Clostridium difficile associated diarrhoea in hospitalised patients: onset in the community and hospital and role of flexible sigmoidoscopy

Johal, S S; Hammond, Jeremy; Solomon, Katie; James, P D; Mahida, Yashwant R.

doi:10.1136/gut.2003.028803

Cited by 113 publications

(77 citation statements)

References 28 publications

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“…Stool samples were collected during flexible sigmoidoscopy from 18 patients with C. difficile-associated diarrhea (22). No bowel preparation was performed prior to sigmoidoscopy, but 10 to 20 ml of 0.9% NaCl was often applied to obtain better views of the mucosa.…”

Section: Methodsmentioning

confidence: 99%

Monocytes Are Highly Sensitive toClostridium difficileToxin A-Induced Apoptotic and Nonapoptotic Cell Death

et al. 2005

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In this study we investigated the in vitro responses of peripheral blood mononuclear preparations and purified monocytes to Clostridium difficile toxin A. In contrast to the responses of T and B cells, exposure to toxin A led to a rapid loss of monocytes in a time-and dose-dependent fashion (the majority of cells were lost within 24 h of exposure to >100 ng of toxin per ml). Transmission electron microscopy, flow cytometry, and fluorescence microscopy after propidium iodide and Hoechst staining showed that cell death in purified preparations of monocytes following exposure to 100 and 1,000 ng of toxin A per ml occurred by apoptosis. Further studies showed that 5,5,6,6-tetrachloro-1,1,3,3-tetraethylbenzimidazole-carbocyanine iodide aggregates were retained within toxin A-exposed monocyte mitochondria, but cytochrome c was released, suggesting that the apoptotic cascade was triggered in the absence of mitochondrial permeability transition. There was also an increase in caspase-3 activity in toxin A-stimulated monocytes. Following exposure to very high concentrations of toxin A (30 g/ml), monocyte cell death was predominantly of the necrotic type, with rapid extracellular release of lactate dehydrogenase. These studies demonstrated that C. difficile toxin A has a cell-specific effect, in which monocytes exhibit greater susceptibility than lymphocytes and their death is induced in a concentration-dependent manner.

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Section: Methodsmentioning

confidence: 99%

Monocytes Are Highly Sensitive toClostridium difficileToxin A-Induced Apoptotic and Nonapoptotic Cell Death

et al. 2005

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“…The fecal cytotoxin assay for direct detection of toxin in stool samples using cell lines and specific neutralization was recognized as the "gold standard" for diagnosis of CDI. However, there is clear evidence that culture followed by demonstration of toxin production by isolates (toxigenic culture) is a more sensitive assay for detection of toxigenic C. difficile than the fecal cytotoxin assay (8,13,15,16,22,27). One study reported that 29 patients with proven pseudomembranous colitis tested negative in the fecal cytotoxin assay; however, 9 of the 29 samples were submitted for culture and all 9 (16).…”

Section: Discussionmentioning

confidence: 99%

“…However, there is clear evidence that culture followed by demonstration of toxin production by isolates (toxigenic culture) is a more sensitive assay for detection of toxigenic C. difficile than the fecal cytotoxin assay (8,13,15,16,22,27). One study reported that 29 patients with proven pseudomembranous colitis tested negative in the fecal cytotoxin assay; however, 9 of the 29 samples were submitted for culture and all 9 (16). In one large 7-year study, toxigenic culture resulted in the diagnosis of 355 cases of CDI that would have been missed using the fecal cytotoxin assay alone (8).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Chromogenic Culture Medium for Isolation of Clostridium difficile within 24 Hours

et al. 2010

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Rapid and effective methods for the isolation of Clostridium difficile from stool samples are desirable to obtain isolates for typing or to facilitate accurate diagnosis of C. difficile-associated diarrhea. We report on the evaluation of a prototype chromogenic medium (ID C. difficile prototype [IDCd]) for isolation of C. difficile. The chromogenic medium was compared using (i) 368 untreated stool samples that were also inoculated onto CLO medium, (ii) 339 stool samples that were subjected to alcohol shock and also inoculated onto five distinct selective agars, and (iii) standardized suspensions of 10 C. difficile ribotypes (untreated and alcohol treated) that were also inoculated onto five distinct selective agars. Two hundred thirty-six isolates of C. difficile were recovered from 368 untreated stool samples, and all but 1 of these strains (99.6%) were recovered on IDCd within 24 h, whereas 74.6% of isolates were recovered on CLO medium after 48 h. Of 339 alcohol-treated stool samples cultured onto IDCd and five other selective agars, C. difficile was recovered from 218 samples using a combination of all media. The use of IDCd allowed recovery of 96.3% of isolates within 24 h, whereas 51 to 83% of isolates were recovered within 24 h using the five other media. Finally, when they were challenged with pure cultures, all 10 ribotypes of C. difficile generated higher colony counts on IDCd irrespective of alcohol pretreatment or duration of incubation. We conclude that IDCd is an effective medium for isolation of C. difficile from stool samples within 24 h.

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“…(iii) Anecdotal experiences with cases of severe CDI missed by toxin tests have promoted a desire for absolute sensitivity, regardless of specificity, and an erroneous belief that all patients with toxigenic C. difficile and diarrhea have CDI as the cause of their symptoms (9)(10)(11)(12)(13)(14). Widespread misclassification of non-CDI diarrhea in patients with C. difficile colonization as "CDI" has reinforced the belief that toxin tests are insensitive for CDI without systematic investigation to verify the true frequency of disease (2,9,11,(15)(16)(17).…”

mentioning

confidence: 99%

Point-Counterpoint: What Is the Optimal Approach for Detection of Clostridium difficile Infection?

2017

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INTRODUCTION In 2010, we published an initial Point-Counterpoint on the laboratory diagnosis of Clostridium difficile infection (CDI). At that time, nucleic acid amplification tests (NAATs) were just becoming commercially available, and the idea of algorithmic approaches to CDI was being explored. Now, there are numerous NAATs in the marketplace, and based on recent proficiency test surveys, they have become the predominant method used for CDI diagnosis in the United States. At the same time, there is a body of literature that suggests that NAATs lack clinical specificity and thus inflate CDI rates. Hospital administrators are taking note of institutional CDI rates because they are publicly reported. They have become an important metric impacting hospital safety ratings and value-based purchasing; hospitals may have millions of dollars of reimbursement at risk. In this Point-Counterpoint using a frequently asked question approach, Ferric Fang of the University of Washington, who has been a consistent advocate for a NAAT-only approach for CDI diagnosis, will discuss the value of a NAAT-only approach, while Christopher Polage of the University of California Davis and Mark Wilcox of Leeds University, Leeds, United Kingdom, each of whom has recently written important articles on the value of toxin detection in the diagnosis, will discuss the impact of toxin detection in CDI diagnosis.

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Clostridium difficile associated diarrhoea in hospitalised patients: onset in the community and hospital and role of flexible sigmoidoscopy

Cited by 113 publications

References 28 publications

Monocytes Are Highly Sensitive toClostridium difficileToxin A-Induced Apoptotic and Nonapoptotic Cell Death

Monocytes Are Highly Sensitive toClostridium difficileToxin A-Induced Apoptotic and Nonapoptotic Cell Death

Evaluation of a Chromogenic Culture Medium for Isolation of Clostridium difficile within 24 Hours

Point-Counterpoint: What Is the Optimal Approach for Detection of Clostridium difficile Infection?

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