Antibiotic Associated Diarrhoea and Colitis : The Role of Clostridium Difficile in Gastrointestinal Disorders

In this book an attempt has been made to collate the Information available on all the different aspects of C dlfflclle and the gastrointestinal diseases associated with it. It Is hoped that the Information presented will be of value to both the experienced researcher familiar with C. difflcile as well as someone In the laboratory contemplating isolation of the organism. or detection of Its toxins. for the first time. Above all. I hope that the Information presented will also highlight the many areas in which we know very little or nothing. and will. therefore. stimulate Interest In this exciting new area of microbiology. S. P. BORRIELLO CHAPTER Antimicrobial-associated diarrhea is often caused by Clostridium difficile; this disease can best be diagnosed by detection of fecal cytotoxin in a tissue culture assay and, when therapy is indicated, can be effectively treated with orally administered vancomycin. The cause of disease in most cases of antimicrobial-associated diarrhea that do not involve C. difficile is not known; fortunately, this form of diarrhea 1S usually mild. Antimicrobial-associated diarrhea may also rarely involve s. aureus and certain enteric pathogens. 37 QHAPTER 4 Qf. TECTlON. ISOLATION Al:iQ. . . IQENTlFICATlON OF CLOSTRIDIUM PIFFICILE S.P. BORRIELLO and PAULINE HONOUR Introduction 38 Detection of Co dlfflcile in stools 38 Direct methods 38 Indirect methods 39 Isolation of Co djfficjle 40 Identification of Co difflcile 44 38 DETECTION ISOLATION AND IDENTIFICATION OF CLOSTRIDIUM DIFFICILE S.P. Borriello and Pauline Honour Introduction In view of the mounting evidence generated world wide in the last few years that firmly implicates £. difficile as the aetiological agent in both antibiotic and non-antibiotic associated pseudomembranous colitis (Larson ~ al., 1978, Bartlett ~ al., 1978a, George ~ al., 1978a), and also recent recognition of the fact that there may be a spectrum of gastrointestinal diseases associated with £. difficile infections (Borriello and Larson, 1981, Bolton ~ al., 1980, Brettle ~ al., 1982), an increasing number of laboratories are seeking to detect, isolate and identify £. difficile from clinical samples Front Matter....Pages I-VIII Introduction....Pages 1-2 Antibiotics Associated with Clostridium Difficile Mediated Diarrhoea and/or Colitis....Pages 3-8 Spectrum of Disease....Pages 9-23 Diagnosis and Treatment of Antimicrobial Agent-Associated Diarrhoea and Colitis....Pages 25-36 Detection, Isolation and Identification of Clostridium Difficile....Pages 37-47 Detection of Clostridium Difficile Toxins....Pages 49-56 Epidemiology of Antimicrobial Agent-Associated Diarrhoea and Colitis....Pages 57-70 Typing Clostridium Difficile....Pages 71-78 Clostridium Difficile and Colonization Resistance....Pages 79-87 Characteristics of the Toxins of Clostridium Difficile....Pages 89-102 Interaction of Clostridium Difficile Toxin B (Cytotoxin) with Cultured Cells....Pages 103-118 Animal Models of Clostridium Difficile Infection....Pages 119-132 The Pathology of Antibiotic-Associated Colitis....Pages 133-146 Concluding remarks — the unanswered questions....Pages 147-149 Back Matter....Pages 151-179