1887

Abstract

Faecal specimens from 843 cases of diarrhoea in the community were tested for the presence of cytotoxin and enterotoxin. . cytotoxin was detected in faecal specimens from 0.6 % of cases aged at least 2 years by using a Vero cell assay. Factors associated with detection of . cytotoxin were antibiotic therapy, age over 60 years and living in a home with other elderly people. Three methods were used for the detection of . enterotoxin: a Vero cell assay, a commercial (TechLab) enzyme immunoassay (EIA) and an in-house EIA. The lower level of detection of pure enterotoxin in buffer was 0.01 μg ml by the TechLab EIA and 1.0 μg ml by the Vero cell assay. enterotoxin was detected by using the TechLab EIA in faecal specimens from 2.5 % of cases. This commercial EIA was less sensitive than the in-house EIA, detecting only 31 % of positive cases, but was specific and could be used for outbreak investigation by routine diagnostic laboratories. Age over 60 years was a factor associated with enterotoxin detection; this age group may be targeted for testing.

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2003-09-01
2024-12-12
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References

  1. Bartholomew B. A, Stringer M. F, Watson G. N, Gilbert R. J. 1985; Development and application of an enzyme-linked immunosorbent assay for Clostridium perfringens type A enterotoxin. J Clin Pathol 38:222–228 [CrossRef]
    [Google Scholar]
  2. Bentley D. W. 1990; Clostridium difficile -associated disease in long-term care facilities. Infect Control Hosp Epidemiol 11:434–438 [CrossRef]
    [Google Scholar]
  3. Berry P. R, Rodhouse J. C, Hughes S, Bartholomew B. A, Gilbert R. J. 1988; Evaluation of ELISA, RPLA, and Vero cell assays for detecting Clostridium perfringens enterotoxin in faecal specimens. J Clin Pathol 41:458–461 [CrossRef]
    [Google Scholar]
  4. Borriello S. P, Larson H. E, Welch A. R, Barclay F, Stringer M. F, Bartholomew B. A. 1984; Enterotoxigenic Clostridium perfringens : a possible cause of antibiotic-associated diarrhoea. Lancet 1:305–307
    [Google Scholar]
  5. Brazier J. S. 1998; The epidemiology and typing of Clostridium difficile . J Antimicrob Chemother 41:Suppl. C47–57
    [Google Scholar]
  6. Brett M. M, Rodhouse J. C, Donovan T. J, Tebbutt G. M, Hutchinson D. N. 1992; Detection of Clostridium perfringens and its enterotoxin in cases of sporadic diarrhoea. J Clin Pathol 45:609–611 [CrossRef]
    [Google Scholar]
  7. Department of Health & Public Health Laboratory Service Joint Working Group 1994 Clostridium difficile InfectionPrevention and Management London: Department of Health;
    [Google Scholar]
  8. Food Standards Agency 2000 A Report of the Study of Infectious Intestinal Disease in England London: The Stationery Office;
    [Google Scholar]
  9. Garibaldi R. A. 1999; Residential care and the elderly: the burden of infection. J Hosp Infect 43:SupplS9–S18 [CrossRef]
    [Google Scholar]
  10. Hancock P. 1997; Antibiotic-associated diarrhoea: Clostridium difficile or C.perfringens ?. Rev Med Microbiol 8:Suppl. 1S66–S67 [CrossRef]
    [Google Scholar]
  11. Hirschhorn L. R, Trnka Y, Onderdonk A, Lee M.-L. T, Platt R. 1994; Epidemiology of community-acquired Clostridium difficile -associated diarrhea. J Infect Dis 169:127–133 [CrossRef]
    [Google Scholar]
  12. Karlström O, Fryklund B, Tullus K, Burman L.G. 1998; A prospective nationwide study of Clostridium difficile -associated diarrhea in Sweden.The Swedish C. difficile Study Group. Clin Infect Dis 26:141–145 [CrossRef]
    [Google Scholar]
  13. Larson H. E, Borriello S. P. 1988; Infectious diarrhea due to Clostridium perfringens . J Infect Dis 157:390–391 [CrossRef]
    [Google Scholar]
  14. Levy D. G, Stergachis A, McFarland L. V. 7 other authors 2000; Antibiotics and Clostridium difficile diarrhea in the ambulatory care setting. Clin Ther 22:91–102 [CrossRef]
    [Google Scholar]
  15. Mpamugo O, Donovan T, Brett M. M. 1995; Enterotoxigenic Clostridium perfringens as a cause of sporadic cases of diarrhoea. J Med Microbiol 43:442–445 [CrossRef]
    [Google Scholar]
  16. Pedler S. J, Orr K. E. 1990; ACP Broadsheet 124: May 1990.Examination of faeces for bacterial pathogens. J Clin Pathol 43:410–415 [CrossRef]
    [Google Scholar]
  17. Riley T. V, Wymer V, Bamford V. W, Bowman R. A. 1986; Clostridium difficile in general practice and community health. J Hyg (Camb) 96:13–17 [CrossRef]
    [Google Scholar]
  18. Riley T. V, Wetherall F, Bowman J, Mogyorosy J, Golledge C. L. 1991; Diarrheal disease due to Clostridium difficile in general practice. Pathology 23:346–349 [CrossRef]
    [Google Scholar]
  19. Samuel S. C, Hancock P, Leigh D. A. 1991; An investigation into Clostridium perfringens enterotoxin-associated diarrhoea. J Hosp Infect 18:219–230 [CrossRef]
    [Google Scholar]
  20. Spencer R. C. 1998; Clinical impact and associated costs of Clostridium difficile -associated disease. J Antimicrob Chemother 41:Suppl. C5–12 [CrossRef]
    [Google Scholar]
  21. Stone S. P. 1999; Soil, seed and climate: developing a strategy for prevention and management of infections in UK nursing homes. J Hosp Infect 43 (Suppl.), S29–S38 [CrossRef]
    [Google Scholar]
  22. Thomas D. R, Bennett R. G, Laughon B. E, Greenough W. B III, Bartlett J. G. 1990; Postantibiotic colonization with Clostridium difficile in nursing home patients. J Am Geriatr Soc 38:415–420 [CrossRef]
    [Google Scholar]
  23. Tompkins D. S, Hudson M. J, Smith H. R. 8 other authors 1999; A study of infectious intestinal disease in England: microbiological findings in cases and controls. Commun Dis Public Health 2:108–113
    [Google Scholar]
  24. Wada A, Masuda Y, Fukayama M, Hatakeyama T, Yanagawa Y, Watanabe H, Inamatsu T. 1996; Nosocomial diarrhoea in the elderly due to enterotoxigenic Clostridium perfringens . Microbiol Immunol 40:767–771 [CrossRef]
    [Google Scholar]
  25. Wheeler J. G, Sethi D, Cowden J. M, Wall P. G, Rodrigues L. C, Tompkins D. S, Hudson M. J, Roderick P. J. 1999; Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance.The Infectious Intestinal Disease Study Executive. BMJ 318:1046–1050 [CrossRef]
    [Google Scholar]
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