Toxin-Producing Bacteria in Infants

Effects of Clostridium difficile toxins given intragastrically to animals

“…All four of the hamsters given undiluted samples of culture filtrate from toxigenic strain 10463 developed hemorrhagic fluid in the stomach, small intestine, and cecum within several hours. Diarrhea was evident in all of the animals by 5 h and two of the animals died within 15 h. In mice, the small intestine and cecum were distended with fluid by 12 h, but only 4 of 16 mice had diarrhea. Some hemorrhage was apparent along the intestinal mucosa.…”

“…In addition to the variation in sensitivity among animal species, there appears to be an age-dependent variation. Human infants can have titers of toxins A and B equivalent to those found in adults with pseudomembranous colitis, yet show no clinical symptoms of the disease (7,12,17,28). As many as half of the normal neonate population may carry C. difficile as part of their colonic flora so any effects of toxin A on gut permeability could influence the susceptibility to other intestinal diseases and toxins.…”

Cell surface binding site for Clostridium difficile enterotoxin: evidence for a glycoconjugate containing the sequence Gal alpha 1-3Gal beta 1-4GlcNAc

“…Branched structures of this kind are believed to be developmentally regulated antigens that are found on certain adult cells but not on fetal cells. The possibility that such carbohydrate sequences could be developmentally regulated also could explain why many human infants have high levels of toxin A in their colons but lack any disease symptoms (19,26,32; P. J. G. M. Rietra, K. W. Slaterus, H. C. Zonen, and S. G. M. Meuwissen, Letter. Lancet ii:319.…”

Recognition and Treatment of Antibiotic-Associated Colitis

“…The toxin is also noted in 2-8% of patients who receive antibiotics but who have no gastroin testinal complaints. The only other consis tent association noted is in healthy newborn infants who frequently have positive toxin assays in the absence of any identifiable dis ease [19][20][21], Occasional investigators have reported positive toxin assays among pa tients with relapses of inflammatory bowel disease [22], although the experience of our group and that of others [24] suggests that this occurs primarily when these patients have been given typical antibiotic-inducing agents. Thus, it is our impression that C. dif ficile does not cause relapses of IBD in the absence of antibiotic exposure.…”