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Pereira de Araújo M, Sato MO, Sato M, Bandara WM KM, Coelho LFL, Souza RLM, Kawai S, Marques MJ. Unbalanced relationships: insights into the interaction between gut microbiota, geohelminths, and schistosomiasis. PeerJ 2022; 10:e13401. [PMID: 35539016 PMCID: PMC9080432 DOI: 10.7717/peerj.13401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/17/2022] [Indexed: 01/14/2023] Open
Abstract
Hosts and their microbiota and parasites have co-evolved in an adaptative relationship since ancient times. The interaction between parasites and intestinal bacteria in terms of the hosts' health is currently a subject of great research interest. Therapeutic interventions can include manipulations of the structure of the intestinal microbiota, which have immunological interactions important for modulating the host's immune system and for reducing inflammation. Most helminths are intestinal parasites; the intestinal environment provides complex interactions with other microorganisms in which internal and external factors can influence the composition of the intestinal microbiota. Moreover, helminths and intestinal microorganisms can modulate the host's immune system either beneficially or harmfully. The immune response can be reduced due to co-infection, and bacteria from the intestinal microbiota can translocate to other organs. In this way, the treatment can be compromised, which, together with drug resistance by the parasites makes healing even more difficult. Thus, this work aimed to understand interactions between the microbiota and parasitic diseases caused by the most important geohelminths and schistosomiasis and the consequences of these associations.
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Affiliation(s)
- Matheus Pereira de Araújo
- Institute of Biomedical Sciences, Universidade Federal de Alfenas, Alfenas, Minas Gerais, Brazil,Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Marcello Otake Sato
- Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Megumi Sato
- Graduate School of Health Sciences, Niigata University, Niigata, Niigata, Japan
| | | | | | | | - Satoru Kawai
- Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Marcos José Marques
- Institute of Biomedical Sciences, Universidade Federal de Alfenas, Alfenas, Minas Gerais, Brazil
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Bouza E, Aguado JM, Alcalá L, Almirante B, Alonso-Fernández P, Borges M, Cobo J, Guardiola J, Horcajada JP, Maseda E, Mensa J, Merchante N, Muñoz P, Pérez Sáenz JL, Pujol M, Reigadas E, Salavert M, Barberán J. Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR). REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:151-175. [PMID: 32080996 PMCID: PMC7111242 DOI: 10.37201/req/2065.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/26/2020] [Indexed: 12/12/2022]
Abstract
This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.
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Affiliation(s)
- E Bouza
- Emilio Bouza MD, PhD, Instituto de Investigación Sanitaria Gregorio Marañón, Servicio de Microbiología Clínica y E. Infecciosas C/ Dr. Esquerdo, 46 - 28007 Madrid, Spain.
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3
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Liu M, Wang J, Chang Y, Zhang Q, Chang D, Hui CY, Brennan JD, Li Y. In Vitro Selection of a DNA Aptamer Targeting Degraded Protein Fragments for Biosensing. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.202000025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Meng Liu
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Jiayi Wang
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Yangyang Chang
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Qiang Zhang
- School of Bioengineering Dalian University of Technology Dalian 116024 China
| | - Dingran Chang
- Department of Biochemistry and Biomedical Sciences Michael G. DeGroote Institute of Infectious Disease Research (IIDR) McMaster University 1280 Main Street West Hamilton Ontario L8S4K1 Canada
| | - Christy Y. Hui
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
| | - John D. Brennan
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
| | - Yingfu Li
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
- Department of Biochemistry and Biomedical Sciences Michael G. DeGroote Institute of Infectious Disease Research (IIDR) McMaster University 1280 Main Street West Hamilton Ontario L8S4K1 Canada
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4
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Liu M, Wang J, Chang Y, Zhang Q, Chang D, Hui CY, Brennan JD, Li Y. In Vitro Selection of a DNA Aptamer Targeting Degraded Protein Fragments for Biosensing. Angew Chem Int Ed Engl 2020; 59:7706-7710. [PMID: 32155319 DOI: 10.1002/anie.202000025] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Indexed: 12/15/2022]
Abstract
Protein biomarkers often exist as degradation fragments in biological samples, and affinity agents derived using a purified protein may not recognize them, limiting their value for clinical diagnosis. Herein, we present a method to overcome this issue, by selecting aptamers against a degraded form of the toxin B protein, which is a marker for diagnosing toxigenic Clostridium difficile infections. This approach has led to isolation of a DNA aptamer that recognizes degraded toxin B, fresh toxin B, and toxin B spiked into human stool samples. DNA aptamers selected using intact recombinant toxin B failed to recognize degraded toxin B, which is the form present in stored stool samples. Using this new aptamer, we produced a simple paper-based analytical device for colorimetric detection of toxin B in stool samples, or in the NAP1 strain of Clostridium difficile. The combined aptamer-selection and paper-sensing strategy can expand the practical utility of DNA aptamers in clinical diagnosis.
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Affiliation(s)
- Meng Liu
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Jiayi Wang
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Yangyang Chang
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qiang Zhang
- School of Bioengineering, Dalian University of Technology, Dalian, 116024, China
| | - Dingran Chang
- Department of Biochemistry and Biomedical Sciences, Michael G. DeGroote Institute of Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4K1, Canada
| | - Christy Y Hui
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada
| | - Yingfu Li
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada.,Department of Biochemistry and Biomedical Sciences, Michael G. DeGroote Institute of Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4K1, Canada
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5
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Liu M, Yin Q, Chang Y, Zhang Q, Brennan JD, Li Y. In Vitro Selection of Circular DNA Aptamers for Biosensing Applications. Angew Chem Int Ed Engl 2019. [DOI: 10.1002/ange.201901192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Meng Liu
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Qingxin Yin
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Yangyang Chang
- School of Environmental Science and Technology Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education) Dalian University of Technology Dalian 116024 China
| | - Qiang Zhang
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
- School of Life Science and Biotechnology Dalian University of Technology Dalian 116024 China
| | - John D. Brennan
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
| | - Yingfu Li
- Department of Biochemistry and Biomedical Sciences McMaster University 1280 Main Street West Hamilton Ontario L8S4K1 Canada
- Biointerfaces Institute McMaster University 1280 Main Street West Hamilton Ontario L8S4O3 Canada
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6
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Liu M, Yin Q, Chang Y, Zhang Q, Brennan JD, Li Y. In Vitro Selection of Circular DNA Aptamers for Biosensing Applications. Angew Chem Int Ed Engl 2019; 58:8013-8017. [PMID: 31020784 DOI: 10.1002/anie.201901192] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/17/2019] [Indexed: 01/01/2023]
Abstract
We report on the first effort to select DNA aptamers from a circular DNA library, which resulted in the discovery of two high-affinity circular DNA aptamers that recognize the glutamate dehydrogenase (GDH) from Clostridium difficile, an established antigen for diagnosing Clostridium difficile infection (CDI). One aptamer binds effectively in both the circular and linear forms, the other is functional only in the circular configuration. Interestingly, these two aptamers recognize different epitopes on GDH, demonstrating the advantage of selecting aptamers from circular DNA libraries. A sensitive diagnostic test was developed to take advantage of the high stability of circular DNA aptamers in biological samples and their compatibility with rolling circle amplification. This test is capable of identifying patients with active CDI using stool samples. This work represents a significant step forward towards demonstrating the practical utility of DNA aptamers in clinical diagnosis.
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Affiliation(s)
- Meng Liu
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qingxin Yin
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Yangyang Chang
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qiang Zhang
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada.,School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada
| | - Yingfu Li
- Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4K1, Canada.,Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4O3, Canada
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7
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Liu M, Yin Q, Brennan JD, Li Y. Selection and characterization of DNA aptamers for detection of glutamate dehydrogenase from Clostridium difficile. Biochimie 2017; 145:151-157. [PMID: 28882627 DOI: 10.1016/j.biochi.2017.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/31/2017] [Indexed: 12/18/2022]
Abstract
Rapid and accurate diagnosis of Clostridium difficile infections (CDI) is crucial for patient treatment, infection control and epidemiological monitoring. As an important antigen, glutamate dehydrogenase (GDH) has been proposed as a preliminary screening test target for CDI. However, current assays based on GDH activity or GDH immunoassays have suboptimal sensitivity and specificity. Herein, we describe the selection and characterization of single-stranded DNA aptamers that specifically target GDH. After 10 rounds of selection, high-throughput sequencing was used to identify enriched aptamer candidates. Of 10 candidates, three aptamers for GDH were identified. Gel shift assays showed that these aptamers exhibited low nanomolar affinities. One aptamer was optimized based on structural analysis and further engineered into a structure-switching fluorescence signaling aptamer, wherein desorption from reduced graphene oxide (RGO) upon binding of GDH led to an increase in fluorescence emission. This method allowed for quantitative detection of GDH with a detection limit of 1 nM, providing great potential for its further application in CDI diagnosis.
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Affiliation(s)
- Meng Liu
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qingxin Yin
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - John D Brennan
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; The Michael G. DeGroote Institute for Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Yingfu Li
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; The Michael G. DeGroote Institute for Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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8
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Determining the Long-term Effect of Antibiotic Administration on the Human Normal Intestinal Microbiota Using Culture and Pyrosequencing Methods. Clin Infect Dis 2015; 60 Suppl 2:S77-84. [DOI: 10.1093/cid/civ137] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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9
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Rashid MU, Weintraub A, Nord CE. Development of antimicrobial resistance in the normal anaerobic microbiota during one year after administration of clindamycin or ciprofloxacin. Anaerobe 2015; 31:72-7. [DOI: 10.1016/j.anaerobe.2014.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
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10
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Stiles BG, Pradhan K, Fleming JM, Samy RP, Barth H, Popoff MR. Clostridium and bacillus binary enterotoxins: bad for the bowels, and eukaryotic being. Toxins (Basel) 2014; 6:2626-56. [PMID: 25198129 PMCID: PMC4179152 DOI: 10.3390/toxins6092626] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/22/2014] [Accepted: 08/27/2014] [Indexed: 12/18/2022] Open
Abstract
Some pathogenic spore-forming bacilli employ a binary protein mechanism for intoxicating the intestinal tracts of insects, animals, and humans. These Gram-positive bacteria and their toxins include Clostridium botulinum (C2 toxin), Clostridium difficile (C. difficile toxin or CDT), Clostridium perfringens (ι-toxin and binary enterotoxin, or BEC), Clostridium spiroforme (C. spiroforme toxin or CST), as well as Bacillus cereus (vegetative insecticidal protein or VIP). These gut-acting proteins form an AB complex composed of ADP-ribosyl transferase (A) and cell-binding (B) components that intoxicate cells via receptor-mediated endocytosis and endosomal trafficking. Once inside the cytosol, the A components inhibit normal cell functions by mono-ADP-ribosylation of globular actin, which induces cytoskeletal disarray and death. Important aspects of each bacterium and binary enterotoxin will be highlighted in this review, with particular focus upon the disease process involving the biochemistry and modes of action for each toxin.
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Affiliation(s)
- Bradley G Stiles
- Biology Department, Wilson College, 1015 Philadelphia Avenue, Chambersburg, PA 17201, USA.
| | - Kisha Pradhan
- Environmental Science Department, Wilson College, 1015 Philadelphia Avenue, Chambersburg, PA 17201, USA.
| | - Jodie M Fleming
- Department of Biology, North Carolina Central University, 1801 Fayetteville Street, Durham, NC 27707, USA.
| | - Ramar Perumal Samy
- Venom and Toxin Research Programme, Department of Anatomy, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Kent Ridge 117597, Singapore.
| | - Holger Barth
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Albert-Einstein-Allee 11, Ulm D-89081, Germany.
| | - Michel R Popoff
- Bacteries Anaerobies et Toxines, Institut Pasteur, 28 Rue du Docteur Roux, Paris 75724, France.
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Hughes G, Nickerson E, Enoch D, Ahluwalia J, Wilkinson C, Ayers R, Brown N. Impact of cleaning and other interventions on the reduction of hospital-acquired Clostridium difficile infections in two hospitals in England assessed using a breakpoint model. J Hosp Infect 2013; 84:227-34. [DOI: 10.1016/j.jhin.2012.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 12/16/2012] [Indexed: 11/25/2022]
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12
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Qutub MO, AlBaz N, Hawken P, Anoos A. Comparison between the two-step and the three-step algorithms for the detection of toxigenic Clostridium difficile. Indian J Med Microbiol 2011; 29:293-6. [DOI: 10.4103/0255-0857.83916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Kim J, Pierik AJ, Buckel W. A complex of 2-hydroxyisocaproyl-coenzyme A dehydratase and its activator from Clostridium difficile stabilized by aluminium tetrafluoride-adenosine diphosphate. Chemphyschem 2010; 11:1307-12. [PMID: 20146278 DOI: 10.1002/cphc.200900876] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The dehydration of 2-hydroxyisocaproyl-CoA to isocaprenoyl-CoA is the chemically most demanding step in the reduction of leucine to isocaproate by Clostridium difficile, because the beta-hydrogen of the substrate is not acidic (pK(a) ca. 40). A two-component system, composed of a homodimeric activator and an heterodimeric dehydratase, catalyses this unusual alpha,beta-elimination of water. The reduced activator transfers an electron from its [4Fe-4S](+) cluster to that of the dehydratase in an ATP-dependent manner, similar to the iron protein of nitrogenase. Here we show that AlF(4)(-) x ADP traps the interaction of the activator with the dehydratase by forming a stable complex containing 1.0 mol homodimeric activator, 1.0 mol heterodimeric dehydratase and 1.2 mol ADP. The complex (148 kDa) was isolated by size exclusion chromatography, affinity chromatography using the Strep-tag at the activator, or most conveniently by ultrafiltration (100 kDa cut off membrane). Kinetic and EPR-spectroscopic experiments revealed that the complex formation proceeds much slower than the activation but in an almost irreversible manner. The isolated complex is devoid of any activity, because the dehydratase is in the oxidized form whereas the activator remains in the reduced state due to the presence of dithionite.
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Affiliation(s)
- Jihoe Kim
- Fachbereich Biologie, Philipps Universität, 35032 Marburg, Germany
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14
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Prevention of Clostridium difficile infection with Saccharomyces boulardii: a systematic review. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2010; 23:817-21. [PMID: 20011734 DOI: 10.1155/2009/915847] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clostridium difficile is a major cause of antibiotic-associated diarrhea within the hospital setting. The yeast Saccharomyces boulardii has been found to have some effect in reducing the risk of C difficile infection (CDI); however, its role in preventive therapy has yet to be firmly established. OBJECTIVE To review the effectiveness of S boulardii in the prevention of primary and recurrent CDI. Benefit was defined as a reduction of diarrhea associated with C difficile. Risk was defined as any adverse effects of S boulardii. METHODS A literature search in MEDLINE, EMBASE, CINAHL and the Cochrane Library was performed. Included studies were English language, randomized, double-blind placebo controlled trials evaluating S boulardii in CDI prevention. RESULTS Four studies were reviewed. Two studies investigated the prevention of recurrence in populations that were experiencing CDI at baseline. One trial showed a reduction of relapses in patients experiencing recurrent CDI (RR=0.53; P<0.05). The other demonstrated a trend toward reduction of CDI relapse in the recurrent treatment group of patients receiving high-dose vancomycin (RR=0.33; P=0.05). Two other studies examined primary prevention of CDI in populations that had been recently prescribed antibiotics. These studies lacked the power to detect statistically significant differences. Patients on treatment experienced increased risk for thirst and constipation. CONCLUSION S boulardii seems to be well tolerated and may be effective for secondary prevention in some specific patient populations with particular concurrent antibiotic treatment. Its role in primary prevention is poorly defined and more research is required before changes in practice are recommended.
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Viswanathan VK, Mallozzi MJ, Vedantam G. Clostridium difficile infection: An overview of the disease and its pathogenesis, epidemiology and interventions. Gut Microbes 2010; 1:234-242. [PMID: 21327030 PMCID: PMC3023605 DOI: 10.4161/gmic.1.4.12706] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 06/15/2010] [Accepted: 06/16/2010] [Indexed: 02/03/2023] Open
Abstract
Clostridium difficile infection (CDI) is the primary cause of antibiotic-associated diarrhea and is a significant nosocomial disease. In the past ten years, variant toxin-producing strains of C. difficile have emerged, that have been associated with severe disease as well as outbreaks worldwide. This review summarizes current information on C. difficile pathogenesis and disease, and highlights interventions used to combat single and recurrent episodes of CDI.
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Affiliation(s)
- VK Viswanathan
- Department of Veterinary Science and Microbiology; University of Arizona; Tucson, AZ USA
| | - MJ Mallozzi
- Department of Veterinary Science and Microbiology; University of Arizona; Tucson, AZ USA
| | - Gayatri Vedantam
- Department of Veterinary Science and Microbiology; University of Arizona; Tucson, AZ USA,Research Service; Southern Arizona VA Healthcare System; Tucson, AZ USA
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Nemat H, Khan R, Ashraf MS, Matta M, Ahmed S, Edwards BT, Hussain R, Lesser M, Pekmezaris R, Dlugacz Y, Wolf-Klein G. Diagnostic value of repeated enzyme immunoassays in Clostridium difficile infection. Am J Gastroenterol 2009; 104:2035-41. [PMID: 19367273 DOI: 10.1038/ajg.2009.174] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES There has been a significant increase in the prevalence, severity, and mortality of Clostridium difficile infection (CDI), with an estimated three million new cases per year in the United States. Yet diagnosing CDI remains problematic. The most commonly used test is stool enzyme immunoassay (EIA) detecting toxin A and/or B, but there are no clear guidelines specifying the optimal number of tests to be ordered in the diagnostic workup, although multiple tests are frequently ordered. Thus, we designed a study with the primary objective of evaluating the diagnostic utility of repeat second and third tests of stool EIA detecting both toxins A and B (EIA (A&B)) in cases with negative initial samples, and sought to describe the physicians' patterns of ordering this test in the workup of suspected CDI. METHODS A retrospective study was carried out using a database of all stool EIA (A&B) tests ordered for a presumptive diagnosis of CDI. All patients were adults admitted to a major teaching hospital over a three-and-a-half-year period (tests completed within 5 days of ordering the first test were grouped into a single episode, and only the first three samples per episode were analyzed). Age, gender, and results of stool EIA were tabulated. In addition, physicians' ordering patterns and proportion of positive stools relative to the number of tests ordered were also analyzed. A single positive EIA result was interpreted as evidence for the clinical presence of CDI. RESULTS A total of 3,712 patients contributed to 5,865 separate diarrhea episodes (total stool EIA (A&B)=9,178), and 1,165 (19.9%) of these episodes were positive for CDI. Of the positive patients, 73.2% were over the age of 65 years and 54.2% of them were females. The most frequent ordering pattern for presumptive CDI was a single stool test (60.1%), followed by two more tests (23.2%). Three tests were still ordered in 16.6% of the cases. Of the 1,165 positive cases, 1,046 (89.8%) were diagnosed in the very first test, 95 (8.2%) in the second, and only 24 (2.0%) in the third test. In 1,934 instances, a second test was ordered after an initial negative result, of which 95 (4.91%) became positive. In 793 episodes, a third test was ordered after two negative samples, of which only 24 (3.03%) became positive. CONCLUSIONS This study highlights the low diagnostic yield of repeat stool EIA (A&B) testing. Findings strongly support the utility of limiting the workup of suspected CDI to a single stool test with only one repeat test in cases of high clinical suspicion, and avoiding the routine ordering of multiple stool samples. As Clostridium difficile is becoming an endemic health-care problem resulting in major financial burdens for the US health-care system, clear guidelines specifying the optimal number of stool EIA (A&B) tests to be ordered in the diagnostic workup of suspected CDI must be established to assist physicians in the practice of evidence-based medicine.
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Affiliation(s)
- Hashim Nemat
- Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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ADP-ribosylation of actin by the Clostridium botulinum C2 toxin in mammalian cells results in delayed caspase-dependent apoptotic cell death. Infect Immun 2008; 76:4600-8. [PMID: 18710868 DOI: 10.1128/iai.00651-08] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The binary C2 toxin from Clostridium botulinum mono-ADP-ribosylates G-actin in the cytosol of eukaryotic cells. This modification leads to depolymerization of actin filaments accompanied by cell rounding within 3 h of incubation but does not immediately induce cell death. Here we investigated the long-term responses of mammalian cell lines (HeLa and Vero) following C2 toxin treatment. Cells stayed round even though the toxin was removed from the medium after its internalization into the cells. No unmodified actin reappeared in the C2 toxin-treated cells within 48 h. Despite actin being completely ADP-ribosylated after about 7 h, no obvious decrease in the overall amount of actin was observed for at least 48 h. Therefore, ADP-ribosylation was not a signal for an accelerated degradation of actin in the tested cell lines. C2 toxin treatment resulted in delayed apoptotic cell death that became detectable about 15 to 24 h after toxin application in a portion of the cells. Poly(ADP)-ribosyltransferase 1 (PARP-1) was cleaved in C2 toxin-treated cells, an indication of caspase 3 activation and a hallmark of apoptosis. Furthermore, specific caspase inhibitors prevented C2 toxin-induced apoptosis, implying that caspases 8 and 9 were activated in C2 toxin-treated cells. C2I, the ADP-ribosyltransferase component of the C2 toxin, remained active in the cytosol for at least 48 h, and no extensive degradation of C2I was observed. From our data, we conclude that the long-lived nature of C2I in the host cell cytosol was essential for the nonreversible cytotoxic effect of C2 toxin, resulting in delayed apoptosis of the tested mammalian cells.
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18
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Peterson LR, Manson RU, Paule SM, Hacek DM, Robicsek A, Thomson RB, Kaul KL. Detection of Toxigenic Clostridium difficile in Stool Samples by Real-Time Polymerase Chain Reaction for the Diagnosis of C. difficile-Associated Diarrhea. Clin Infect Dis 2007; 45:1152-60. [DOI: 10.1086/522185] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 07/16/2007] [Indexed: 01/16/2023] Open
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19
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Beausoleil M, Fortier N, Guénette S, L'ecuyer A, Savoie M, Franco M, Lachaine J, Weiss K. Effect of a fermented milk combining Lactobacillus acidophilus Cl1285 and Lactobacillus casei in the prevention of antibiotic-associated diarrhea: a randomized, double-blind, placebo-controlled trial. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:732-6. [PMID: 18026577 PMCID: PMC2658588 DOI: 10.1155/2007/720205] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 03/02/2007] [Indexed: 01/15/2023]
Abstract
BACKGROUND Antibiotic-associated diarrhea is an important problem in hospitalized patients. The use of probiotics is gaining interest in the scientific community as a potential measure to prevent this complication. The main objective of the present study was to assess the efficacy and safety of a fermented milk combining Lactobacillus acidophilus and Lactobacillus casei that is widely available in Canada, in the prevention of antibiotic-associated diarrhea. METHODS In this double-blind, randomized study, hospitalized patients were randomly assigned to receive either a lactobacilli-fermented milk or a placebo on a daily basis. RESULTS Among 89 randomized patients, antibiotic-associated diarrhea occurred in seven of 44 patients (15.9%) in the lactobacilli group and in 16 of 45 patients (35.6%) in the placebo group (OR 0.34, 95% CI 0.125 to 0.944; P=0.05). The median hospitalization duration was eight days in the lactobacilli group, compared with 10 days in the placebo group (P=0.09). Overall, the lactobacilli-fermented milk was well tolerated. CONCLUSION The daily administration of a lactobacilli-fermented milk was safe and effective in the prevention of antibiotic-associated diarrhea in hospitalized patients.
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Affiliation(s)
- M Beausoleil
- Department of Pharmacy, University of Montreal, Montreal, Canada.
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20
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Goytia M, Chamond N, Cosson A, Coatnoan N, Hermant D, Berneman A, Minoprio P. Molecular and structural discrimination of proline racemase and hydroxyproline-2-epimerase from nosocomial and bacterial pathogens. PLoS One 2007; 2:e885. [PMID: 17849014 PMCID: PMC1964878 DOI: 10.1371/journal.pone.0000885] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 08/23/2007] [Indexed: 11/19/2022] Open
Abstract
The first eukaryotic proline racemase (PRAC), isolated from the human Trypanosoma cruzi pathogen, is a validated therapeutic target against Chagas' disease. This essential enzyme is implicated in parasite life cycle and infectivity and its ability to trigger host B-cell nonspecific hypergammaglobulinemia contributes to parasite evasion and persistence. Using previously identified PRAC signatures and data mining we present the identification and characterization of a novel PRAC and five hydroxyproline epimerases (HyPRE) from pathogenic bacteria. Single-mutation of key HyPRE catalytic cysteine abrogates enzymatic activity supporting the presence of two reaction centers per homodimer. Furthermore, evidences are provided that Brucella abortus PrpA [for 'proline racemase' virulence factor A] and homologous proteins from two Brucella spp are bona fide HyPREs and not 'one way' directional PRACs as described elsewhere. Although the mechanisms of aminoacid racemization and epimerization are conserved between PRAC and HyPRE, our studies demonstrate that substrate accessibility and specificity partly rely on constraints imposed by aromatic or aliphatic residues distinctively belonging to the catalytic pockets. Analysis of PRAC and HyPRE sequences along with reaction center structural data disclose additional valuable elements for in silico discrimination of the enzymes. Furthermore, similarly to PRAC, the lymphocyte mitogenicity displayed by HyPREs is discussed in the context of bacterial metabolism and pathogenesis. Considering tissue specificity and tropism of infectious pathogens, it would not be surprising if upon infection PRAC and HyPRE play important roles in the regulation of the intracellular and extracellular amino acid pool profiting the microrganism with precursors and enzymatic pathways of the host.
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Affiliation(s)
- Maira Goytia
- Laboratoire d'Immunobiologie des Infections à Trypanosoma, Département d'Immunologie, Institut Pasteur, Paris, France
| | - Nathalie Chamond
- Laboratoire d'Immunobiologie des Infections à Trypanosoma, Département d'Immunologie, Institut Pasteur, Paris, France
| | - Alain Cosson
- Laboratoire d'Immunobiologie des Infections à Trypanosoma, Département d'Immunologie, Institut Pasteur, Paris, France
| | - Nicolas Coatnoan
- Laboratoire d'Immunobiologie des Infections à Trypanosoma, Département d'Immunologie, Institut Pasteur, Paris, France
| | - Daniel Hermant
- Laboratoire d'Immunobiologie des Infections à Trypanosoma, Département d'Immunologie, Institut Pasteur, Paris, France
| | - Armand Berneman
- Laboratoire d'Immunobiologie des Infections à Trypanosoma, Département d'Immunologie, Institut Pasteur, Paris, France
| | - Paola Minoprio
- Laboratoire d'Immunobiologie des Infections à Trypanosoma, Département d'Immunologie, Institut Pasteur, Paris, France
- * To whom correspondence should be addressed. E-mail:
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Rakoff-Nahoum S, Medzhitov R. Role of the innate immune system and host-commensal mutualism. Curr Top Microbiol Immunol 2006; 308:1-18. [PMID: 16922084 DOI: 10.1007/3-540-30657-9_1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Host organisms live in intimate contact with indigenous microflora. The interactions between the host and commensal microbiota are highly complex and heterogeneous. A growing body of evidence indicates that commensal symbionts provide many benefits to the host physiology, particularly in the gastrointestinal system. The molecular mechanisms of the mutualistic interactions between the host and commensals are largely unknown but can be due either to bioactivity of the commensals or to the reaction of the host immune system to the commensal-derived products. Recent advances in our understanding of the innate immune system allow re-evaluation of some of the older findings regarding the mechanisms of benefits conferred by microflora. Here we review the examples of the benefits of host-commensal interactions that are due to recognition of commensal microbial products by the host innate immune system.
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Affiliation(s)
- S Rakoff-Nahoum
- Howard Hughes Medical Institute and Section of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
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22
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Rothstein DM, Shalish C, Murphy CK, Sternlicht A, Campbell LA. Development potential of rifalazil and other benzoxazinorifamycins. Expert Opin Investig Drugs 2006; 15:603-23. [PMID: 16732714 DOI: 10.1517/13543784.15.6.603] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rifalazil and other benzoxazinorifamycins (new chemical entities [NCEs]) are rifamycins that contain a distinct planar benzoxazine ring. Rifalazil has excellent antibacterial activity, high intracellular levels and high tissue penetration, which are attributes that favour its use in treating diseases caused by the obligate intracellular pathogens of the genus Chlamydia. Recent studies have shown that rifalazil has efficacy in the treatment of human sexually transmitted disease caused by Chlamydia trachomatis. The extraordinary potency of rifalazil and other NCEs, such as ABI-0043, extends to the related microorganism, C. pneumoniae, a respiratory pathogen that can disseminate and persist chronically in the vasculature, resulting in increased plaque formation in animal studies. A pivotal clinical trial with rifalazil has been initiated for the treatment of peripheral arterial disease. Other opportunities include gastric ulcer disease caused by Helicobacter pylori and antibiotic-associated colitis caused by infection with Clostridium difficile in the colon. The NCEs could prove to be valuable as follow-on compounds in these indications, as rifampin replacements in antibacterial combination therapy or as stand-alone topical antibacterials (e.g., to treat acne). Neither rifalazil nor NCEs appear to induce the cytochrome P450 3A4, an attribute of rifampin that can result in adverse events due to drug-drug interactions.
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23
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McPherson S, Rees CJ, Ellis R, Soo S, Panter SJ. Intravenous immunoglobulin for the treatment of severe, refractory, and recurrent Clostridium difficile diarrhea. Dis Colon Rectum 2006; 49:640-5. [PMID: 16525744 DOI: 10.1007/s10350-006-0511-8] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Clostridium difficile diarrhea is common in elderly patients and leads to prolonged hospitalization. Patients with severe or recurrent Clostridium difficile diarrhea have poor antitoxin antibody responses. Intravenous immunoglobulin has been advocated in these patients. This study was designed to assess the response of patients with refractory, recurrent, or severe Clostridium difficile diarrhea to intravenous immunoglobulin. METHODS Retrospective review (November 2003-January 2005) of 14 patients with severe, refractory, recurrent Clostridium difficile diarrhea treated with intravenous immunoglobulin (Flebogamma, 150-400 mg/kg) from 264 Clostridium difficile toxin-positive patients. RESULTS Median age was 79 (range, 54-91) years. Median length of symptoms before intravenous immunoglobulin was 29 (range, 3-90) days. Patients received a median of three (range, 1-5) courses of vancomycin or metronidazole before intravenous immunoglobulin. All had hypoalbuminemia (median, 22 g/l; range, 18-33) and raised C-reactive protein (median, 47 mg/l; range, 25-255) at time of infusion. The median white cell count was 15.3 x 10(9)/liters (range, 4-24). Eight patients had evidence of pancolitis on abdominal imaging, suggesting severe Clostridium difficile diarrhea. All patients tolerated intravenous immunoglobulin without side effects. Nine (64 percent) responded with bowels normalizing in a median of ten (range, 2-26) days; one patient received two doses. One patient had a partial response from two doses but died two months later after a recurrence. The other four patients died of other causes within three weeks of infusion. CONCLUSIONS Intravenous immunoglobulin may be effective for severe, refractory, or recurrent Clostridium difficile diarrhea after failed conventional treatment.
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Affiliation(s)
- Stuart McPherson
- Department of Gastroenterology, South Tyneside District Hospital, Harton Lane, South Shields, NE34 0PL, United Kingdom
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24
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Reinert DJ, Jank T, Aktories K, Schulz GE. Structural basis for the function of Clostridium difficile toxin B. J Mol Biol 2005; 351:973-81. [PMID: 16054646 DOI: 10.1016/j.jmb.2005.06.071] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 06/13/2005] [Accepted: 06/29/2005] [Indexed: 11/22/2022]
Abstract
Toxin B is a member of the family of large clostridial cytotoxins which are of great medical importance. Its catalytic fragment was crystallized in the presence of UDP-glucose and Mn2+. The structure was determined at 2.2 A resolution, showing that toxin B belongs to the glycosyltransferase type A family. However, toxin B contains as many as 309 residues in addition to the common chainfold, which most likely contribute to the target specificity. A superposition with other glycosyltransferases shows the expected positions of the acceptor oxygen atom during glucosyl transfer and indicates further that the reaction proceeds probably along a single-displacement pathway. The C1'' donor carbon atom position is defined by the bound UDP and glucose. It assigns the surface area of toxin B that forms the interface to the target protein during the modifying reaction. A docking attempt brought the known acceptor atom, Thr37 O(gamma1) of the switch I region of the RhoA:GDP target structure, near the expected position. The relative orientation of the two proteins was consistent with both being attached to a membrane. Sequence comparisons between toxin B variants revealed that the highest exchange rate occurs around the active center at the putative docking interface, presumably due to a continuous hit-and-evasion struggle between Clostridia and their eukaryotic hosts.
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Affiliation(s)
- Dirk J Reinert
- Institut für Organische Chemie und Biochemie, Albert-Ludwigs-Universität, Albertstr. 21, 79104 Freiburg im Breisgau, Germany
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25
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Borek AP, Aird DZ, Carroll KC. Frequency of sample submission for optimal utilization of the cell culture cytotoxicity assay for detection of Clostridium difficile toxin. J Clin Microbiol 2005; 43:2994-5. [PMID: 15956442 PMCID: PMC1151944 DOI: 10.1128/jcm.43.6.2994-2995.2005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We reviewed the results of repeated sample submissions within a 7-day time frame for Clostridium difficile toxin testing. A total of 2,940 samples were tested during a 3-month period using a cell culture cytotoxicity assay (CCCA). The results from all second samples (n = 1,101) were concordant with the original test result. In only two cases (0.8%; n = 247) was a third sample positive when the first two samples were negative. In this study, submission of multiple samples for CCCA did not increase detection of Clostridium difficile infection.
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Affiliation(s)
- Anita P Borek
- Division of Microbiology, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287-7093, USA.
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Yapar N, Sener A, Karaca B, Yucesoy M, Tarakci H, Cakir N, Yuce A. Antibiotic-associated diarrhea in a Turkish outpatient population: investigation of 288 cases. J Chemother 2005; 17:77-81. [PMID: 15828448 DOI: 10.1179/joc.2005.17.1.77] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Oral antibiotics are often prescribed, especially for respiratory tract infections in the community. The widespread use of broad-spectrum antibiotics causes an increased incidence of antibiotic-associated diarrhea (AAD). Although AAD has been studied in hospitalized patients, there is little available information concerning the characteristics of AAD in outpatient populations. The aim of this study was to investigate the clinical and laboratory findings of adult patients with community-acquired AAD. Between June 1998 and December 2003, the clinical reports of 288 patients were retrospectively reviewed. We observed that the duration between the start of antibiotic treatment and onset of symptoms was 7 days in most of the patients (86%), and the mean time was 9+/-1.0 days. The diarrhea was self-limited in all cases and mean duration of symptoms was 3 (+/-1.0) days (1-7 days). The most common symptoms were abdominal discomfort and tenesmus (61.1%), while elevated WBC counts and fever were detected rarely. We were able to perform microbiologic investigations in only 88 patients because of the financial problems. Of the 88 stool specimens tested, none of them were positive for pathogenic bacterial growth or toxin A production.
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Affiliation(s)
- N Yapar
- Dokuz Eylul University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, 35340 Inciralti, Izmir, Turkey.
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27
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van Dissel JT, de Groot N, Hensgens CM, Numan S, Kuijper EJ, Veldkamp P, van 't Wout J. Bovine antibody-enriched whey to aid in the prevention of a relapse of Clostridium difficile-associated diarrhoea: preclinical and preliminary clinical data. J Med Microbiol 2005; 54:197-205. [PMID: 15673517 DOI: 10.1099/jmm.0.45773-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
In a pilot study, the feasibility of immune whey protein concentrate (40%; immune WPC-40) to aid the prevention of relapse of Clostridium difficile diarrhoea was evaluated. Immune WPC-40 was made from milk after immunization of Holstein-Frisian cows with C. difficile-inactivated toxins and killed whole-cell C. difficile. Immune WPC-40 contained a high concentration of specific sIgA antibodies, and was effective in neutralizing the cytotoxic effect of C. difficile toxins in cell assays in vitro. Immune WPC-40 conferred protection from otherwise lethal C. difficile-associated caecitis in hamsters. To obtain preliminary data in humans, 16 patients (10 male; median 57 years) with toxin- and culture-confirmed C. difficile diarrhoea were enrolled in an uncontrolled cohort study. Nine had a history of relapsing C. difficile diarrhoea. After completion of standard antibiotic treatment, the patients received immune WPC-40 TID for 2 weeks; it was well tolerated and no treatment-related adverse effects were observed. In all but one case, C. difficile toxins had disappeared from the faeces upon completion of treatment. During a follow-up period of median 333 days (range 35 days to 1 year), none of the patients had suffered another episode of C. difficile diarrhoea. These preliminary data suggest that immune whey protein concentrate-40 may be of help in the prevention of relapse of C. difficile diarrhoea.
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Affiliation(s)
- Jaap T van Dissel
- Department of Infectious Diseases1 and Department of Medical Microbiology3, Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands 2MucoVax bv, Niels Bohrweg 11-13, Leiden, The Netherlands 4Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, USA 5Department of Internal Medicine, Bronovo Hospital, Bronovolaan 5, The Hague, The Netherlands
| | - Nanda de Groot
- Department of Infectious Diseases1 and Department of Medical Microbiology3, Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands 2MucoVax bv, Niels Bohrweg 11-13, Leiden, The Netherlands 4Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, USA 5Department of Internal Medicine, Bronovo Hospital, Bronovolaan 5, The Hague, The Netherlands
| | - Charles Mh Hensgens
- Department of Infectious Diseases1 and Department of Medical Microbiology3, Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands 2MucoVax bv, Niels Bohrweg 11-13, Leiden, The Netherlands 4Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, USA 5Department of Internal Medicine, Bronovo Hospital, Bronovolaan 5, The Hague, The Netherlands
| | - Sandra Numan
- Department of Infectious Diseases1 and Department of Medical Microbiology3, Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands 2MucoVax bv, Niels Bohrweg 11-13, Leiden, The Netherlands 4Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, USA 5Department of Internal Medicine, Bronovo Hospital, Bronovolaan 5, The Hague, The Netherlands
| | - Ed J Kuijper
- Department of Infectious Diseases1 and Department of Medical Microbiology3, Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands 2MucoVax bv, Niels Bohrweg 11-13, Leiden, The Netherlands 4Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, USA 5Department of Internal Medicine, Bronovo Hospital, Bronovolaan 5, The Hague, The Netherlands
| | - Peter Veldkamp
- Department of Infectious Diseases1 and Department of Medical Microbiology3, Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands 2MucoVax bv, Niels Bohrweg 11-13, Leiden, The Netherlands 4Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, USA 5Department of Internal Medicine, Bronovo Hospital, Bronovolaan 5, The Hague, The Netherlands
| | - Jan van 't Wout
- Department of Infectious Diseases1 and Department of Medical Microbiology3, Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands 2MucoVax bv, Niels Bohrweg 11-13, Leiden, The Netherlands 4Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, USA 5Department of Internal Medicine, Bronovo Hospital, Bronovolaan 5, The Hague, The Netherlands
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Abstract
The hadBC and hadI genes from Clostridium difficile were functionally expressed in Escherichia coli and shown to encode the novel 2-hydroxyisocaproyl-CoA dehydratase HadBC and its activator HadI. The activated enzyme catalyses the dehydration of (R)-2-hydroxyisocaproyl-CoA to isocaprenoyl-CoA in the pathway of leucine fermentation. The extremely oxygen-sensitive homodimeric activator as well as the heterodimeric dehydratase, contain iron and inorganic sulfur; besides varying amounts of zinc, other metal ions, particularly molybdenum, were not detected in the dehydratase. The reduced activator transfers one electron to the dehydratase concomitant with hydrolysis of ATP, a process similar to that observed with the unrelated nitrogenase. The thus activated dehydratase was separated from the activator and ATP; it catalyzed about 10(4) dehydration turnovers until the enzyme became inactive. Adding activator, ATP, MgCl(2), dithionite and dithioerythritol reactivated the enzyme. This is the first demonstration with a 2-hydroxyacyl-CoA dehydratase that the catalytic electron is recycled after each turnover. In agreement with this observation, only substoichiometric amounts of activator (dehydratase/activator = 10 mol/mol) were required to generate full activity.
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Affiliation(s)
- Jihoe Kim
- Laboratorium für Mikrobiologie, Fachbereich Biologie, Philipps-Universität, 35032 Marburg, Germany
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Barth H, Aktories K, Popoff MR, Stiles BG. Binary bacterial toxins: biochemistry, biology, and applications of common Clostridium and Bacillus proteins. Microbiol Mol Biol Rev 2004; 68:373-402, table of contents. [PMID: 15353562 PMCID: PMC515256 DOI: 10.1128/mmbr.68.3.373-402.2004] [Citation(s) in RCA: 285] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Certain pathogenic species of Bacillus and Clostridium have developed unique methods for intoxicating cells that employ the classic enzymatic "A-B" paradigm for protein toxins. The binary toxins produced by B. anthracis, B. cereus, C. botulinum, C. difficile, C. perfringens, and C. spiroforme consist of components not physically associated in solution that are linked to various diseases in humans, animals, or insects. The "B" components are synthesized as precursors that are subsequently activated by serine-type proteases on the targeted cell surface and/or in solution. Following release of a 20-kDa N-terminal peptide, the activated "B" components form homoheptameric rings that subsequently dock with an "A" component(s) on the cell surface. By following an acidified endosomal route and translocation into the cytosol, "A" molecules disable a cell (and host organism) via disruption of the actin cytoskeleton, increasing intracellular levels of cyclic AMP, or inactivation of signaling pathways linked to mitogen-activated protein kinase kinases. Recently, B. anthracis has gleaned much notoriety as a biowarfare/bioterrorism agent, and of primary interest has been the edema and lethal toxins, their role in anthrax, as well as the development of efficacious vaccines and therapeutics targeting these virulence factors and ultimately B. anthracis. This review comprehensively surveys the literature and discusses the similarities, as well as distinct differences, between each Clostridium and Bacillus binary toxin in terms of their biochemistry, biology, genetics, structure, and applications in science and medicine. The information may foster future studies that aid novel vaccine and drug development, as well as a better understanding of a conserved intoxication process utilized by various gram-positive, spore-forming bacteria.
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Affiliation(s)
- Holger Barth
- Institut für Experimentelle und Klinische Pharmakologie und Toxikologie der Albert-Ludwigs-Universität Freiburg, Otto-Krayer-Haus, Albertstrasse 25, D-79104 Freiburg, Germany.
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Zheng L, Keller SF, Lyerly DM, Carman RJ, Genheimer CW, Gleaves CA, Kohlhepp SJ, Young S, Perez S, Ye K. Multicenter evaluation of a new screening test that detects Clostridium difficile in fecal specimens. J Clin Microbiol 2004; 42:3837-40. [PMID: 15297543 PMCID: PMC497597 DOI: 10.1128/jcm.42.8.3837-3840.2004] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clostridium difficile causes approximately 25% of nosocomial antibiotic-associated diarrheas and most cases of pseudomembranous colitis. We evaluated C. DIFF CHEK, a new screening test that detects glutamate dehydrogenase of C. difficile. Our results showed that this test was comparable to PCR in sensitivity and specificity and outperformed bacterial culture.
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Affiliation(s)
- L Zheng
- TechLab, Inc., 2001 Kraft Dr., Blacksburg, VA 24061, USA.
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31
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Abstract
The large clostridial cytotoxins are a family of structurally and functionally related exotoxins from Clostridium difficile (toxins A and B), C. sordellii (lethal and hemorrhagic toxin) and C. novyi (alpha-toxin). The exotoxins are major pathogenicity factors which in addition to their in vivo effects are cytotoxic to cultured cell lines causing reorganization of the cytoskeleton accompanied by morphological changes. The exotoxins are single-chain protein toxins, which are constructed of three domains: receptor-binding, translocation and catalytic domain. These domains reflect the self-mediated cell entry via receptor-mediated endocytosis, translocation into the cytoplasm, and execution of their cytotoxic activity by an inherent enzyme activity. Enzymatically, the toxins catalyze the transfer of a glucosyl moiety from UDP-glucose to the intracellular target proteins which are the Rho and Ras GTPases. The covalent attachment of the glucose moiety to a conserved threonine within the effector region of the GTPases renders the Rho-GTPases functionally inactive. Whereas the molecular mode of cytotoxic effects is fully understood, the mechanisms leading to inflammatory processes in the context of disease (e.g., antibiotic-associated pseudomembranous colitis caused by Clostridium difficile) are less clear.
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Affiliation(s)
- I Just
- Institut für Toxikologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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32
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Abstract
For the survival of humankind, nothing can be as important as the health of a mother and a child. As the world's population grows to more than 6 billion, it might seem ridiculous to suggest that any real threat exists to the human species. Diseases have long ravaged populations, as have wars, poverty, and malnutrition. Life today is no different with new and emerging diseases such as SARS and Mad Cow Disease leaving a trail of concern around the planet. All that being said, the AIDS crisis is threatening humans like no other. In countries such as Botswana, close to half the population of pregnant women is infected. Of great concern, the disease is now prevalent among women and teenage girls, threatening not only their lives but those of their offspring. Efforts to control this spread are quite abysmal, albeit well intentioned. Likewise, the death of a child every 15 seconds from diarrheal disease is not being addressed with the same vigor as SARS, even though the risk of dying from the latter for most people is similar to being struck by lightning. In the end, it is the economy and politics that dictate health spending. Image and perception are everything. While deaths mount among women and children from AIDS and other infections, the potential to intervene with a low-risk natural concept of probiotics seemed all too distant. As evidence mounts of the attributes of certain probiotic strains to treat diarrhea and reduce the risk of urogenital and other diseases, the developing world has failed to embrace it, support its evaluation and implementation, and take it to where it is needed the most. In this review, the case for and against probiotics for urogenital and intestinal infections is presented based on current literature. The story is far from complete, but the potential for improving the health of the mother and child is significant. United Nations and World Health Organization guidelines have now been developed to vanquish the unproved marketing hype products that have given probiotics a bad name. It is now up to science to deliver the remedies, and to society to make sure that only proven products reach the marketplace and the people in most need.
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Affiliation(s)
- Gregor Reid
- Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, Department of Microbiology and Immunology, University of Western Ontario, London, Canada.
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Beaugerie L, Petit JC. Microbial-gut interactions in health and disease. Antibiotic-associated diarrhoea. Best Pract Res Clin Gastroenterol 2004; 18:337-52. [PMID: 15123074 DOI: 10.1016/j.bpg.2003.10.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Most cases of antibiotic-associated diarrhoea (AAD) are directly or indirectly due to the alteration of gut microflora by antibiotics. 'Functional' diarrhoea, usually limited to a mild and brief change in stool frequency, is considered as the most frequent pattern of AAD. Reduced carbohydrate fermentation and impaired metabolism of bile acids have been claimed as the potential causes of this transient digestive discomfort but a critical analysis of the data supporting these theories is necessary. Alternatively, changes in the gut flora ecosystem allow pathogens to proliferate. Clostridium difficile is responsible for approximately 10% of cases of AAD and almost all cases of antibiotic-associated pseudomembranous colitis. The level of evidence which supports the potential responsibility of other candidate pathogens (Klebsiella oxytoca, enterotoxin-producing Clostridium perfringens and Staphylococcus aureus, Candida) needs to be appreciated according to the updated postulates of causality relationships between a bacterium and a disease.
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Affiliation(s)
- Laurent Beaugerie
- Department of Gastroenterology, Saint-Antoine Hospital, and Pierre et Marie Curie University, Paris, France.
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34
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Abstract
A large number of drugs have gastrointestinal side-effects of which diarrhoea or constipation, nausea and vomiting are amongst the commonest. In relatively few are there diagnostic pathological changes and this review draws attention to the most common. Incriminating a drug as a cause of specific pathological changes requires the drug to be associated with the changes, for the latter to resolve when the drug is withdrawn and for them to re-appear when a patient is rechallenged with the drug. Individual histological features such as apoptosis, tissue infiltration by eosinophils and increased intra-epithelial lymphocytes within the gut mucosa can be clues to an iatrogenic aetiology but these are by no means specific. Amongst the few pathognomonic patterns of drug reactions is pseudomembranous colitis and diaphragm disease. These, along with others such as reactive gastritis and the collagenous and lymphocytic forms of microscopic colitis, in which drugs have also been implicated, are described here.
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Affiliation(s)
- Ashley B Price
- Department of Cellular Pathology, Northwick Park and St Mark's Hospitals, Watford Road, Harrow, HA1 3UJ.
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35
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Wade WG. Non-Culturable Bacteria in Complex Commensal Populations. ADVANCES IN APPLIED MICROBIOLOGY 2004; 54:93-106. [PMID: 15251277 DOI: 10.1016/s0065-2164(04)54003-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- William G Wade
- Department of Microbiology, Dental Institute, King's College London WC2R 2LS, United Kingdom
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36
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Naaber P, Mikelsaar M. Interactions between Lactobacilli and Antibiotic-Associated Diarrhea. ADVANCES IN APPLIED MICROBIOLOGY 2004; 54:231-60. [PMID: 15251283 DOI: 10.1016/s0065-2164(04)54009-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Paul Naaber
- Department of Microbiology, University of Tartu, Tartu 50411, Estonia
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