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Clostridium difficile: its disease and toxins.

D M Lyerly1, H C Krivan, T D Wilkins

  • 1Department of Anaerobic Microbiology, Virginia Polytechnic Institute and State University, Blacksburg 24061.

Clinical Microbiology Reviews
|January 1, 1988
PubMed
Summary

Clostridium difficile causes severe colitis, often treated with antibiotics. Newer therapies like fecal microbiota transplant show promise for recurrent cases, while understanding toxin mechanisms is key.

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Area of Science:

  • Microbiology
  • Gastroenterology
  • Toxicology

Background:

  • Clostridium difficile is the primary cause of pseudomembranous colitis in adults receiving antibiotics.
  • This severe condition can be fatal and is paradoxically treated with antibiotics.
  • Recurrent cases may benefit from alternative treatments like bowel flora replacement.

Purpose of the Study:

  • To review the pathogenic mechanisms of Clostridium difficile infections.
  • To discuss the roles of Toxin A and Toxin B in disease development.
  • To evaluate diagnostic assays for Clostridium difficile infection.

Main Methods:

  • Review of existing literature on Clostridium difficile pathogenesis.
  • Analysis of the molecular mechanisms of Toxin A and Toxin B.
  • Comparison of diagnostic methods: tissue culture assay, enzyme immunoassay, and latex agglutination.

Main Results:

  • Toxin A acts as an enterotoxin causing diarrhea and mucosal damage.
  • Toxin B is a potent cytotoxin with a less understood role in the disease.
  • A cascade of events, including receptor recognition and synergistic toxin action, leads to disease expression.

Conclusions:

  • Understanding the intricate mechanisms of Clostridium difficile toxins is crucial for effective treatment.
  • Emerging therapies offer hope for patients with recurrent infections.
  • Current diagnostic assays have varying advantages and disadvantages that impact clinical decision-making.

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