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Pathogenesis and diagnosis of clostridium difficile enterocolitis.


Antibiotic associated Clostridium difficile enterocolitis is an infectious disease with symptoms ranging from self-limiting diarrhoea to severe colitis with bloody stools and formation of pseudomembranes. The carrier rate of C. difficile in a general Swedish population was found to be low (2%; 11/594). In patients with acute diarrhoea unrelated to antibiotics the bacterium or its toxin was found in 3% (12/398). In patients with diarrhoea associated with antibiotics C. difficile or its toxin was demonstrated in 18% (873/4 793) during 1980-1982. Local outbreaks reported recently from different hospital wards in Sweden suggest that nosocomial spread of C. difficile takes place among patients on antibiotic treatment. Immunochemical fingerprinting of the isolates from one outbreak showed that one specific strain of C. difficile had spread among the patients in one hospital ward. C. difficile produces at least 2 toxins: a cytotoxin currently used in the diagnosis of C. difficile enterocolitis, and an enterotoxin. A "sandwich" enzyme-linked immunosorbent assay (ELISA) was used for the detection of enterotoxin in stool specimens. The enterotoxin was demonstrated in 80% (57/71) of patients with cytotoxin in stools. In an additional 5 patients with colitis the immunoassay was positive while the cytotoxin assay remained negative. An immunoassay demonstrating circulating antibodies to C. difficile toxins seemed to be positive in about half of the patients with verified C. difficile infection. It was notable that most patients suffering from repeated episodes of colitis did not develop an antibody response until after final recovery.

[Indexed for MEDLINE]

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