five ward admissions introduced c. difficile to the ward, and 54 initia ...19921323621
diminished clostridium difficile toxin a sensitivity in newborn rabbit ileum is associated with decreased toxin a receptor.human infants are relatively resistant to clostridium difficile-associated diarrhea and colitis compared to adults. in that toxin a is the major cause of intestinal damage with this organism, we compared toxin a receptor binding and biological effects in newborn vs adult rabbit ileum. purified toxin a (m(r) 308 kd) was labeled with tritium or biotin with full retention of biologic activity. appearance of specific toxin a brush border (bb) binding was strongly age dependent with minimal [3h]toxin ...19921325998
clostridium difficile infection: responses, relapses and re-infections.clostridium difficile infection is a common and potentially lethal complication of antibiotic usage. since the aetiology of antibiotic-associated colitis was discovered 14 years ago, two antibiotics in particular, metronidazole and vancomycin, have been used to treat c. difficile infection. studies comparing the efficacy of these antibiotics are reviewed. it is now apparent that many of the so-called 'relapses' of c. difficile infection following antibiotic treatment are, in fact, re-infections. ...19921358964
search for enteric microbial pathogens in patients with ulcerative colitis.microbial pathogens were sought in faeces of patients with active ulcerative colitis and again after 3 months treatment. 64 patients were examined during their first episode of ulcerative colitis and 30 with relapse of chronic disease. at presentation, bacterial pathogens were not found; 1 patient had cryptosporidiosis. in 10 patients treatment appeared to result in some loss of colonisation resistance as evidenced by colonisation with beta-haemolytic streptococci, staphylococcus aureus, candida ...19921363319
virulence factors in anaerobic bacteria.various surface structures can be expressed in bacteroides fragilis, but little is known about capsular structures in other non-spore-forming anaerobes. fimbriae have been isolated from bacteroides fragilis and porphyromonas gingivalis. the importance of iron-repressible outer membrane proteins as virulence factors in bacteroides fragilis is under study. the low endotoxic activity of bacteroides fragilis lipopolysaccharide can be attributed to the chemical composition of this organism's lipid a. ...19921363545
comparison of clostridium sordellii toxins ht and lt with toxins a and b of c. difficile.clostridium sordellii produces two toxins, designated ht (haemorrhagic toxin) and lt (lethal toxin), that are similar to toxins a and b of c. difficile. the physicochemical properties of toxins ht and a were remarkably similar. the specific biological activities of toxin ht were almost the same as those of toxin a, and their nh2-terminal sequences shared close homology. the properties of toxins lt and b were similar, as were their nh2-terminal sequences, but toxin b was much more cytotoxic than ...19921370542
localization of two epitopes recognized by monoclonal antibody pcg-4 on clostridium difficile toxin a.the toxin a gene of clostridium difficile contains a 2.5-kb region encoding a series of contiguous repeating units located at the cooh terminus of the molecule. we previously showed that the monoclonal antibody (mab) pcg-4, which neutralizes the enterotoxic activity of toxin a, binds to epitopes located within these repeating units. in the present study, we subcloned a series of fragments from this portion of the gene. the recombinant peptides expressed from the gene fragments were examined for ...19921375199
monoclonal antibodies specific for clostridium difficile toxin b and their use in immunoassays.five mouse monoclonal antibodies (mabs) against clostridium difficile toxin b have been raised and characterized. three of them were immunoglobulin m (igm) antibodies (6b10, 6g3, and 10b9), and the other two were of the igg1 isotype (9e5 and 17g2), recognizing specifically two distinct epitopes on the toxin b molecule. no mab was able to neutralize cytotoxic activity significantly. the two igg1 mabs were purified and applied to various immunodiagnostic assays. mabs coupled to latex beads were us ...19921378062
high prevalence of clostridium difficile diarrhoea during intensive chemotherapy for disseminated germ cell cancer.a prospective, consecutive study of the aetiology of treatment-associated diarrhoea was conducted in 25 patients with disseminated germ cell cancer treated with intensive chemotherapy. clostridium difficile was isolated in 45% of the diarrhoea episodes, which makes this species the most important bacterial pathogen in the development of clinically significant diarrhoea in this group of immunocompromised patients.19921384640
evaluation of a commercial enzyme immunoassay kit for the detection of clostridium difficile toxin a.a new enzyme immunoassay (eia) kit developed for the rapid detection of clostridium difficile toxin a in faecal specimens, premier (meridian diagnostics), was evaluated using 101 faecal specimens. sixty-nine specimens were positive for clostridium difficile by isolation of the organism and by cytotoxicity in tissue culture. the eia for toxin a was positive in 49 of these 69 cases. no specimen that was negative for cytotoxicity was positive by eia. eight of the 32 specimens negative by both eia a ...19921396759
comparison of selective media for optimal recovery of clostridium difficile from diarrhoeal stools.five selective media were compared for their efficacy in the recovery of c. difficile from stool specimens. of 341 diarrhoeic stool samples, 38 (11%) yielded c. difficile. eighty per cent of the isolates were detected on modified taurocholate cycloserine cefoxitin fructose agar (mtccfa) and 73 per cent were detected on taurocholate cycloserine cefoxitin fructose agar (tccfa). mtccfa was also found superior to the other four media as it supported better growth of c. difficile colonies, by effecti ...19921398806
molecular, immunological, and biological characterization of a toxin a-negative, toxin b-positive strain of clostridium difficile.a cytotoxigenic clostridium difficile strain that fails to produce toxin a but causes hemorrhage and bloody fluid accumulation in ligated ileal loops of rabbits and hemorrhage and diarrhea in hamsters is described. the lack of reaction of dna from this strain in hybridization studies with a toxin a gene-specific 4.5-kb probe and polymerase chain reaction studies with six toxin a-specific primers indicate the absence of the toxin a gene. the cytotoxin produced by this strain was not responsible f ...19921398930
characterization of a toxin a-negative, toxin b-positive strain of clostridium difficile.this study was undertaken to examine toxin production by clostridium difficile 8864, a naturally occurring isolate that has been reported to produce toxin b in the absence of toxin a. to date, this is the only strain of c. difficile reported to produce only one of the toxins. the results of our initial studies with antibodies against toxins a and b confirmed these observations. toxin b from strain 8864 and from vpi strain 10463, a strain that produces high levels of both toxin a and toxin b, was ...19921398977
ciprofloxacin and clostridium difficile-associated diarrhoea.recent reports have implicated ciprofloxacin as a cause of clostridium difficile-associated diarrhoea. this problem was examined in three ways. first, the mic of ciprofloxacin for c. difficile was determined. the mic range was 8-32 mg/l, with c. difficile were 'treated' with ciprofloxacin and clindamycin in a test-tube, and the growth of c. difficile monitored. the clindamycin-treated emulsions supported growth of c. difficile, while the ciprofloxacin-treated and control emulsions did not differ ...19921399923
new selective medium for isolating clostridium difficile from compare ccfa (cycloserine, cefoxitin fructose agar) with a new selective medium cdmn (containing cysteine hydrochloride, norfloxacin, and moxalactam) for the isolation of clostridium difficile after direct faecal culture.19921401214
selective criteria for the microbiological examination of faecal assess the effectiveness of predetermined investigation criteria for the examination of faecal samples from inpatients, cultured stool specimens were prospectively examined for salmonella spp, shigella spp, campylobacter spp and clostridium difficile, and screened microscopically for intestinal parasites. out of a total of 505 specimens, 421 (83%) fulfilled the criteria for examination for c difficile, 254 (50%) for salmonella spp, shigella spp, and campylobacter spp, and 87 (17%) for intesti ...19921401225
successful treatment of clostridium difficile colitis with ciprofloxacin. 19921401841
pseudomembranous colitis following resection for hirschsprung's disease.enterocolitis is the most common cause of significant morbidity and death in hirschsprung's disease. although most cases respond to nasogastric decompression, antibiotics, and colonic evacuation, some children have an unusually fulminant or protracted clinical course. four cases are reported of pseudomembranous colitis (pmc) that developed 1 to 18 months (mean, 8 months) after definitive surgery for hirschsprung's disease (soave endorectal pull-though, 2; duhamel procedure, 2). while all childre ...19921403498
[surgical treatment of toxic megacolon complicating pseudomembranous colitis. apropos of a case, review of the literature].toxic megacolon complicating pseudomembranous colitis has been rarely observed. only 36 cases have been previously reported. we present herein a new case report in which pseudomembranous colitis was secondary to prophylactic antibiotherapy with pefloxacin for hip prosthesis. despite specific oral treatment (against clostridium difficile) by vancomycin, toxic megacolon required urgent subtotal colectomy with ileostomy and sigmoidostomy. postoperative course was uneventful. analysis of the reporte ...19921416759
effects of antibiotics and other drugs on toxin production in clostridium difficile in vitro and in an attempt to understand more completely why patients treated with phenothiazines (chlorpromazine and cyamemazine), methotrexate, and certain antibiotics such as clindamycin have an increased risk of developing pseudomembranous colitis, the production of toxins a and b by clostridium difficile in the presence of these drugs was measured in vitro as well as in vivo by using axenic mice. none of the drugs tested increased the production of toxins either in vitro or in vivo.19921416834
presence of clostridium difficile and antibiotic and beta-lactamase activities in feces of volunteers treated with oral cefixime, oral cefpodoxime proxetil, or placebo.three groups of six healthy adult volunteers were randomly assigned to a treatment with 400 mg of oral cefpodoxime proxetil, oral cefixime, or placebo per day for 10 days. informed consent was obtained from all volunteers. clostridium difficile was not detected in the feces of any subject before treatment or at any time in the subjects in the placebo group. c. difficile was, however, detected in all subjects treated with cefpodoxime proxetil and in five of six treated with cefixime. genomic dna ...19921416894
antibiotic-associated diarrhea.diarrhea is clearly one of the most common side effects encountered with antimicrobial treatment. virtually all drugs with an antibacterial spectrum of activity have been implicated, although there are definite differences in associated incidence rates that appear to depend on spectrum of activity and pharmacokinetic properties. most cases of antibiotic-associated diarrhea can be classified in two categories: cases in which clostridium difficile is implicated and cases in which no putative agent ...19921420669
use of bacitracin in the prevention and treatment of experimentally-induced idiopathic colitis in horses.ten healthy ponies from a single herd were found by repeated fecal culture to be free of salmonella species and clostridium cadaveris. in a preliminary study, four ponies administered a single oral dose of 10 mg/kg lincomycin did not develop idiopathic colitis when the drug was administered alone. four other ponies were administered 10 mg/kg lincomycin by stomach tube together with 0.45 l of colonic content from a horse with idiopathic colitis induced earlier by lincomycin alone. two of the four ...19921423060
evaluation of c. diff.-cube test for detection of clostridium difficile-associated diarrhea.the toxin b assay was used to evaluate c. diff.-cube, a new dot-immunobinding assay (dia) for the laboratory diagnosis of clostridium difficile-associated diarrhea. the widely used latex agglutination test was also included for comparison. stools from 100 patients suspected of having c. difficile-associated diarrhea were tested. the toxin b assay, latex agglutination, and dia tests were positive for 12%, 9%, and 22% of the specimens, respectively. the sensitivity, specificity, and positive and n ...19921424501
in vitro activity of l-627 against anaerobic bacteria.the in vitro activity of l-627 against 370 anaerobic bacterial strains including anaerobic cocci, propionibacterium acnes, clostridium perfringens, clostridium difficile, bacteroides fragilis, other bacteroides spp. and fusobacteria was determined by the agar dilution method. this activity was compared with that of piperacillin, cefoxitin, imipenem, meropenem, clindamycin, metronidazole and chloramphenicol. l-627, imipenem, meropenem, clindamycin, metronidazole and chloramphenicol were the most ...19921425740
pseudomembranous colitis: an ultrasound diagnosis. 19921425754
antimicrobial susceptibility of clostridium difficile strains isolated from hospitalised patients with acute diarrhoea.the susceptibility of 43 clostridium difficile strains to twelve antimicrobials was tested in vitro by agar dilution. all of the 43 strains were inhibited by low concentrations of metronidazole, penicillin g, tetracycline and ampicillin. the strains were highly resistant to gentamycin, trimethoprim, sulphamethoxazole, nalidixic acid, cycloserine, cefotaxime and uniformly sensitive to metronidazole and penicillin g whereas the activity of other antimicrobials are variable.19921430970
reduction of c difficile-associated diarrhea. 19921430997
systemic and mucosal antibody responses to toxin a in patients infected with clostridium difficile.the systemic and mucosal humoral response to toxin a, the primary virulence factor of clostridium difficile, was measured in sera and intestinal secretions from 21 patients with c. difficile diarrhea, 9 asymptomatic c. difficile fecal excretors, and 10 noncolonized control subjects. toxin a-specific igg was higher in convalescent sera of the patients with diarrhea (mean +/- se, 990 +/- 260 ng/ml) than in acute sera (620 +/- 150 ng/ml), in sera from asymptomatic excretors (410 +/- 140 ng/ml), or ...19921431247
nosocomial infection with clostridium difficile investigated by pyrolysis mass spectrometry.fifty-eight isolates of clostridium difficile from two distinct outbreaks were examined for inter-strain similarity by pyrolysis mass spectrometry (pms). the first outbreak began on a geriatric acute unit and spread to a long stay geriatric facility. pms analysis showed that most isolates from both sites were indistinguishable. isolates obtained in the preceding year from the long stay facility were found to be closely similar to these outbreak isolates. in the second, smaller outbreak on a fema ...19921433258
[evaluation of the immunoenzyme test (elisa) in detecting clostiridium difficile toxin a in fecal samples].currently, the method of choice in diagnosis of clostridium difficile-associated intestinal diseases is the detection of toxin b in fecal specimens. this method is long (72 h) and can be realized in laboratories which have tissue culture facilities. commercial agglutination test have been evaluated but they lack in specificity. an immunoenzymatic test has been recently commercialized for detection of toxin a. we have compared the results of this assay on 275 fecal specimens from patients suspect ...19921443788
prospective study of oral teicoplanin versus oral vancomycin for therapy of pseudomembranous colitis and clostridium difficile-associated diarrhea.a prospective, randomized study comparing oral teicoplanin with oral vancomycin in the treatment of pseudomembranous colitis (pmc) and clostridium difficile-associated diarrhea (cdad) was performed. teicoplanin was administered at a dosage of 100 mg twice a day for 10 days, and vancomycin was administered at a dosage of 500 mg four times a day for 10 days. cdad was diagnosed by demonstrating both c. difficile and cytotoxin in the feces of symptomatic patients (more than three loose stools per da ...19921444298
pseudomembranous colitis in sickle cell disease responding to exchange transfusion.we report a case of ischemic colitis with pseudomembrane formation in a 6 1/2-year-old boy with sickle cell disease that responded to medical management including exchange transfusion. this case was not associated with clostridium difficile infection but with an elevation of serum levels of tumor necrosis factor alpha. this rare complication of sickle cell disease has been reported only in adults.19921447655
surgical laparoscopic experience during the first year on a teaching service.recently, general surgeons have become actively involved in laparoscopic operations. the best method for teaching these techniques to surgical residents is unclear. since june 1990, at st. luke's-roosevelt hospital center in new york city, we have instituted a formal course of instruction for surgical residents. this includes a reference syllabus, didactic instruction, use of an inanimate training device and a hands-on practice in swine. clinically, the residents progress from observer to camera ...19921448732
multiple dose pharmacokinetics, safety, and effects on faecal microflora, of cefepime in healthy a randomized, double-blind, placebo-controlled study in 12 healthy volunteers pharmacokinetics, safety and impact on the faecal microflora of cefepime were determined. for eight days eight volunteers received cefepime 1000 mg bd by constant infusion over 30 min, four volunteers received placebo. concentrations of cefepime in serum and urine were measured by bioassay and hplc. the correlation between the two methods was good and the bioassay results were used for pharmacokinetic calculations. ...19921452502
new rapid identification test for clostridium difficile.a set of five tests were developed and tested for their ability to confirm the identity of c difficile colonies within 30 minutes.19921452788
prevalence of bacterial agents of diarrhoeal disease at the national university hospital, singapore and their resistance to antimicrobial agents.over a 50-month period, 4,508 stool specimens from patients with diarrhoea were bacteriologically examined at the national university hospital, singapore. salmonella serotypes other than the typhoid and paratyphoid bacilli were the most common finding, being isolated in 10.8% of cases. campylobacter jejuni was unexpectedly infrequent (1.9%); aeromonas hydrophila was found in 1.8%. no other aerobic pathogen occurred in more than 1% of cases. clostridium difficile was sought only when requested, a ...19921455527
multiple relapses of clostridium difficile-associated diarrhea in a cancer patient. successful control with long-term cholestyramine therapy.clostridium difficile-associated diarrhea (cdad) is caused by a toxin elaborated by the anaerobic organism clostridium difficile. although the vast majority of cdad cases are now associated with antibiotic use, the administration of antineoplastic agents alone can result in clinical manifestations. while therapy with oral vancomycin is usually successful, one quarter of patients will relapse. we describe a 16-year-old girl with osteogenic sarcoma whose therapy was significantly complicated by mu ...19921456403
[bacterial pathogens in diarrhea: demonstration of verotoxin-producing escherichia coli using the polymerase chain reaction].in 23% of 576 diarrhea patients we were able to demonstrate putative bacterial pathogens. not included in this number is clostridium difficile which was found in 8 of 48 (8.3%) specimens analyzed. in addition to salmonella (8.2%), campylobacter (6.0%), aeromonas (2.7%), shigella (1.9%) and yersinia (0.8%) we identified verotoxin-producing escherichia coli (vtec) in 10 patients (1.9%). vtec were found as frequently as shigella (occurring exclusively in patients returning from the tropics) and we ...19921465595
cell injury and death caused by bacterial protein toxins.bacterial protein toxins, such as clostridium difficile toxin a and the escherichia coli cytotoxic necrotizing factor 1 are known to exert their cytotoxic action via a modification of some cytoskeletal components. the changes in actin organization caused by these toxins appear to be the primary events in the mechanism leading to cell death.19921471224
susceptibility to infection in relation to sids.because there is little evidence that invasive bacterial diseases contribute to cot deaths, most studies on infectious causes of sids have focused on viruses or toxin producing bacteria. although epidemiological studies found marginally significant associations between influenza virus and sids, respiratory syncytial virus (rsv) was isolated from 90% of older infants with sids. there are conflicting reports that some toxigenic bacteria (clostridium botulinum, clostridium difficle, enterotoxigenic ...19921474153
[clostridium difficile and diarrhea in infants in the first half-year of life].in order to study a possible etiological relationship between clostridium and diarrhea in children of the first half year of life and to characterize the colonization of the intestine with these bacteria, bacteriological investigations of feces were carried out in neonates and babies aged 1, 4 and 14 days and 1, 3 and 6 months. the development of the children and their health status were monitored under home conditions. it has been established that the colonization of the neonates' intestine wit ...19921475133
evaluation of new anti-infective drugs for the treatment of antibiotic-associated colitis. infectious diseases society of america and the food and drug administration.colitis due to clostridium difficile is diagnosed in 10%-15% of hospitalized patients who develop diarrhea after treatment with antimicrobial drugs. diagnosis is based on the concurrence of diarrhea, one or more signs or symptoms of enteric intoxication, and stool from which toxigenic c. difficile is isolated or from which its toxins are identified. clinical trials evaluating therapy may be placebo controlled (for mild disease) or concurrently controlled with an active drug. a randomized, double ...19921477241
gas chromatographic detection of anaerobic bacteria from environment.a rapid method of detection of anaerobic bacteria in environment using gas chromatograph is described. metabolically produced volatile and non-volatile fatty acid by the anaerobic bacteria are detected gas-chromatographically. using this technique anaerobic bacteria are detected from soil, air, laboratory and operation theatre environments and drinking water samples. in the polluted drinking water apart from drug resistant e. coli, clostridium difficile is isolated indicating faecal pollution of ...19921478718
[effect of dq-2556, a new cephalosporin derivative, on fecal microflora].a new cephalosporin derivative antibacterial agent, dq-2556, was administered intravenously to 4 healthy adult male volunteers at 2 grams per dosage 2 times a day for 5 days, and degrees of effects of drug concentrations on the fecal microflora were investigated. 1. the total viable count remained unchanged during the study period due to the minimal change in the number of members of the family bacteroidaceae, which were the most dominant organisms. in one of the volunteers, however, the total c ...19921479685
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