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J Infect Chemother. 2003 Dec;9(4):351-4.

Pseudomembranous colitis caused by toxin A-negative/toxin B-positive variant strain of Clostridium difficile.

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Laboratory for Clinical Investigation, Osaka University Hospital, Osaka University, 2-15 Yamadaoka, Suita, 565-0871 Osaka, Japan.


We report the first case of pseudomembranous colitis (PMC) due to a toxin A-negative, toxin B-positive strain (toxin A variant strain) of Clostridium difficile in Japan. The toxin A variant strain of C. difficile is capable of causing PMC and is undetectable in clinical laboratories that use only toxin A immunoassays for C. difficile testing. If C. difficile-associated diarrhea is clinically suspected and toxin A is not detected, then the possibility of a toxin A variant strain should be considered, and further diagnostic testing, such as polymerase chain reaction (PCR) analysis for the detection of C. difficile toxin genes should be performed.

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