Abstract
Clostridium difficile is an opportunistic pathogen that causes a spectrum of disease ranging from antibiotic-associated diarrhea to pseudomembranous colitis. Although the disease was first described in 1893, the etiologic agent was not isolated and identified until 1978. Since clinical and pathological features of C. difficile-associated disease are not easily distinguished from those of other gastrointestinal diseases, including ulcerative colitis, chronic inflammatory bowel disease, and Crohn's disease, diagnostic methods have relied on either isolation and identification of the microorganism or direct detection of bacterial antigens or toxins in stool specimens. The current review focuses on the sensitivity, specificity, and practical use of several diagnostic tests, including methods for culture of the etiologic agent, cellular cytotoxicity assays, latex agglutination tests, enzyme immunoassay systems, counterimmunoelectrophoresis, fluorescent-antibody assays, and polymerase chain reactions.
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- ALTEMEIER W. A., HUMMEL R. P., HILL E. O. Staphylococcal enterocolitis following antibiotic therapy. Ann Surg. 1963 Jun;157:847–858. doi: 10.1097/00000658-196306000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- ANGEVINE D. M., HARTMANN H. A. Pseudomembranous colitis complicating prolonged antibiotic therapy. Am J Med Sci. 1956 Dec;232(6):667–673. doi: 10.1097/00000441-195612000-00007. [DOI] [PubMed] [Google Scholar]
- Abrams G. D., Allo M., Rifkin G. D., Fekety R., Silva J., Jr Mucosal damage mediated by clostridial toxin in experimental clindamycin-associated colitis. Gut. 1980 Jun;21(6):493–499. doi: 10.1136/gut.21.6.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Adler S. P., Chandrika T., Berman W. F. Clostridium difficile associated with pseudomembranous colitis. Occurrence in a 12-week-old infant without prior antibiotic therapy. Am J Dis Child. 1981 Sep;135(9):820–822. [PubMed] [Google Scholar]
- Allen S. D., Dunn G. D., Page D. L., Wilson F. A. Bacteriological studies in a patient with antibiotic-associated pseudomembranous colitis. Gastroenterology. 1977 Jul;73(1):158–163. [PubMed] [Google Scholar]
- Allo M., Silva J., Jr, Fekety R., Rifkin G. D., Waskin H. Prevention of clindamycin-induced colitis in hamsters by Clostridium sordellii antitoxin. Gastroenterology. 1979 Feb;76(2):351–355. [PubMed] [Google Scholar]
- Ambrose N. S., Johnson M., Burdon D. W., Keighley M. R. The influence of single dose intravenous antibiotics on faecal flora and emergence of Clostridium difficile. J Antimicrob Chemother. 1985 Mar;15(3):319–326. doi: 10.1093/jac/15.3.319. [DOI] [PubMed] [Google Scholar]
- Aronsson B., Granström M., Möllby R., Nord C. E. Enzyme immunoassay for detection of Clostridium difficile toxins A and B in patients with antibiotic-associated diarrhoea and colitis. Eur J Clin Microbiol. 1985 Apr;4(2):102–107. doi: 10.1007/BF02013572. [DOI] [PubMed] [Google Scholar]
- Aronsson B., Möllby R., Nord C. E. Antimicrobial agents and Clostridium difficile in acute enteric disease: epidemiological data from Sweden, 1980-1982. J Infect Dis. 1985 Mar;151(3):476–481. doi: 10.1093/infdis/151.3.476. [DOI] [PubMed] [Google Scholar]
- Aronsson B., Möllby R., Nord C. E. Diagnosis and epidemiology of Clostridium difficile enterocolitis in Sweden. J Antimicrob Chemother. 1984 Dec;14 (Suppl 500):85–95. doi: 10.1093/jac/14.suppl_d.85. [DOI] [PubMed] [Google Scholar]
- Azmy A. A., Raine P. A., Young D. G. Pseudomembranous enterocolitis--a potentially lethal disease. J Pediatr Surg. 1990 Apr;25(4):453–456. doi: 10.1016/0022-3468(90)90393-n. [DOI] [PubMed] [Google Scholar]
- Bacon A. E., Fekety R., Schaberg D. R., Faix R. G. Epidemiology of Clostridium difficile colonization in newborns: results using a bacteriophage and bacteriocin typing system. J Infect Dis. 1988 Aug;158(2):349–354. doi: 10.1093/infdis/158.2.349. [DOI] [PubMed] [Google Scholar]
- Baldacini O., Girardot R., Green G. A., Rihn B., Monteil H. Comparative study of immunological properties and cytotoxic effects of Clostridium difficile toxin B and Clostridium sordellii toxin L. Toxicon. 1992 Feb;30(2):129–140. doi: 10.1016/0041-0101(92)90466-i. [DOI] [PubMed] [Google Scholar]
- Banno Y., Kobayashi T., Kono H., Watanabe K., Ueno K., Nozawa Y. Biochemical characterization and biologic actions of two toxins (D-1 and D-2) from Clostridium difficile. Rev Infect Dis. 1984 Mar-Apr;6 (Suppl 1):S11–S20. doi: 10.1093/clinids/6.supplement_1.s11. [DOI] [PubMed] [Google Scholar]
- Barroso L. A., Wang S. Z., Phelps C. J., Johnson J. L., Wilkins T. D. Nucleotide sequence of Clostridium difficile toxin B gene. Nucleic Acids Res. 1990 Jul 11;18(13):4004–4004. doi: 10.1093/nar/18.13.4004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bartlett J. G. Antibiotic-associated pseudomembranous colitis. Rev Infect Dis. 1979 May-Jun;1(3):530–539. doi: 10.1093/clinids/1.3.530. [DOI] [PubMed] [Google Scholar]
- Bartlett J. G. Antimicrobial agents implicated in Clostridium difficile toxin-associated diarrhea of colitis. Johns Hopkins Med J. 1981 Jul;149(1):6–9. [PubMed] [Google Scholar]
- Bartlett J. G., Chang T. W., Gurwith M., Gorbach S. L., Onderdonk A. B. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med. 1978 Mar 9;298(10):531–534. doi: 10.1056/NEJM197803092981003. [DOI] [PubMed] [Google Scholar]
- Bartlett J. G., Chang T., Taylor N. S., Onderdonk A. B. Colitis induced by Clostridium difficile. Rev Infect Dis. 1979 Mar-Apr;1(2):370–378. doi: 10.1093/clinids/1.2.370. [DOI] [PubMed] [Google Scholar]
- Bartlett J. G., Gorbach S. L. Pseudomembranous enterocolitis (antibiotic-related colitis). Adv Intern Med. 1977;22:455–476. [PubMed] [Google Scholar]
- Bartlett J. G., Onderdonk A. B., Cisneros R. L., Kasper D. L. Clindamycin-associated colitis due to a toxin-producing species of Clostridium in hamsters. J Infect Dis. 1977 Nov;136(5):701–705. doi: 10.1093/infdis/136.5.701. [DOI] [PubMed] [Google Scholar]
- Bartlett J. G., Taylor N. S., Chang T., Dzink J. Clinical and laboratory observations in Clostridium difficile colitis. Am J Clin Nutr. 1980 Nov;33(11 Suppl):2521–2526. doi: 10.1093/ajcn/33.11.2521. [DOI] [PubMed] [Google Scholar]
- Bartlett J. G. Treatment of Clostridium difficile colitis. Gastroenterology. 1985 Nov;89(5):1192–1195. doi: 10.1016/0016-5085(85)90227-6. [DOI] [PubMed] [Google Scholar]
- Bartlett J. G. Treatment of antibiotic-associated pseudomembranous colitis. Rev Infect Dis. 1984 Mar-Apr;6 (Suppl 1):S235–S241. doi: 10.1093/clinids/6.supplement_1.s235. [DOI] [PubMed] [Google Scholar]
- Bassaris H. P., Lianou P. E., Legakis N. J., Papavassiliou J. T. Interaction between Clostridium difficile and polymorphonuclear leucocytes from the elderly and post-operative cancer patients: phagocytosis and bactericidal function. Med Microbiol Immunol. 1984;173(1):49–55. doi: 10.1007/BF02123569. [DOI] [PubMed] [Google Scholar]
- Bate G. Comparison of Minitek Anaerobe II, API An-Ident, and RapID ANA systems for identification of Clostridium difficile. Am J Clin Pathol. 1986 Jun;85(6):716–718. doi: 10.1093/ajcp/85.6.716. [DOI] [PubMed] [Google Scholar]
- Bette P., Oksche A., Mauler F., von Eichel-Streiber C., Popoff M. R., Habermann E. A comparative biochemical, pharmacological and immunological study of Clostridium novyi alpha-toxin, C. difficile toxin B and C. sordellii lethal toxin. Toxicon. 1991;29(7):877–887. doi: 10.1016/0041-0101(91)90224-f. [DOI] [PubMed] [Google Scholar]
- Bolton R. P., Tait S. K., Dear P. R., Losowsky M. S. Asymptomatic neonatal colonisation by Clostridium difficile. Arch Dis Child. 1984 May;59(5):466–472. doi: 10.1136/adc.59.5.466. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Borriello S. P. 12th C. L. Oakley lecture. Pathogenesis of Clostridium difficile infection of the gut. J Med Microbiol. 1990 Dec;33(4):207–215. doi: 10.1099/00222615-33-4-207. [DOI] [PubMed] [Google Scholar]
- Borriello S. P., Barclay F. E., Reed P. J., Welch A. R., Brown J. D., Burdon D. W. Analysis of latex agglutination test for Clostridium difficile toxin A (D-1) and differentiation between C difficile toxins A and B and latex reactive protein. J Clin Pathol. 1987 May;40(5):573–580. doi: 10.1136/jcp.40.5.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Borriello S. P., Honour P. Simplified procedure for the routine isolation of Clostridium difficile from faeces. J Clin Pathol. 1981 Oct;34(10):1124–1127. doi: 10.1136/jcp.34.10.1124. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Borriello S. P., Honour P., Turner T., Barclay F. Household pets as a potential reservoir for Clostridium difficile infection. J Clin Pathol. 1983 Jan;36(1):84–87. doi: 10.1136/jcp.36.1.84. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Borriello S. P., Vale T., Brazier J. S., Hyde S., Chippeck E. Evaluation of a commercial enzyme immunoassay kit for the detection of Clostridium difficile toxin A. Eur J Clin Microbiol Infect Dis. 1992 Apr;11(4):360–363. doi: 10.1007/BF01962079. [DOI] [PubMed] [Google Scholar]
- Brettle R. P., Wallace E. Clostridium difficile-associated diarrhoea. J Infect. 1984 Mar;8(2):123–128. doi: 10.1016/s0163-4453(84)92443-5. [DOI] [PubMed] [Google Scholar]
- Brooks J. B. Review of frequency-pulsed electron-capture gas-liquid chromatography studies of diarrheal diseases caused by members of the family Enterobacteriaceae, Clostridium difficile, and rotavirus. J Clin Microbiol. 1986 Nov;24(5):687–691. doi: 10.1128/jcm.24.5.687-691.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Browne R. A., Fekety R., Jr, Silva J., Jr, Boyd D. I., Work C. O., Abrams G. D. The protective effect of vancomycin on clindamycin-induced colitis in hamsters. Johns Hopkins Med J. 1977 Oct;141(4):183–192. [PubMed] [Google Scholar]
- Burdon D. W., Brown J. D., Youngs D. J., Arabi Y., Shinagawa N., Alexander-Williams J., Keighley M. R., George R. H. Antibiotic susceptibility of Clostridium difficile. J Antimicrob Chemother. 1979 May;5(3):307–310. doi: 10.1093/jac/5.3.307. [DOI] [PubMed] [Google Scholar]
- Caspar M., Florin I., Thelestam M. Calcium and calmodulin in cellular intoxication with Clostridium difficile toxin B. J Cell Physiol. 1987 Jul;132(1):168–172. doi: 10.1002/jcp.1041320124. [DOI] [PubMed] [Google Scholar]
- Chang T. W., Bartlett J. G., Gorbach S. L., Onderdonk A. B. Clindamycin-induced enterocolitis in hamsters as a model of pseudomembranous colitis in patients. Infect Immun. 1978 May;20(2):526–529. doi: 10.1128/iai.20.2.526-529.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chang T. W., Gorbach S. L., Bartlett J. B. Neutralization of Clostridium difficile toxin by Clostridium sordellii antitoxins. Infect Immun. 1978 Nov;22(2):418–422. doi: 10.1128/iai.22.2.418-422.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chang T. W., Gorbach S. L., Bartlett J. G., Saginur R. Bacitracin treatment of antibiotic-associated colitis and diarrhea caused by Clostridium difficile toxin. Gastroenterology. 1980 Jun;78(6):1584–1586. [PubMed] [Google Scholar]
- Chang T. W., Lauermann M., Bartlett J. G. Cytotoxicity assay in antibiotic-associated colitis. J Infect Dis. 1979 Nov;140(5):765–770. doi: 10.1093/infdis/140.5.765. [DOI] [PubMed] [Google Scholar]
- Chang T. W., Sullivan N. M., Wilkins T. D. Insusceptibility of fetal intestinal mucosa and fetal cells to Clostridium difficile toxins. Zhongguo Yao Li Xue Bao. 1986 Sep;7(5):448–453. [PubMed] [Google Scholar]
- Cherry R. D., Portnoy D., Jabbari M., Daly D. S., Kinnear D. G., Goresky C. A. Metronidazole: an alternate therapy for antibiotic-associated colitis. Gastroenterology. 1982 May;82(5 Pt 1):849–851. [PubMed] [Google Scholar]
- Ciesielski-Treska J., Ulrich G., Rihn B., Aunis D. Mechanism of action of Clostridium difficile toxin B: role of external medium and cytoskeletal organization in intoxicated cells. Eur J Cell Biol. 1989 Apr;48(2):191–202. [PubMed] [Google Scholar]
- Colarian J. Clostridium difficile colitis following antiviral therapy in the acquired immunodeficiency syndrome. Am J Med. 1988 Jun;84(6):1081–1081. doi: 10.1016/0002-9343(88)90316-6. [DOI] [PubMed] [Google Scholar]
- Collignon A., Chaumard C., Torlotin J. C. Implantation de Clostridium difficile chez les nourrissons en cours d'antibiothérapie. Pathol Biol (Paris) 1987 May;35(5):590–594. [PubMed] [Google Scholar]
- Cone J. B., Wetzel W. Toxic megacolon secondary to pseudomembranous colitis. Dis Colon Rectum. 1982 Jul-Aug;25(5):478–482. doi: 10.1007/BF02553662. [DOI] [PubMed] [Google Scholar]
- Cooperstock M. S., Steffen E., Yolken R., Onderdonk A. Clostridium difficile in normal infants and sudden infant death syndrome: an association with infant formula feeding. Pediatrics. 1982 Jul;70(1):91–95. [PubMed] [Google Scholar]
- Corthier G., Muller M. C. Emergence in gnotobiotic mice of nontoxinogenic clones of Clostridium difficile from a toxinogenic one. Infect Immun. 1988 Jun;56(6):1500–1504. doi: 10.1128/iai.56.6.1500-1504.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
- D'Ari L., Barker H. A. p-Cresol formation by cell-free extracts of Clostridium difficile. Arch Microbiol. 1985 Dec;143(3):311–312. doi: 10.1007/BF00411256. [DOI] [PubMed] [Google Scholar]
- DEARING W. H., BAGGENTOSS A. H., WEED L. A. Studies on the relationship of Staphylococcus aureus to pseudomembranous enteritis and to postantibiotic enteritis. Gastroenterology. 1960 Mar;38:441–451. [PubMed] [Google Scholar]
- Dabard J., Dubos F., Martinet L., Ducluzeau R. Experimental reproduction of neonatal diarrhea in young gnotobiotic hares simultaneously associated with Clostridium difficile and other Clostridium strains. Infect Immun. 1979 Apr;24(1):7–11. doi: 10.1128/iai.24.1.7-11.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dane T. E., King E. G. Fatal pseudomembranous enterocolitis following clindamycin therapy. Br J Surg. 1976 Apr;63(4):305–308. doi: 10.1002/bjs.1800630413. [DOI] [PubMed] [Google Scholar]
- De Girolami P. C., Hanff P. A., Eichelberger K., Longhi L., Teresa H., Pratt J., Cheng A., Letourneau J. M., Thorne G. M. Multicenter evaluation of a new enzyme immunoassay for detection of Clostridium difficile enterotoxin A. J Clin Microbiol. 1992 May;30(5):1085–1088. doi: 10.1128/jcm.30.5.1085-1088.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Deery H. G., Jones P. G., Kauffman C. A., Fekety R., Silva J., Sell T. L., Supena R. B. Effect of therapy with latamoxef (moxalactam) on carriage of Clostridium difficile. J Antimicrob Chemother. 1984 May;13(5):521–524. doi: 10.1093/jac/13.5.521. [DOI] [PubMed] [Google Scholar]
- Delmée M., Mackey T., Hamitou A. Evaluation of a new commercial Clostridium difficile toxin A enzyme immunoassay using diarrhoeal stools. Eur J Clin Microbiol Infect Dis. 1992 Mar;11(3):246–249. doi: 10.1007/BF02098089. [DOI] [PubMed] [Google Scholar]
- DiPersio J. R., Varga F. J., Conwell D. L., Kraft J. A., Kozak K. J., Willis D. H. Development of a rapid enzyme immunoassay for Clostridium difficile toxin A and its use in the diagnosis of C. difficile-associated disease. J Clin Microbiol. 1991 Dec;29(12):2724–2730. doi: 10.1128/jcm.29.12.2724-2730.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Doern G. V., Coughlin R. T., Wu L. Laboratory diagnosis of Clostridium difficile-associated gastrointestinal disease: comparison of a monoclonal antibody enzyme immunoassay for toxins A and B with a monoclonal antibody enzyme immunoassay for toxin A only and two cytotoxicity assays. J Clin Microbiol. 1992 Aug;30(8):2042–2046. doi: 10.1128/jcm.30.8.2042-2046.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Donta S. T., Myers M. G. Clostridium difficile toxin in asymptomatic neonates. J Pediatr. 1982 Mar;100(3):431–434. doi: 10.1016/s0022-3476(82)80454-x. [DOI] [PubMed] [Google Scholar]
- Donta S. T., Sullivan N., Wilkins T. D. Differential effects of Clostridium difficile toxins on tissue-cultured cells. J Clin Microbiol. 1982 Jun;15(6):1157–1158. doi: 10.1128/jcm.15.6.1157-1158.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dove C. H., Wang S. Z., Price S. B., Phelps C. J., Lyerly D. M., Wilkins T. D., Johnson J. L. Molecular characterization of the Clostridium difficile toxin A gene. Infect Immun. 1990 Feb;58(2):480–488. doi: 10.1128/iai.58.2.480-488.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ellis M. E., Mandal B. K., Dunbar E. M., Bundell K. R. Clostridium difficile and its cytotoxin in infants admitted to hospital with infectious gastroenteritis. Br Med J (Clin Res Ed) 1984 Feb 18;288(6416):524–526. doi: 10.1136/bmj.288.6416.524. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fainstein V., Bodey G. P., Fekety R. Relapsing pseudomembranous colitis associated with cancer chemotherapy. J Infect Dis. 1981 Jun;143(6):865–865. doi: 10.1093/infdis/143.6.865. [DOI] [PubMed] [Google Scholar]
- Farrar W. E., Jr, Kent T. H. Enteritis and coliform bacteremia in guinea pigs given penicillin. Am J Pathol. 1965 Oct;47(4):629–642. [PMC free article] [PubMed] [Google Scholar]
- Feingold D. S., Chen W. C., Chou D. L., Chang T. W. Induction of colitis in hamsters by topical application of antibiotics. Arch Dermatol. 1979 May;115(5):580–581. [PubMed] [Google Scholar]
- Fekety R., Kim K. H., Batts D. H., Browne R. A., Cudmore M. A., Silva J., Jr, Toshniwal R., Wilson K. H. Studies on the epidemiology of antibiotic-associated Clostridium difficile colitis. Am J Clin Nutr. 1980 Nov;33(11 Suppl):2527–2532. doi: 10.1093/ajcn/33.11.2527. [DOI] [PubMed] [Google Scholar]
- Fekety R., Silva J., Browne R. A., Rifkin G. D., Ebright J. R. Clindamycin-induced colitis. Am J Clin Nutr. 1979 Jan;32(1):244–250. doi: 10.1093/ajcn/32.1.244. [DOI] [PubMed] [Google Scholar]
- Fekety R., Silva J., Toshniwal R., Allo M., Armstrong J., Browne R., Ebright J., Rifkin G. Antibiotic-associated colitis: effects of antibiotics on Clostridium difficile and the disease in hamsters. Rev Infect Dis. 1979 Mar-Apr;1(2):386–397. doi: 10.1093/clinids/1.2.386. [DOI] [PubMed] [Google Scholar]
- Fiorentini C., Thelestam M. Clostridium difficile toxin A and its effects on cells. Toxicon. 1991;29(6):543–567. doi: 10.1016/0041-0101(91)90050-2. [DOI] [PubMed] [Google Scholar]
- Florin I., Thelestam M. Intoxication of cultured human lung fibroblasts with Clostridium difficile toxin. Infect Immun. 1981 Jul;33(1):67–74. doi: 10.1128/iai.33.1.67-74.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fluit A. C., Wolfhagen M. J., Verdonk G. P., Jansze M., Torensma R., Verhoef J. Nontoxigenic strains of Clostridium difficile lack the genes for both toxin A and toxin B. J Clin Microbiol. 1991 Nov;29(11):2666–2667. doi: 10.1128/jcm.29.11.2666-2667.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fontaine E. A., Taylor-Robinson D., Hanna N. F., Coufalik E. D. Anaerobes in men with urethritis. Br J Vener Dis. 1982 Oct;58(5):321–326. doi: 10.1136/sti.58.5.321. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gebhard R. L., Gerding D. N., Olson M. M., Peterson L. R., McClain C. J., Ansel H. J., Shaw M. J., Schwartz M. L. Clinical and endoscopic findings in patients early in the course of clostridium difficile-associated pseudomembranous colitis. Am J Med. 1985 Jan;78(1):45–48. doi: 10.1016/0002-9343(85)90460-7. [DOI] [PubMed] [Google Scholar]
- George R. H., Symonds J. M., Dimock F., Brown J. D., Arabi Y., Shinagawa N., Keighley M. R., Alexander-Williams J., Burdon D. W. Identification of Clostridium difficile as a cause of pseudomembranous colitis. Br Med J. 1978 Mar 18;1(6114):695–695. doi: 10.1136/bmj.1.6114.695. [DOI] [PMC free article] [PubMed] [Google Scholar]
- George W. L., Rolfe R. D., Finegold S. M. Clostridium difficile and its cytotoxin in feces of patients with antimicrobial agent-associated diarrhea and miscellaneous conditions. J Clin Microbiol. 1982 Jun;15(6):1049–1053. doi: 10.1128/jcm.15.6.1049-1053.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- George W. L., Rolfe R. D., Finegold S. M. Treatment and prevention of antimicrobial agent-induced colitis and diarrhae. Gastroenterology. 1980 Aug;79(2):366–372. [PubMed] [Google Scholar]
- George W. L., Rolfe R. D., Harding G. K., Klein R., Putnam C. W., Finegold S. M. Clostridium difficile and cytotoxin in feces of patients with antimicrobial agent-associated pseudomembranous colitis. Infection. 1982;10(4):205–208. doi: 10.1007/BF01666910. [DOI] [PubMed] [Google Scholar]
- George W. L., Rolfe R. D., Sutter V. L., Finegold S. M. Diarrhea and colitis associated with antimicrobial therapy in man and animals. Am J Clin Nutr. 1979 Jan;32(1):251–257. doi: 10.1093/ajcn/32.1.251. [DOI] [PubMed] [Google Scholar]
- George W. L., Sutter V. L., Citron D., Finegold S. M. Selective and differential medium for isolation of Clostridium difficile. J Clin Microbiol. 1979 Feb;9(2):214–219. doi: 10.1128/jcm.9.2.214-219.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- George W. L., Sutter V. L., Finegold S. M. Antimicrobial agent-induced diarrhea--a bacterial disease. J Infect Dis. 1977 Dec;136(6):822–828. doi: 10.1093/infdis/136.6.822. [DOI] [PubMed] [Google Scholar]
- George W. L., Sutter V. L., Goldstein E. J., Ludwig S. L., Finegold S. M. Aetiology of antimicrobial-agent-associated colitis. Lancet. 1978 Apr 15;1(8068):802–803. doi: 10.1016/s0140-6736(78)93001-5. [DOI] [PubMed] [Google Scholar]
- Gerding D. N., Olson M. M., Peterson L. R., Teasley D. G., Gebhard R. L., Schwartz M. L., Lee J. T., Jr Clostridium difficile-associated diarrhea and colitis in adults. A prospective case-controlled epidemiologic study. Arch Intern Med. 1986 Jan;146(1):95–100. [PubMed] [Google Scholar]
- Gianfrilli P., Luzzi I., Pantosti A., Occhionero M., Gentile G., Panichi G. Cytotoxin and enterotoxin production by Clostridium difficile. Microbiologica. 1984 Oct;7(4):375–379. [PubMed] [Google Scholar]
- Gianfrilli P., Pantosti A., Luzzi I. Evaluation of gas-liquid chromatography for the rapid diagnosis of Clostridium difficile associated disease. J Clin Pathol. 1985 Jun;38(6):690–693. doi: 10.1136/jcp.38.6.690. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gibson G. E., Rowland R., Hecker R. Diarrhoea and colitis associated with antibiotic treatment. Aust N Z J Med. 1975 Aug;5(4):340–347. doi: 10.1111/j.1445-5994.1975.tb03269.x. [DOI] [PubMed] [Google Scholar]
- Gorbach S. L., Bartlett J. G. Pseudomembranous enterocolitis: a review of its diverse forms. J Infect Dis. 1977 Mar;135 (Suppl):S89–S94. doi: 10.1093/infdis/135.supplement.s89. [DOI] [PubMed] [Google Scholar]
- Gorbach S. L., Thadepalli H. Isolation of Clostridium in human infections: evaluation of 114 cases. J Infect Dis. 1975 May;131 (Suppl):S81–S85. doi: 10.1093/infdis/131.supplement.s81. [DOI] [PubMed] [Google Scholar]
- Green R. H. The association of viral activation with penicillin toxicity in guinea pigs and hamsters. Yale J Biol Med. 1974 Sep;47(3):166–181. [PMC free article] [PubMed] [Google Scholar]
- Gresser M. E., Shanholtzer C. J., Gerding D. N., Garrett C. R., Peterson L. R. Evaluation of the 24-h API 20A anaerobe system for identification of Clostridium difficile. J Clin Microbiol. 1984 Jun;19(6):915–916. doi: 10.1128/jcm.19.6.915-916.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gryboski J. D., Pellerano R., Young N., Edberg S. Positive role of Clostridium difficile infection in diarrhea in infants and children. Am J Gastroenterol. 1991 Jun;86(6):685–689. [PubMed] [Google Scholar]
- Gumerlock P. H., Tang Y. J., Meyers F. J., Silva J., Jr Use of the polymerase chain reaction for the specific and direct detection of Clostridium difficile in human feces. Rev Infect Dis. 1991 Nov-Dec;13(6):1053–1060. doi: 10.1093/clinids/13.6.1053. [DOI] [PubMed] [Google Scholar]
- Gurwith M. J., Rabin H. R., Love K. Diarrhea associated with clindamycin and ampicillin therapy: preliminary results of a cooperative study. J Infect Dis. 1977 Mar;135 (Suppl):S104–S110. doi: 10.1093/infdis/135.supplement.s104. [DOI] [PubMed] [Google Scholar]
- HJORT P. F., RAPAPORT S. I. THE SHWARTZMAN REACTION: PATHOGENETIC MECHANISMS AND CLINICAL MANIFESTATIONS. Annu Rev Med. 1965;16:135–168. doi: 10.1146/annurev.me.16.020165.001031. [DOI] [PubMed] [Google Scholar]
- HUMMEL R. P., ALTEMEIER W. A., HILL E. O. IATROGENIC STAPHYLOCOCCAL ENTEROCOLITIS. Ann Surg. 1964 Sep;160:551–560. doi: 10.1097/00000658-196409000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hafiz S., McEntegart M. G., Morton R. S., Waitkins S. A. Clostridium defficiel in the urogenital tract of males and females. Lancet. 1975 Feb 22;1(7904):420–421. doi: 10.1016/s0140-6736(75)91489-0. [DOI] [PubMed] [Google Scholar]
- Hafiz S., Oakley C. L. Clostridium difficile: isolation and characteristics. J Med Microbiol. 1976 May;9(2):129–136. doi: 10.1099/00222615-9-2-129. [DOI] [PubMed] [Google Scholar]
- Hanvanich M., Viscidi R., Laughon B. E., Bartlett J. G., Yolken R. H. Stool desorbing activity: a possible cause of false-positive reactions in competitive enzyme immunoassays. J Clin Microbiol. 1985 Feb;21(2):184–188. doi: 10.1128/jcm.21.2.184-188.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Head C. B., Ratnam S. Comparison of API ZYM system with API AN-Ident, API 20A, Minitek Anaerobe II, and RapID-ANA systems for identification of Clostridium difficile. J Clin Microbiol. 1988 Jan;26(1):144–146. doi: 10.1128/jcm.26.1.144-146.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hirsh D. C., Biberstein E. L., Jang S. S. Obligate anaerobes in clinical veterinary practice. J Clin Microbiol. 1979 Aug;10(2):188–191. doi: 10.1128/jcm.10.2.188-191.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Holst E., Helin I., Mårdh P. A. Recovery of Clostridium difficile from children. Scand J Infect Dis. 1981;13(1):41–45. doi: 10.1080/00365548.1981.11690365. [DOI] [PubMed] [Google Scholar]
- Humphrey C. D., Condon C. W., Cantey J. R., Pittman F. E. Partial purification of a toxin found in hamsters with antibiotic-associated colitis. Reversible binding of the toxin by cholestyramine. Gastroenterology. 1979 Mar;76(3):468–476. [PubMed] [Google Scholar]
- Humphrey C. D., Lushbaugh W. B., Condon C. W., Pittman J. C., Pittman F. E. Light and electron microscopic studies of antibiotic associated colitis in the hamster. Gut. 1979 Jan;20(1):6–15. doi: 10.1136/gut.20.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Huovinen P., Räihä I., Vuento R., Eerola E., Lehtonen A. False-positive Clostridium difficile latex agglutination tests. Lancet. 1990 Jun 16;335(8703):1467–1468. doi: 10.1016/0140-6736(90)91500-a. [DOI] [PubMed] [Google Scholar]
- Jarvis W., Nunez-Montiel O., Thompson F., Dowell V., Towns M., Morris G., Hill E. Comparison of bacterial isolation, cytotoxicity assay, and counterimmunoelectrophoresis for the detection of Clostridium difficile and its toxin. J Infect Dis. 1983 Apr;147(4):778–778. doi: 10.1093/infdis/147.4.778. [DOI] [PubMed] [Google Scholar]
- Johnson L. L., McFarland L. V., Dearing P., Raisys V., Schoenknecht F. D. Identification of Clostridium difficile in stool specimens by culture-enhanced gas-liquid chromatography. J Clin Microbiol. 1989 Oct;27(10):2218–2221. doi: 10.1128/jcm.27.10.2218-2221.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KAY A. W., RICHARDS R. L., WATSON A. J. Acute necrotizing (pseudomembranous) enterocolitis. Br J Surg. 1958 Jul;46(195):45–57. doi: 10.1002/bjs.18004619509. [DOI] [PubMed] [Google Scholar]
- Kabins S. A., Spira T. J. Outbreak of clindamycin-associated colitis. Ann Intern Med. 1975 Dec;83(6):830–831. doi: 10.7326/0003-4819-83-6-830. [DOI] [PubMed] [Google Scholar]
- Kappas A., Shinagawa N., Arabi Y., Thompson H., Burdon D., Dimock F., George R. H., Alexander-Williams J., Keighley M. R. Diagnosis of pseudomembranous colitis. Br Med J. 1978 Mar 18;1(6114):675–678. doi: 10.1136/bmj.1.6114.675. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Karsch W., Strelau E., Grahlow W. D., Fischer E., Schulz R. Occurrence and significance of Clostridium difficile in faecal specimens of hospitalized children. Zentralbl Bakteriol Mikrobiol Hyg A. 1989 Jan;270(3):441–448. doi: 10.1016/s0176-6724(89)80014-8. [DOI] [PubMed] [Google Scholar]
- Kato N., Ou C. Y., Kato H., Bartley S. L., Brown V. K., Dowell V. R., Jr, Ueno K. Identification of toxigenic Clostridium difficile by the polymerase chain reaction. J Clin Microbiol. 1991 Jan;29(1):33–37. doi: 10.1128/jcm.29.1.33-37.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Katz L., LaMont J. T., Trier J. S., Sonnenblick E. B., Rothman S. W., Broitman S. A., Rieth S. Experimental clindamycin-associated colitis in rabbits. Evidence of toxin-mediated mucosal damage. Gastroenterology. 1978 Feb;74(2 Pt 1):246–252. [PubMed] [Google Scholar]
- Kelly W. F., Wait K. J., Gilligan P. H. Evaluation of the latex agglutination test for detection of Clostridium difficile. Arch Pathol Lab Med. 1992 May;116(5):517–520. [PubMed] [Google Scholar]
- Kennedy E., Burke V., Pearman J., Robinson J., Gracey M. Cytotoxic effects of children's faeces: relation to diarrhoea due to Clostridium difficile and other enteric pathogens. Ann Trop Paediatr. 1991;11(2):107–112. doi: 10.1080/02724936.1991.11747487. [DOI] [PubMed] [Google Scholar]
- Kim K. H., Fekety R., Batts D. H., Brown D., Cudmore M., Silva J., Jr, Waters D. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis. 1981 Jan;143(1):42–50. doi: 10.1093/infdis/143.1.42. [DOI] [PubMed] [Google Scholar]
- Knoop F., Martig R., Owens M. Degradation of 2-phosphoglycerate by cytotoxin B of Clostridium difficile. FEBS Lett. 1990 Jul 2;267(1):9–12. doi: 10.1016/0014-5793(90)80274-m. [DOI] [PubMed] [Google Scholar]
- Krishnan C. Detection of Clostridium difficile toxins by enzyme immunoassay. J Hyg (Lond) 1986 Feb;96(1):5–12. doi: 10.1017/s0022172400062471. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Krivan H. C., Clark G. F., Smith D. F., Wilkins T. D. Cell surface binding site for Clostridium difficile enterotoxin: evidence for a glycoconjugate containing the sequence Gal alpha 1-3Gal beta 1-4GlcNAc. Infect Immun. 1986 Sep;53(3):573–581. doi: 10.1128/iai.53.3.573-581.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kurzynski T. A., Cembrowski G. S., Kimball J. L. The use of CIE for the detection of Clostridium difficile toxin in stool filtrates: laboratory and clinical correlation. Am J Clin Pathol. 1983 Mar;79(3):370–374. doi: 10.1093/ajcp/79.3.370. [DOI] [PubMed] [Google Scholar]
- Larson H. E., Barclay F. E., Honour P., Hill I. D. Epidemiology of Clostridium difficile in infants. J Infect Dis. 1982 Dec;146(6):727–733. doi: 10.1093/infdis/146.6.727. [DOI] [PubMed] [Google Scholar]
- Larson H. E., Parry J. V., Price A. B., Davies D. R., Dolby J., Tyrrell D. A. Undescribed toxin in pseudomembranous colitis. Br Med J. 1977 May 14;1(6071):1246–1248. doi: 10.1136/bmj.1.6071.1246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Larson H. E., Price A. B., Honour P., Borriello S. P. Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet. 1978 May 20;1(8073):1063–1066. doi: 10.1016/s0140-6736(78)90912-1. [DOI] [PubMed] [Google Scholar]
- Larson H. E., Price A. B. Pseudomembranous colitis: Presence of clostridial toxin. Lancet. 1977 Dec 24;2(8052-8053):1312–1314. doi: 10.1016/s0140-6736(77)90363-4. [DOI] [PubMed] [Google Scholar]
- Laughon B. E., Viscidi R. P., Gdovin S. L., Yolken R. H., Bartlett J. G. Enzyme immunoassays for detection of Clostridium difficile toxins A and B in fecal specimens. J Infect Dis. 1984 May;149(5):781–788. doi: 10.1093/infdis/149.5.781. [DOI] [PubMed] [Google Scholar]
- Le Frock J. L., Klainer A. S., Chen S., Gainer R. B., Omar M., Anderson W. The spectrum of colitis associated with lincomycin and clindamycin therapy. J Infect Dis. 1975 May;131 (Suppl):S108–S115. doi: 10.1093/infdis/131.supplement.s108. [DOI] [PubMed] [Google Scholar]
- Levett P. N. Detection of Clostridium difficile in faeces by direct gas liquid chromatography. J Clin Pathol. 1984 Feb;37(2):117–119. doi: 10.1136/jcp.37.2.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Levett P. N., Phillips K. D. Gas chromatographic identification of Clostridium difficile and detection of cytotoxin from a modified selective medium. J Clin Pathol. 1985 Jan;38(1):82–85. doi: 10.1136/jcp.38.1.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Levine H. G., Kennedy M., LaMont J. T. Counterimmunoelectrophoresis vs. cytotoxicity assay for the detection of Clostridium difficile toxin. J Infect Dis. 1982 Mar;145(3):398–398. doi: 10.1093/infdis/145.3.398. [DOI] [PubMed] [Google Scholar]
- Libby J. M., Jortner B. S., Wilkins T. D. Effects of the two toxins of Clostridium difficile in antibiotic-associated cecitis in hamsters. Infect Immun. 1982 May;36(2):822–829. doi: 10.1128/iai.36.2.822-829.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Libby J. M., Wilkins T. D. Production of antitoxins to two toxins of Clostridium difficile and immunological comparison of the toxins by cross-neutralization studies. Infect Immun. 1982 Jan;35(1):374–376. doi: 10.1128/iai.35.1.374-376.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lusk R. H., Fekety F. R., Jr, Silva J., Jr, Bodendorfer T., Devine B. J., Kawanishi H., Korff L., Nakauchi D., Rogers S., Siskin S. B. Gastrointestinal side effects of clindamycin and ampicillin therapy. J Infect Dis. 1977 Mar;135 (Suppl):S111–S119. doi: 10.1093/infdis/135.supplement.s111. [DOI] [PubMed] [Google Scholar]
- Lusk R. H., Fekety R., Silva J., Browne R. A., Ringler D. H., Abrams G. D. Clindamycin-induced enterocolitis in hamsters. J Infect Dis. 1978 Apr;137(4):464–475. doi: 10.1093/infdis/137.4.464. [DOI] [PubMed] [Google Scholar]
- Lyerly D. M., Ball D. W., Toth J., Wilkins T. D. Characterization of cross-reactive proteins detected by Culturette Brand Rapid Latex Test for Clostridium difficile. J Clin Microbiol. 1988 Mar;26(3):397–400. doi: 10.1128/jcm.26.3.397-400.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyerly D. M., Barroso L. A., Wilkins T. D. Identification of the latex test-reactive protein of Clostridium difficile as glutamate dehydrogenase. J Clin Microbiol. 1991 Nov;29(11):2639–2642. doi: 10.1128/jcm.29.11.2639-2642.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyerly D. M., Krivan H. C., Wilkins T. D. Clostridium difficile: its disease and toxins. Clin Microbiol Rev. 1988 Jan;1(1):1–18. doi: 10.1128/cmr.1.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyerly D. M., Lockwood D. E., Richardson S. H., Wilkins T. D. Biological activities of toxins A and B of Clostridium difficile. Infect Immun. 1982 Mar;35(3):1147–1150. doi: 10.1128/iai.35.3.1147-1150.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyerly D. M., Phelps C. J., Toth J., Wilkins T. D. Characterization of toxins A and B of Clostridium difficile with monoclonal antibodies. Infect Immun. 1986 Oct;54(1):70–76. doi: 10.1128/iai.54.1.70-76.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyerly D. M., Phelps C. J., Wilkins T. D. Monoclonal and specific polyclonal antibodies for immunoassay of Clostridium difficile toxin A. J Clin Microbiol. 1985 Jan;21(1):12–14. doi: 10.1128/jcm.21.1.12-14.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyerly D. M., Saum K. E., MacDonald D. K., Wilkins T. D. Effects of Clostridium difficile toxins given intragastrically to animals. Infect Immun. 1985 Feb;47(2):349–352. doi: 10.1128/iai.47.2.349-352.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyerly D. M., Sullivan N. M., Wilkins T. D. Enzyme-linked immunosorbent assay for Clostridium difficile toxin A. J Clin Microbiol. 1983 Jan;17(1):72–78. doi: 10.1128/jcm.17.1.72-78.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyerly D. M., Wilkins T. D. Commercial latex test for Clostridium difficile toxin A does not detect toxin A. J Clin Microbiol. 1986 Mar;23(3):622–623. doi: 10.1128/jcm.23.3.622-623.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Makin T. Rapid identification of Clostridium difficile by direct detection of volatile organic acids from primary isolation media. J Clin Pathol. 1984 Jun;37(6):711–712. doi: 10.1136/jcp.37.6.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Malamou-Ladas H., O'Farrell S., Nash J. Q., Tabaqchali S. Isolation of Clostridium difficile from patients and the environment of hospital wards. J Clin Pathol. 1983 Jan;36(1):88–92. doi: 10.1136/jcp.36.1.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mandal B. K., Watson B., Ellis M. Pseudomembranous colitis in a 5-week-old infant. Br Med J (Clin Res Ed) 1982 Jan 30;284(6312):345–346. doi: 10.1136/bmj.284.6312.345-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Maniar A. C., Williams T. W., Hammond G. W. Detection of Clostridium difficile toxin in various tissue culture monolayers. J Clin Microbiol. 1987 Oct;25(10):1999–2000. doi: 10.1128/jcm.25.10.1999-2000.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marler L. M., Siders J. A., Wolters L. C., Pettigrew Y., Skitt B. L., Allen S. D. Comparison of five cultural procedures for isolation of Clostridium difficile from stools. J Clin Microbiol. 1992 Feb;30(2):514–516. doi: 10.1128/jcm.30.2.514-516.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marler L., Allen S., Siders J. Rapid enzymatic characterization of clinically encountered anaerobic bacteria with the API ZYM system. Eur J Clin Microbiol. 1984 Aug;3(4):294–300. doi: 10.1007/BF01977476. [DOI] [PubMed] [Google Scholar]
- Marrie T. J., Furlong M., Faulkner R. S., Sidorov J., Haldane E. V., Kerr E. A. Clostridium difficile: epidemiology and clinical features. Can J Surg. 1982 Jul;25(4):438–442. [PubMed] [Google Scholar]
- Martinez R. D., Wilkins T. D. Comparison of Clostridium sordellii toxins HT and LT with toxins A and B of C. difficile. J Med Microbiol. 1992 Jan;36(1):30–36. doi: 10.1099/00222615-36-1-30. [DOI] [PubMed] [Google Scholar]
- Martinez R. D., Wilkins T. D. Purification and characterization of Clostridium sordellii hemorrhagic toxin and cross-reactivity with Clostridium difficile toxin A (enterotoxin). Infect Immun. 1988 May;56(5):1215–1221. doi: 10.1128/iai.56.5.1215-1221.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Masfari A. N., Kinghorn G. R., Duerden B. I. Anaerobes in genitourinary infections in men. Br J Vener Dis. 1983 Aug;59(4):255–259. doi: 10.1136/sti.59.4.255. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Matches J. R., Liston J. Mesophilic clostridia in Puget Sound. Can J Microbiol. 1974 Jan;20(1):1–7. doi: 10.1139/m74-001. [DOI] [PubMed] [Google Scholar]
- McFarland L. V., Elmer G. W., Stamm W. E., Mulligan M. E. Correlation of immunoblot type, enterotoxin production, and cytotoxin production with clinical manifestations of Clostridium difficile infection in a cohort of hospitalized patients. Infect Immun. 1991 Jul;59(7):2456–2462. doi: 10.1128/iai.59.7.2456-2462.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McFarland L. V., Mulligan M. E., Kwok R. Y., Stamm W. E. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989 Jan 26;320(4):204–210. doi: 10.1056/NEJM198901263200402. [DOI] [PubMed] [Google Scholar]
- McKinley M. J., Troncale F., Sangree M. H., Scholhamer C., Brand M. Antibiotic-associated colitis: clinical and epidemiological features. Am J Gastroenterol. 1982 Feb;77(2):77–81. [PubMed] [Google Scholar]
- McMillin D. E., Muldrow L. L., Leggette S. J., Abdulahi Y., Ekanemesang U. M. Molecular screening of Clostridium difficile toxins A and B genetic determinants and identification of mutant strains. FEMS Microbiol Lett. 1991 Feb;62(1):75–80. doi: 10.1016/0378-1097(91)90258-c. [DOI] [PubMed] [Google Scholar]
- Meador J., 3rd, Tweten R. K. Purification and characterization of toxin B from Clostridium difficile. Infect Immun. 1988 Jul;56(7):1708–1714. doi: 10.1128/iai.56.7.1708-1714.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Midtvedt T., Norman A. Bile acid transformations by microbial strains belonging to genera found in intestinal contents. Acta Pathol Microbiol Scand. 1967;71(4):629–638. doi: 10.1111/j.1699-0463.1967.tb05183.x. [DOI] [PubMed] [Google Scholar]
- Milligan D. W., Kelly J. K. Pseudomembranous colitis in a leukaemia unit: a report of five fatal cases. J Clin Pathol. 1979 Dec;32(12):1237–1243. doi: 10.1136/jcp.32.12.1237. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mitchell T. J., Ketley J. M., Haslam S. C., Stephen J., Burdon D. W., Candy D. C., Daniel R. Effect of toxin A and B of Clostridium difficile on rabbit ileum and colon. Gut. 1986 Jan;27(1):78–85. doi: 10.1136/gut.27.1.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mogg G. A., Keighley M. R., Burdon D. W., Alexander-Williams J., Youngs D., Johnson M., Bentley S., George R. H. Antibiotic-associated colitis--a review of 66 cases. Br J Surg. 1979 Oct;66(10):738–742. doi: 10.1002/bjs.1800661017. [DOI] [PubMed] [Google Scholar]
- Moss S. Isolation and identification of anaerobic organisms from the male and female urogenital tracts. Br J Vener Dis. 1983 Jun;59(3):182–185. doi: 10.1136/sti.59.3.182. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Möllby R., Nord C. E., Aronsson B. Diagnosis of Clostridium difficile-associated enterocolitis in Sweden. Laboratory and epidemiological aspects. Scand J Infect Dis Suppl. 1980;(Suppl 22):30–36. [PubMed] [Google Scholar]
- Nachamkin I., Lotz-Nolan L., Skalina D. Evaluation of a commercial cytotoxicity assay for detection of Clostridium difficile toxin. J Clin Microbiol. 1986 May;23(5):954–955. doi: 10.1128/jcm.23.5.954-955.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nakamura S., Mikawa M., Nakashio S., Takabatake M., Okado I., Yamakawa K., Serikawa T., Okumura S., Nishida S. Isolation of Clostridium difficile from the feces and the antibody in sera of young and elderly adults. Microbiol Immunol. 1981;25(4):345–351. doi: 10.1111/j.1348-0421.1981.tb00036.x. [DOI] [PubMed] [Google Scholar]
- Nash J. Q., Chattopadhyay B., Honeycombe J., Tabaqchali S. Clostridium difficile and cytotoxin in routine faecal specimens. J Clin Pathol. 1982 May;35(5):561–565. doi: 10.1136/jcp.35.5.561. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nguyen V. K., Rihn B., Heckel C., Bisseret F., Girardot R., Monteil H. Enzyme immunoassay (ELISA) for detection of Clostridium difficile toxin B in specimens of faeces. J Med Microbiol. 1990 Apr;31(4):251–257. doi: 10.1099/00222615-31-4-251. [DOI] [PubMed] [Google Scholar]
- Onderdonk A. B., Cisneros R. L., Bartlett J. G. Clostridium difficile in gnotobiotic mice. Infect Immun. 1980 Apr;28(1):277–282. doi: 10.1128/iai.28.1.277-282.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
- PETTET J. D., BAGGENSTOSS A. H., DEARING W. H., JUDD E. S., Jr Postoperative pseudomembranous enterocolitis. Surg Gynecol Obstet. 1954 May;98(5):546–552. [PubMed] [Google Scholar]
- Pepersack F., Labbe M., Nonhoff C., Schoutens E. Use of gas-liquid chromatography as a screening test for toxigenic Clostridium difficile in diarrhoeal stools. J Clin Pathol. 1983 Nov;36(11):1233–1236. doi: 10.1136/jcp.36.11.1233. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Peterson L. R., Holter J. J., Shanholtzer C. J., Garrett C. R., Gerding D. N. Detection of Clostridium difficile toxins A (enterotoxin) and B (cytotoxin) in clinical specimens. Evaluation of a latex agglutination test. Am J Clin Pathol. 1986 Aug;86(2):208–211. doi: 10.1093/ajcp/86.2.208. [DOI] [PubMed] [Google Scholar]
- Phillips K. D., Rogers P. A. Rapid detection and presumptive identification of Clostridium difficile by p-cresol production on a selective medium. J Clin Pathol. 1981 Jun;34(6):642–644. doi: 10.1136/jcp.34.6.642. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pierce P. F., Jr, Wilson R., Silva J., Jr, Garagusi V. F., Rifkin G. D., Fekety R., Nunez-Montiel O., Dowell V. R., Jr, Hughes J. M. Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases. J Infect Dis. 1982 Feb;145(2):269–274. doi: 10.1093/infdis/145.2.269. [DOI] [PubMed] [Google Scholar]
- Pittman F. E., Pittman J. C., Humphrey C. D. Colitis following oral lincomycin therapy. Arch Intern Med. 1974 Aug;134(2):368–372. [PubMed] [Google Scholar]
- Popoff M. R. Purification and characterization of Clostridium sordellii lethal toxin and cross-reactivity with Clostridium difficile cytotoxin. Infect Immun. 1987 Jan;55(1):35–43. doi: 10.1128/iai.55.1.35-43.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pothoulakis C., Barone L. M., Ely R., Faris B., Clark M. E., Franzblau C., LaMont J. T. Purification and properties of Clostridium difficile cytotoxin B. J Biol Chem. 1986 Jan 25;261(3):1316–1321. [PubMed] [Google Scholar]
- Pothoulakis C., Sullivan R., Melnick D. A., Triadafilopoulos G., Gadenne A. S., Meshulam T., LaMont J. T. Clostridium difficile toxin A stimulates intracellular calcium release and chemotactic response in human granulocytes. J Clin Invest. 1988 Jun;81(6):1741–1745. doi: 10.1172/JCI113514. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Potvliege C., Labbé M., Yourassowsky E. Gas-liquid chromatography as screening test for Clostridium difficile. Lancet. 1981 Nov 14;2(8255):1105–1105. doi: 10.1016/s0140-6736(81)91296-4. [DOI] [PubMed] [Google Scholar]
- Poxton I. R., Byrne M. D. Demonstration of shared antigens in the genus Clostridium by an enzyme-linked immunosorbent assay. J Med Microbiol. 1984 Apr;17(2):171–176. doi: 10.1099/00222615-17-2-171. [DOI] [PubMed] [Google Scholar]
- Poxton I. R., Byrne M. D. Detection of Clostridium difficile toxin by counterimmunoelectrophoresis: a note of caution. J Clin Microbiol. 1981 Sep;14(3):349–349. doi: 10.1128/jcm.14.3.349-349.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Poxton I. R., Cartmill T. D. Immunochemistry of the cell-surface carbohydrate antigens of Clostridium difficile. J Gen Microbiol. 1982 Jun;128(6):1365–1370. doi: 10.1099/00221287-128-6-1365. [DOI] [PubMed] [Google Scholar]
- Price A. B., Davies D. R. Pseudomembranous colitis. J Clin Pathol. 1977 Jan;30(1):1–12. doi: 10.1136/jcp.30.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Price A. B., Larson H. E., Crow J. Morphology of experimental antibiotic-associated enterocolitis in the hamster: a model for human pseudomembranous colitis and antibiotic-associated diarrhoea. Gut. 1979 Jun;20(6):467–475. doi: 10.1136/gut.20.6.467. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Qadri S. M., Akhter J., Ostrawski S., Qadri S. G., Cunha B. A. High incidence of false positives by a latex agglutination test for the diagnosis of Clostridium difficile associated colitis in compromised patients. Diagn Microbiol Infect Dis. 1989 Jul-Aug;12(4):291–294. doi: 10.1016/0732-8893(89)90092-8. [DOI] [PubMed] [Google Scholar]
- Qualman S. J., Petric M., Karmali M. A., Smith C. R., Hamilton S. R. Clostridium difficile invasion and toxin circulation in fatal pediatric pseudomembranous colitis. Am J Clin Pathol. 1990 Oct;94(4):410–416. doi: 10.1093/ajcp/94.4.410. [DOI] [PubMed] [Google Scholar]
- Ramirez-Ronda C. H. Letter: Incidence of clindamycin-associated colitis. Ann Intern Med. 1974 Dec;81(6):860–860. doi: 10.7326/0003-4819-81-6-860_1. [DOI] [PubMed] [Google Scholar]
- Rehg J. E. Cecal toxin(s) from guinea pigs with clindamycin-associated colitis, neutralized by Clostridium sordellii antitoxin. Infect Immun. 1980 Feb;27(2):387–390. doi: 10.1128/iai.27.2.387-390.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Richardson S. A., Alcock P. A., Gray J. Clostridium difficile and its toxin in healthy neonates. Br Med J (Clin Res Ed) 1983 Sep 24;287(6396):878–878. doi: 10.1136/bmj.287.6396.878. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Richardson S. A., Brookfield D. S., French T. A., Gray J. Pseudomembranous colitis in a 5-week-old infant. Br Med J (Clin Res Ed) 1981 Dec 5;283(6305):1510–1510. doi: 10.1136/bmj.283.6305.1510. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rifkin G. D., Fekety F. R., Silva J., Jr Antibiotic-induced colitis implication of a toxin neutralised by Clostridium sordellii antitoxin. Lancet. 1977 Nov 26;2(8048):1103–1106. doi: 10.1016/s0140-6736(77)90547-5. [DOI] [PubMed] [Google Scholar]
- Rifkin G. D., Silva J., Jr, Fekety R. Gastrointestinal and systemic toxicity of fecal extracts from hamsters with clindamycin-induced colitis. Gastroenterology. 1978 Jan;74(1):52–57. [PubMed] [Google Scholar]
- Rihn B., Beck G., Monteil H., Lecerf F., Girardot R. Effect of the cytotoxin of Clostridium difficile on cultured hepatoma cells. Biol Cell. 1985;53(1):23–32. doi: 10.1111/j.1768-322x.1985.tb00351.x. [DOI] [PubMed] [Google Scholar]
- Rihn B., Scheftel J. M., Girardot R., Monteil H. A new purification procedure for Clostridium difficile enterotoxin. Biochem Biophys Res Commun. 1984 Nov 14;124(3):690–695. doi: 10.1016/0006-291x(84)91013-1. [DOI] [PubMed] [Google Scholar]
- Rolfe R. D., Finegold S. M. Purification and characterization of Clostridium difficile toxin. Infect Immun. 1979 Jul;25(1):191–201. doi: 10.1128/iai.25.1.191-201.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ryan R. W., Kwasnik I., Clout D., Tilton R. C. Utility of a rapid latex test for the detection of Clostridium difficile in fecal specimens. Ann Clin Lab Sci. 1987 Jul-Aug;17(4):232–235. [PubMed] [Google Scholar]
- Ryan R. W., Kwasnik I., Tilton R. C. Improved immunologic detection of Clostridium difficile antigen by counterimmunoelectrophoresis. Diagn Microbiol Infect Dis. 1983 Mar;1(1):59–63. doi: 10.1016/0732-8893(83)90033-0. [DOI] [PubMed] [Google Scholar]
- Ryan R. W., Kwasnik I., Tilton R. C. Rapid detection of Clostridium difficile toxin in human feces. J Clin Microbiol. 1980 Dec;12(6):776–779. doi: 10.1128/jcm.12.6.776-779.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SMITH L. D., KING E. O. Occurrence of Clostridium difficile in infections of man. J Bacteriol. 1962 Jul;84:65–67. doi: 10.1128/jb.84.1.65-67.1962. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sands M., Yungbluth M., Sommers H. M. The non-value of counterimmunoelectrophoresis for the direct rapid detection of Clostridium difficile toxin in stool filtrates. Am J Clin Pathol. 1983 Mar;79(3):375–377. doi: 10.1093/ajcp/79.3.375. [DOI] [PubMed] [Google Scholar]
- Sauerborn M., von Eichel-Streiber C. Nucleotide sequence of Clostridium difficile toxin A. Nucleic Acids Res. 1990 Mar 25;18(6):1629–1630. doi: 10.1093/nar/18.6.1629. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Scopes J. W., Smith M. F., Beach R. C. Pseudomembranous colitis and sudden infant death. Lancet. 1980 May 24;1(8178):1144–1144. doi: 10.1016/s0140-6736(80)91598-6. [DOI] [PubMed] [Google Scholar]
- Shanholtzer C. J., Willard K. E., Holter J. J., Olson M. M., Gerding D. N., Peterson L. R. Comparison of the VIDAS Clostridium difficile toxin A immunoassay with C. difficile culture and cytotoxin and latex tests. J Clin Microbiol. 1992 Jul;30(7):1837–1840. doi: 10.1128/jcm.30.7.1837-1840.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sherertz R. J., Sarubbi F. A. The prevalence of Clostridium difficile and toxin in a nursery population: a comparison between patients with necrotizing enterocolitis and an asymptomatic group. J Pediatr. 1982 Mar;100(3):435–439. doi: 10.1016/s0022-3476(82)80455-1. [DOI] [PubMed] [Google Scholar]
- Sherman M. E., DeGirolami P. C., Thorne G. M., Kimber J., Eichelberger K. Evaluation of a latex agglutination test for diagnosis of Clostridium difficile-associated colitis. Am J Clin Pathol. 1988 Feb;89(2):228–233. doi: 10.1093/ajcp/89.2.228. [DOI] [PubMed] [Google Scholar]
- Siegel D. L., Edelstein P. H., Nachamkin I. Inappropriate testing for diarrheal diseases in the hospital. JAMA. 1990 Feb 16;263(7):979–982. [PubMed] [Google Scholar]
- Sivsammye G., Sims H. V. Presumptive identification of Clostridium difficile by detection of p-cresol in prepared peptone yeast glucose broth supplemented with p-hydroxyphenylacetic acid. J Clin Microbiol. 1990 Aug;28(8):1851–1853. doi: 10.1128/jcm.28.8.1851-1853.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Small J. D. Fatal enterocolitis in hamsters given lincomycin hydrochloride. Lab Anim Care. 1968 Aug;18(4):411–420. [PubMed] [Google Scholar]
- Stark P. L., Lee A. Clostridia isolated from the feces of infants during the first year of life. J Pediatr. 1982 Mar;100(3):362–365. doi: 10.1016/s0022-3476(82)80430-7. [DOI] [PubMed] [Google Scholar]
- Steer H. W. The pseudomembranous colitis associated with clindamycin therapy--a viral colitis. Gut. 1975 Sep;16(9):695–706. doi: 10.1136/gut.16.9.695. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sullivan N. M., Pellett S., Wilkins T. D. Purification and characterization of toxins A and B of Clostridium difficile. Infect Immun. 1982 Mar;35(3):1032–1040. doi: 10.1128/iai.35.3.1032-1040.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sutter V. L., Finegold S. M. The effect of antimicrobial agents on human faecal flora: studies with cephalexin, cyclacillin and clindamycin. Soc Appl Bacteriol Symp Ser. 1974;3(0):229–240. [PubMed] [Google Scholar]
- Svedhem A., Kaijser B., MacDowall I. Intestinal occurrence of Campylobacter fetus subspecies jejuni and Clostridium difficile in children in Sweden. Eur J Clin Microbiol. 1982 Feb;1(1):29–32. doi: 10.1007/BF02014137. [DOI] [PubMed] [Google Scholar]
- Tabaqchali S., O'Farrell S., Nash J. Q., Wilks M. Vaginal carriage and neonatal acquisition of Clostridium difficile. J Med Microbiol. 1984 Aug;18(1):47–53. doi: 10.1099/00222615-18-1-47. [DOI] [PubMed] [Google Scholar]
- Taylor N. S., Bartlett J. G. Partial purification and characterization of a cytotoxin from Clostridium difficile. Rev Infect Dis. 1979 Mar-Apr;1(2):379–385. doi: 10.1093/clinids/1.2.379. [DOI] [PubMed] [Google Scholar]
- Taylor N. S., Thorne G. M., Bartlett J. G. Comparison of two toxins produced by Clostridium difficile. Infect Immun. 1981 Dec;34(3):1036–1043. doi: 10.1128/iai.34.3.1036-1043.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tedesco F. J., Barton R. W., Alpers D. H. Clindamycin-associated colitis. A prospective study. Ann Intern Med. 1974 Oct;81(4):429–433. doi: 10.7326/0003-4819-81-4-429. [DOI] [PubMed] [Google Scholar]
- Tedesco F. J. Clindamycin-associated colitis. Review of the clinical spectrum of 47 cases. Am J Dig Dis. 1976 Jan;21(1):26–32. doi: 10.1007/BF01074135. [DOI] [PubMed] [Google Scholar]
- Tedesco F. J. Pseudomembranous colitis: pathogenesis and therapy. Med Clin North Am. 1982 May;66(3):655–664. doi: 10.1016/s0025-7125(16)31413-4. [DOI] [PubMed] [Google Scholar]
- Thelestam M., Brönnegård M. Interaction of cytopathogenic toxin from Clostridium difficile with cells in tissue culture. Scand J Infect Dis Suppl. 1980;(Suppl 22):16–29. [PubMed] [Google Scholar]
- Torres-López J. F., Carreño-Bibián C., Muñoz-Hernández O. Production of toxins A and B by Clostridium difficile strains isolated from infants and adults. Arch Invest Med (Mex) 1985 Jan-Mar;16(1):119–125. [PubMed] [Google Scholar]
- Torres J. F., Lönnroth I. Production, purification and characterization of Clostridium difficile toxic proteins different from toxin A and from toxin B. Biochim Biophys Acta. 1989 Oct 5;998(2):151–157. doi: 10.1016/0167-4838(89)90267-7. [DOI] [PubMed] [Google Scholar]
- Torres J. F. Purification and characterisation of toxin B from a strain of Clostridium difficile that does not produce toxin A. J Med Microbiol. 1991 Jul;35(1):40–44. doi: 10.1099/00222615-35-1-40. [DOI] [PubMed] [Google Scholar]
- Torres J., Jennische E., Lange S., Lönnroth I. Enterotoxins from Clostridium difficile; diarrhoeogenic potency and morphological effects in the rat intestine. Gut. 1990 Jul;31(7):781–785. doi: 10.1136/gut.31.7.781. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Totten M. A., Gregg J. A., Fremont-Smith P., Legg M. Clinical and pathological spectrum of antibiotic-associated colitis. Am J Gastroenterol. 1978 Mar;69(3 Pt 1):311–319. [PubMed] [Google Scholar]
- Triadafilopoulos G., Shah M. H., Pothoulakis C. The chemotactic response of human granulocytes to Clostridium difficile toxin A is age dependent. Am J Gastroenterol. 1991 Oct;86(10):1461–1465. [PubMed] [Google Scholar]
- Tucker K. D., Wilkins T. D. Toxin A of Clostridium difficile binds to the human carbohydrate antigens I, X, and Y. Infect Immun. 1991 Jan;59(1):73–78. doi: 10.1128/iai.59.1.73-78.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Varki N. M., Aquino T. I. Isolation of Clostridium difficile from hospitalized patients without antibiotic-associated diarrhea or colitis. J Clin Microbiol. 1982 Oct;16(4):659–662. doi: 10.1128/jcm.16.4.659-662.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Vernet A., Corthier G., Dubos-Ramaré F., Parodi A. L. Relationship between levels of Clostridium difficile toxin A and toxin B and cecal lesions in gnotobiotic mice. Infect Immun. 1989 Jul;57(7):2123–2127. doi: 10.1128/iai.57.7.2123-2127.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Viscidi R. P., Yolken R. H., Laughon B. E., Bartlett J. G. Enzyme immunoassay for detection of antibody to toxins A and B of Clostridium difficile. J Clin Microbiol. 1983 Aug;18(2):242–247. doi: 10.1128/jcm.18.2.242-247.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Viscidi R., Laughon B. E., Hanvanich M., Bartlett J. G., Yolken R. H. Improved enzyme immunoassays for the detection of antigens in fecal specimens. Investigation and correction of interfering factors. J Immunol Methods. 1984 Feb 24;67(1):129–143. doi: 10.1016/0022-1759(84)90092-9. [DOI] [PubMed] [Google Scholar]
- Viscidi R., Laughon B. E., Yolken R., Bo-Linn P., Moench T., Ryder R. W., Bartlett J. G. Serum antibody response to toxins A and B of Clostridium difficile. J Infect Dis. 1983 Jul;148(1):93–100. doi: 10.1093/infdis/148.1.93. [DOI] [PubMed] [Google Scholar]
- Viscidi R., Willey S., Bartlett J. G. Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. Gastroenterology. 1981 Jul;81(1):5–9. [PubMed] [Google Scholar]
- WAKEFIELD R. D., SOMMERS S. C. Fatal membranous staphylococcal enteritis in surgical patients. Ann Surg. 1953 Aug;138(2):249–252. doi: 10.1097/00000658-195308000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WOOD J. S., Jr, BENNETT I. V., Jr, YARDLEY J. H. Staphylococcal enterocolitis in chinchillas. Bull Johns Hopkins Hosp. 1956 Jun;98(6):454–463. [PubMed] [Google Scholar]
- Walker R. C., Ruane P. J., Rosenblatt J. E., Lyerly D. M., Gleaves C. A., Smith T. F., Pierce P. F., Jr, Wilkins T. D. Comparison of culture, cytotoxicity assays, and enzyme-linked immunosorbent assay for toxin A and toxin B in the diagnosis of Clostridium difficile-related enteric disease. Diagn Microbiol Infect Dis. 1986 May;5(1):61–69. doi: 10.1016/0732-8893(86)90092-1. [DOI] [PubMed] [Google Scholar]
- Welch D. F., Menge S. K., Matsen J. M. Identification of toxigenic Clostridium difficile by counterimmunoelectrophoresis. J Clin Microbiol. 1980 May;11(5):470–473. doi: 10.1128/jcm.11.5.470-473.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
- West S. E., Wilkins T. D. Problems associated with counterimmunoelectrophoresis assays for detecting Clostridium difficile toxin. J Clin Microbiol. 1982 Feb;15(2):347–349. doi: 10.1128/jcm.15.2.347-349.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Willey S. H., Bartlett J. G. Cultures for Clostridium difficile in stools containing a cytotoxin neutralized by Clostridium sordellii antitoxin. J Clin Microbiol. 1979 Dec;10(6):880–884. doi: 10.1128/jcm.10.6.880-884.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson K. H., Kennedy M. J., Fekety F. R. Use of sodium taurocholate to enhance spore recovery on a medium selective for Clostridium difficile. J Clin Microbiol. 1982 Mar;15(3):443–446. doi: 10.1128/jcm.15.3.443-446.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson K. H., Silva J., Fekety F. R. Fluorescent-antibody test for detection of Clostridium difficile in stool specimens. J Clin Microbiol. 1982 Sep;16(3):464–468. doi: 10.1128/jcm.16.3.464-468.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Woods G. L., Iwen P. C. Comparison of a dot immunobinding assay, latex agglutination, and cytotoxin assay for laboratory diagnosis of Clostridium difficile-associated diarrhea. J Clin Microbiol. 1990 May;28(5):855–857. doi: 10.1128/jcm.28.5.855-857.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wren B. W. A family of clostridial and streptococcal ligand-binding proteins with conserved C-terminal repeat sequences. Mol Microbiol. 1991 Apr;5(4):797–803. doi: 10.1111/j.1365-2958.1991.tb00752.x. [DOI] [PubMed] [Google Scholar]
- Wren B. W., Russell R. R., Tabaqchali S. Antigenic cross-reactivity and functional inhibition by antibodies to Clostridium difficile toxin A, Streptococcus mutans glucan-binding protein, and a synthetic peptide. Infect Immun. 1991 Sep;59(9):3151–3155. doi: 10.1128/iai.59.9.3151-3155.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wren B., Clayton C., Tabaqchali S. Rapid identification of toxigenic Clostridium difficile by polymerase chain reaction. Lancet. 1990 Feb 17;335(8686):423–423. doi: 10.1016/0140-6736(90)90267-9. [DOI] [PubMed] [Google Scholar]
- Wren B., Heard S. R., Tabaqchali S. Association between production of toxins A and B and types of Clostridium difficile. J Clin Pathol. 1987 Dec;40(12):1397–1401. doi: 10.1136/jcp.40.12.1397. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wu T. C., Gersch S. M. Evaluation of a commercial kit for the routine detection of Clostridium difficile cytotoxin by tissue culture. J Clin Microbiol. 1986 Apr;23(4):792–793. doi: 10.1128/jcm.23.4.792-793.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Yolken R. H., Whitcomb L. S., Marien G., Bartlett J. D., Libby J., Ehrich M., Wilkins T. Enzyme immunoassay for the detection of Clostridium difficile antigen. J Infect Dis. 1981 Oct;144(4):378–378. doi: 10.1093/infdis/144.4.378. [DOI] [PubMed] [Google Scholar]
- von Eichel-Streiber C., Laufenberg-Feldmann R., Sartingen S., Schulze J., Sauerborn M. Cloning of Clostridium difficile toxin B gene and demonstration of high N-terminal homology between toxin A and B. Med Microbiol Immunol. 1990;179(5):271–279. doi: 10.1007/BF00192465. [DOI] [PubMed] [Google Scholar]
- von Eichel-Streiber C., Laufenberg-Feldmann R., Sartingen S., Schulze J., Sauerborn M. Comparative sequence analysis of the Clostridium difficile toxins A and B. Mol Gen Genet. 1992 May;233(1-2):260–268. doi: 10.1007/BF00587587. [DOI] [PubMed] [Google Scholar]