Clostridium Difficile (eBook)

Front Cover 1
Clostridium difficile: Its Role in Intestinal Disease 4
Copyright Page 5
Table of Contents 6
Contributors 14
Preface 16
Chapter 1. Introduction 18
REFERENCES 29
Chapter 2. Historical Aspects 32
I. INTRODUCTION 32
II. THE ORGANISM 33
III. THE SYNDROME 36
REFERENCES 41
Part I: Clinical Aspects of Clostridium difficile-Associated Intestinal Disease 46
Chapter 3. Antimicrobial Agent–Associated Diarrhea in Adult Humans 48
I. POSTOPERATIVE PSEUDOMEMBRANOUS ENTEROCOLITIS 49
II. STAPHYLOCOCCAL ENTEROCOLITIS 50
III. ANTIMICROBIAL AGENT-ASSOCIATED DIARRHEA AND COLITIS 52
REFERENCES 58
Chapter 4. Clostridium difficile in Infants and Children 62
I. INTRODUCTION 63
II. CARRIER STATE IN INFANCY 63
III. CLOSTRIDIUM DIFFICILE AS A CAUSE OF DIARRHEA IN INFANCY AND CHILDHOOD 67
IV. SUDDEN INFANT DEATH SYNDROME 72
V. TREATMENT OF CLOSTRIDIUM DIFFICILE DISEASE IN CHILDREN 73
VI. SUMMARY AND FUTURE PROSPECTS 74
REFERENCES 76
Chapter 5. Other Clostridial Causes of Diarrhea and Colitis in Man and Animals 82
I. OTHER CLOSTRIDIAL CAUSES OF DIARRHEA AND COLITIS IN MAN 83
II. OTHER CLOSTRIDIAL CAUSES OF DIARRHEA AND COLITIS IN ANIMALS 92
III. CLOSTRIDIAL CAUSES OF DIARRHEA IN INSECTS 108
IV. CONCLUSIONS 108
ACKNOWLEDGMENTS 109
REFERENCES 109
Chapter 6. Immunological Response to Clostridium difficile Infection 116
I. INTRODUCTION 117
II. ROLE OF LOCAL IMMUNITY AGAINST CLOSTRIDIUM DIFFICILE 117
III. SYSTEMIC IMMUNE RESPONSE 119
IV. GENERAL DISCUSSION 125
REFERENCES 127
Part II: Animal Models of Clostridium difficile–Associated Intestinal Disease 130
Chapter 7. Role of the Hamster Model of Antibiotic-Associated Colitis in Defining the Etiology of the Disease 132
I. INTRODUCTION 132
II. USE OF HAMSTERS TO DETERMINE WHETHER BACTERIA ARE INVOLVED IN PSEUDOMEMBRANOUS COLITIS 134
III. ASSOCIATION OF CLOSTRIDIUM DIFFICILE WITH ANTIBIOTIC-ASSOCIATED COLITIS IN HUMANS 137
IV. DEVELOPMENT OF THE MOUSE MODEL FOR THE STUDY OF CLOSTRIDIUM DIFFICILE IN VIVO 138
V. COMPARISON OF THE HAMSTER MODEL TO THE HUMAN DISEASE: LESSONS FOR THE FUTURE 139
VI. SUMMARY 141
REFERENCES 142
Chapter 8. Other Animal Models of Intestinal Disease Caused by Clostridia 144
I. INTRODUCTION 145
II. GUINEA PIGS AND ANTIBIOTIC-INDUCED ENTEROCOLITIS 146
III. MICE AND ANTIBIOTIC-INDUCED DIARRHEA 147
IV. PSEUDOMEMBRANOUS COLITIS IN RATS 148
V. ANTIBIOTIC-ASSOCIATED COLITIS IN RABBITS AND HARES 148
VI. PRAIRIE DOGS 151
VIL CHINCHILLA MODELS OF ENTEROCOLITIS INDUCED BY ANTIBIOTICS 151
VIII. DOGS AND OTHER HOUSEHOLD PETS 152
IX. SWINE 152
X. CATTLE 152
XI. HORSES 153
XII. URSUS (BEARS) 153
XIII. OPOSSUMS 153
XIV. FOWL 154
XV. SUMMARY 154
REFERENCES 155
Part III: Pathogenic Mechanisms of Clostridium difficile-Associated Intestinal Disease 160
Chapter 9. Purification and Properties of Toxins A and B of Clostridium difficile 162
I. INTRODUCTION 163
II. TOXIN PRODUCTION 164
III. PURIFICATION 166
IV. PHYSICOCHEMICAL PROPERTIES 169
V. BIOLOGICAL ACTIVITY 172
VI. IMMUNOLOGICAL PROPERTIES 176
VII. RECEPTORS 177
VIII. PROPOSED STRUCTURAL MODELS OF TOXINS A AND B 179
IX. SUMMARY 179
REFERENCES 180
Chapter 10. Mechanism of Action of Clostridium difficile Toxins 186
I. INTRODUCTION 186
II. IN VIVO STUDIES 187
III. IN VITRO STUDIES AND THEIR RELATIONSHIP TO IN VIVO EFFECTS 188
IV. SUMMARY OF PATHOGENETIC SEQUENCE OF EVENTS 194
REFERENCES 196
Chapter 11. Microbial Ecology of Clostridium difficile 200
I. INTRODUCTION 200
II. CLOSTRIDIUM DIFFICILE AND ECOLOGIC SUCCESSION 202
III. POPULATION DYNAMICS OF INGESTED CLOSTRIDIUM DIFFICILE 205
IV. SYNTHETIC MICROFLORAS 207
V. CONTROL MECHANISMS 211
VI. PROSPECTS FOR CLINICAL USE OF SYNTHETIC MICROFLORA 213
REFERENCES 215
Chapter 12. Asymptomatic Intestinal Colonization by Clostridium difficile 218
I. INTRODUCTION 219
II. INCIDENCE OF ASYMPTOMATIC COLONIZATION 220
III. MECHANISMS OF ASYMPTOMATIC COLONIZATION 226
IV. CONCLUSION 235
REFERENCES 235
Part IV: Epidemiology of Clostridium difficile–Associated Intestinal Disease 244
Chapter 13. General Epidemiology, Potential Reservoirs, and Typing Procedures 246
I. HISTORICAL CONSIDERATIONS 247
II. SPECTRUM OF DISEASE 247
III. RESERVOIRS AND POSSIBLE MODES OF TRANSMISSION 248
IV. RISK FACTORS FOR DISEASE 253
V. METHODS FOR TYPING CLOSTRIDIUM DIFFICILE 259
VI. INFECTION CONTROL MEASURES 262
VII. OTHER FACTORS, UNEXPLAINED OR UNEXPLORED 265
REFERENCES 266
Part V: Diagnosis of Clostridium difficile–Associated Intestinal Disease 274
Chapter 14. Pathology and Diagnosis of Clostridium difficile Disease 276
I. INTRODUCTION 277
II. PATHOLOGICAL FINDINGS 277
III. DIAGNOSIS OF CLOSTRIDIUM DIFFICILE DISEASE 283
REFERENCES 300
Chapter 15. Isolation and Identification of Clostridium difficile, Tissue Culture Cytotoxicity Assay 306
I. INTRODUCTION 307
II. ISOLATION TECHNIQUES 307
III. IDENTIFICATION 312
IV. CYTOTOXIN TISSUE CULTURE ASSAY AND NEUTRALIZATION BY ANTITOXIN 315
V. SUMMARY 320
REFERENCES 322
Chapter 16. Other Potential Diagnostic Techniques 328
I. INTRODUCTION 329
II. ELISA Assays 334
III. IMMUNOELECTROPHORETIC SYSTEMS FOR DIAGNOSIS OF CLOSTRIDIUM DIFFICILE TOXINS 340
IV. LATEX ASSAYS FOR CLOSTRIDIUM DIFFICILE TOXINS 346
V. FLUORESCENT ANTIBODY TEST FOR DETECTION OF CLOSTRIDIUM DIFFICILE 350
VI. TIME, EQUIPMENT, AND REAGENT REQUIREMENTS FOR EACH TYPE OF ASSAY 351
VII. CORRELATION WITH CLINICAL DATA 351
VIII. SUMMARY 353
REFERENCES 354
Part VI: Therapy of Clostridium difficile–Associated Intestinal Disease 358
Chapter 17. Therapy Directed against Clostridium difficile and Its Toxins: Complications of Therapy 360
I. DISCONTINUATION OF OFFENDING DRUG 361
II. ANTIMICROBIAL AGENTS 362
III. ANION-EXCHANGE RESINS 367
IV. OTHER AGENTS VERSUS TOXINS 368
V. SUPPORTIVE MEASURES 370
VI. MODIFICATION OF COLONIC FLORA 370
VII. SURGICAL THERAPY 372
VIII. FOLLOWUP OF TREATED PATIENTS 373
IX. CURRENT RECOMMENDATIONS FOR MANAGEMENT 373
X. PROGNOSIS 374
REFERENCES 374
Chapter 18. Surgical Aspects of Therapy 378
I. GENERAL REMARKS 379
II. HISTORICAL REVIEW 379
III. SURGICAL IMPLICATIONS 380
IV. SUMMARY 384
REFERENCES 384
Chapter 19. Prevention of Clostridium difficile–Associated Intestinal Disease 386
I. INTRODUCTION 387
II. CLOSTRIDIUM DIFFICILE IN THE ENVIRONMENT 387
III. CLOSTRIDIUM DIFFICILE IN THE HOSPITAL 387
IV. PREVENTIVE MEASURES IN THE PATIENT 392
V. SUMMARY 396
REFERENCES 396
Part VII: Conclusions 400
Chapter 20. Conclusions and Unanswered Questions 402
I. INTRODUCTION 402
II. CLINICAL ASPECTS 403
III. PATHOGENIC MECHANISMS 405
IV. DIAGNOSIS 408
V. TREATMENT AND PREVENTION 409
VI. THE FUTURE 409
Index 410