Reel syndrome: a rare presentation of a rare cause of cardiac resynchronization malfunction

Reel syndrome is a rare cause of pacemaker lead displacement. This case report shows a rare presentation of Reel syndrome highlighting the importance of an early diagnosis and discussing the underlying mechanism, management and prevention.

Antibiotic Releasing Urethane Polymers for Prevention of Catheter Related Infections

In order to improve the resistance of catheters to microbial infections (particularly Staphylococci), a cephalosporin type antibiotic (cefamandole, CEF), and a glycopeptidic antibiotic (vancomycin), were adsorbed onto functionalized polyurethane films. The polymers were characterized by chemical, FT-IR and 'H-NMR analysis. The amounts of antibiotic adsorbed were higher than the ones reported in the literature. The kinetics of release, under standard conditions, was evaluated by in vitro tests; both the adsorption yield and the antibiotic release from the polymer surface depended on the type of the surface-antibiotic interactions. In particular, matrix hydrophilicity, formation of strong ionic bonds, existence of "spacing arms" between antibiotic and matrix bonding site play a role. The antimicrobial activity of the treated films was evaluated by optical microscopy and the Kirby-Bauer test. When exhausted polymer films, previously treated with CEF were submitted to a second adsorption, a superior antibacterial activity was observed.

Molecular characterization of an inhibitor of NF-κB in the scallop Argopecten purpuratus: First insights into its role on antimicrobial peptide regulation in a mollusk

Inhibitors of nuclear factor kappa B (IκBs) are major control components of the Rel/NF-κB signaling pathway, a key regulator in the modulation of the expression of immune-related genes in vertebrates and invertebrates. The activation of the Rel/NF-κB signaling pathway depends largely in the degradation of IκB proteins and thus, IκBs are a main target for the identification of genes whose expression is controlled by Rel/NF-κB pathway. In order to identify such regulation in bivalve mollusks, the cDNA sequence encoding an IκB protein was characterized in the scallop Argopecten purpuratus, ApIκB. The cDNA sequence of ApIκB is comprised of 1480 nucleotides with a 1086 bp open reading frame encoding for 362 amino acids. Bioinformatics analysis showed that ApIκB displays the conserved features of IκB proteins. The deduced amino acid sequence consists of a 39.7 kDa protein, which has an N-terminal degradation motif, six ankyrin repeats and a C-terminal phosphorylation site motif. Phylogenetic analysis revealed a high degree of identity between ApIκB and other IκBs from mollusks, but also to arthropod cactus proteins and vertebrate IκBs. Tissue expression analysis indicated that ApIκB is expressed in all examined tissues and it is upregulated in circulating hemocytes from scallops challenged with the pathogenic Gram-negative bacterium Vibrio splendidus. After inhibiting ApIκB gene expression using the RNA interference technology, the gene expression of the antimicrobial peptide big defensin was upregulated in hemocytes from non-challenged scallops. Results suggest that ApIκB may control the expression of antimicrobial effectors such as big defensin via a putative Rel/NF-κB signaling pathway. This first evidence will help to deepen the knowledge of the Rel/NF-κB conserved pathway in scallops.

Polyclonal intravenous immunoglobulin: an important additional strategy in sepsis?

Sepsis syndrome is characterized by a systemic inflammatory response to infection potentially leading to acute organ failure and rapid decline to death. Polyclonal intravenous immune globulin, a blood product derived from human donor blood, in addition to antiinfective activities, also exerts a broad antiinflammatory and immunomodulating effect. Intravenous immunoglobulin (IVIg) has been proposed as adjuvant therapy for sepsis even though the clinical studies demonstrating their efficacy and safety are relatively small. Several systematic reviews and meta-analyses of intravenous immunoglobulin treatment in sepsis have been performed. As a result of heterogeneity across studies and inconsistencies in results, the majority have concluded that more evidence, coming from large, well-conducted randomized controlled trials (RCTs), is required. Moreover the appropriate timing of administration and the identification of specific clinical settings represent a key factor to maximizing their beneficial effect. The authors, in this revision, review the basic mechanisms of action of IVIg, the rationale for their use, and their clinical applications.

Polyurethanes Loaded with Antibiotics: Influence of Polymer-Antibiotic Interactions onIn VitroActivity AgainstStaphylococcus epidermidis

Acidic or basic polyurethanes were loaded with antibiotics to develop materials to prevent medical device-related infections. A correlation between polymer-antibiotic interactions and amount of drug absorbed by polymers and released over time was found. Since the employed antibiotics, i.e. amoxicillin, cefamandole nafate, rifampin and vancomycin, possessed at least an acidic group in their structural formula, the introduction of basic tertiary amines in the polyurethane side-chain resulted in an increased polymer ability to adsorb antibiotics. However, a stronger ionic interaction between this polymer and the antibiotics caused a release of lower amount of drug over time. Antibiotics released from polymers inhibited Staphylococcus epidermidis growth on agar. Antibiotic-loaded polyurethanes kept in water for increasing times were still able to show inhibition zones of bacterial growth. The antibacterial activity lasted up to 3 hours for amoxicillin, 24 hours for vancomycin, 8 days for cefamandole nafate and 8 months for rifampin.

Influenza vaccine administration in rheumatoid arthritis patients under treatment with TNFalpha blockers: safety and immunogenicity

Twenty-eight patients with low-moderate, stable rheumatoid arthritis (RA), under treatment with tumor necrosis factor (TNF) alpha blockers, were immunized at least once with non-adjuvanted trivalent influenza vaccine during three consecutive influenza seasons. Antibodies toward A influenza antigens significantly increased and reached protective levels, still detectable 6 months after vaccination, both in RA patients and healthy controls. Response to B antigen instead was only observed from the second year for healthy controls and in the third year for patients. No significant difference in disease activity and anti-nuclear antibodies was observed as a consequence of vaccine administration, whereas T regulatory cells showed a significant increase 30 days after immunization in RA patients. This study confirms safety of influenza vaccine administration in RA patients treated with TNFalpha blockers. The cohort follow-up revealed the overcoming of poor B vaccine antigen immunogenicity via repeated vaccinations. Finally, protective antibody response was still observed 6 months after vaccination.

Are glucocorticoids a consistent risk factor for infections in rheumatoid arthritis patients under treatment with methotrexate and etanercept?

OBJECTIVE

To evaluate the incidence of infections in subjects with rheumatoid arthritis (RA), treated with an anti-TNFalpha blocker during one year follow-up. The aim of the study was focused to evaluate the number of infectious episodes in two groups of patients treated with etanercept (ETN) plus methotrexate (MTX) or ETN plus MTX and glucocorticoid drugs (GCs/prednisone) for a 12 months period.

MATERIALS AND METHODS

Sixty-nine out of 122 RA patients treated with an anti-TNFalpha drug (ETN) were included in an outpatient control system within the Immunology Department Sapienza-University of Rome-II; School of Medicine. RA patients were studied during the first year after ETN introduction. Particularly 20 RA patients have been included in a subgroup. For these 20 patients infections have been monitored for 2 years: 12 months before and 12 months after ETN treatment starting.

RESULTS

According to drugs administration protocols, after a careful screening aiming to exclude latent tuberculosis infection, 20 patients have been treated with ETN (10 of them received treatment in association to MTX, while 10 were given a GCs therapy plus MTX). During the one-year ETN treatment period, 7 infections have been described in the group treated with ETN, MTX and GCs and no infection in the group treated with ETN and MTX. After analysing the infection number in the two groups of patients, in the year preceding biological treatment no significant change arose.

CONCLUSIONS

The risk of infections in subjects treated with the biological drug ETN is well known. Our data show that after one year therapy the [ETN+MTX+GCs] group is marked by a greater frequency of infectious episodes compared to the subjects treated with ETN plus MTX. Therefore, the additional infectious risk appears to be related to steroid therapy itself, though infections were not serious.

Clonality AmongEnterococcus faeciumClinical Isolates

In the course of a survey to determine the epidemiology of enterococcal infections in Italy, a sudden increment, in a 1-year time, was noted in the number of glycopeptide resistant Enterococcus faecium isolated from different wards of the University Hospital in Rome, Italy. The isolates were characterized for clonal relatedness by comparing SmaI gel electropherotypes, presence of vancomycin-resistance genes, and expression of virulence factors. PFGE identified in a single pulsed type all the glycopeptide-resistant isolates but one. Resistance to high levels of aminoglycosides was expressed by these same isolates, which also included a majority of non biofilm-forming strains. Two esp gene-carrying strains were also identified in different PFGE types. Data indicates that a specific clone acquired, in the clinical setting, the genetic determinant for glycopeptide resistance, thus improving environmental adaptation and favoring its persistence and spread.

Analysis of virulence factors in cases of enterococcal endocarditis

Eleven isolates of Enterococcus faecalis causing endocarditis were screened for possible virulence factors with PCR and phenotypic assays. The gene coding for the enterococcal surface protein (esp) was detected in one isolate only, and haemolysin was produced by two isolates. Aggregation substance, biofilm formation and gelatinase were present in seven, nine and eight isolates, respectively. Predisposing factors, particularly hospitalisation and multiple antibiotic therapy, appeared to be more relevant to the development of enterococcal endocarditis following bloodstream infections than the pattern of virulence factors.

New polymer-antibiotic systems to inhibit bacterial biofilm formation: a suitable approach to prevent central venous catheter-associated infections

Intravascular catheters are widely employed in medical practice. However, complications such as local or systemic infections are frequently related to their use. The significant increase in this type of nosocomial infection has prompted the search for new strategies to prevent them. This paper reports on an experimental model to prevent catheter-related infections based on the adsorption of a beta-lactam antibiotic (cefamandole nafate) on functionalized urethane polymers. The polyurethanes synthesized were used to coat a commercial central venous catheter. The influence of functional groups on the polymer-antibiotic interaction was analyzed and the kinetics of the antibiotic release from the catheters was dynamically studied. We were able to realize a polymer-antibiotic system able to inhibit bacterial growth up to 7 days. These promising results have encouraged us to extend this experimental model to other polymer-antibiotic systems in order to identify those allowing bacterial growth inhibition for longer times.

Enterococcus spp. produces slime and survives in rat peritoneal macrophages

Enterococcal clinical isolates were investigated for the ability to form biofilm on inert surfaces, as a measure of slime production, in an attempt to find new possible virulence factors for these microorganisms. This property was commonly found among Enterococcus faecalis. Also E. faecium isolates were able to form biofilm, although to a lesser extent; for this species, however, biofilm formation seemed more frequently associated with isolates from infection rather than with environmental strains or isolates from healthy individuals. Biofilm formation was strongly affected by the presence of an additional carbohydrate source in the medium, or by iron deprivation, indicating a role of slime for survival in stressful conditions. Slime-producing E. faecalis were able to survive inside peritoneal macrophages for extended periods compared to slime-negative strains or to slime-positive bacteria grown in conditions depressing slime production. In particular, slime-producing and slime-negative cells showed a decrease of 1 and 2 log units, respectively, at 1 h after infection; slime-negative cells were then rapidly killed, with clearance of bacterial cells at 24 h. Slime-producing bacteria persisted up to 48 h, which was the last time point examined, as after that time viability of both infected and non-infected macrophages started to decline. Scanning electron microscopy observations showed the presence of abundant amorphous extracellular material, of possible polysaccharide nature, embedding bacterial cells to form a multilayered biofilm. Even in conditions not supporting biofilm formation, bacterial cells appeared capsulated, suggesting that capsule and slime might represent different structures. Genes belonging to the epa locus or to a putative icaA homolog did not seem to be involved in synthesis and export of slime.

Antibiotic resistance and genotypic characterization by PFGE of clinical and environmental isolates of enterococci

Fifty-four Enterococcus faecalis and 20 Enterococcus faecium isolates from clinical and non-human sources in Rome, Italy, were characterized by antibiotic resistance and pulsed field gel electrophoresis (PFGE). Resistance to vancomycin, teicoplanin, ampicillin, and ciprofloxacin was more frequent in E. faecium than in E. faecalis, whereas high-level resistance to aminoglycoside was found primarily in E. faecalis. Multi-resistance was found primarily among clinical isolates, but was also observed among environmental isolates. Common genotypes shared among clinical and environmental isolates were observed, however, the majority of isolates occurred as unique, source-specific clones. Several PFGE types were associated with shared features in their antibiotic resistance patterns; evidences of clonal spread between and within wards were also noted. This is the first report indicating clonal relatedness between human and environmental enterococci isolated in Italy.

Is melatonin circadian rhythm a physiological feature associated with healthy longevity? A study of long-living subjects and their progeny

The study investigates the circadian rhythm (CR) of urinary 6-sulphatoxy-melatonin (aMT6s) in long-living (longevous) subjects and their progeny. The aim is to detect whether or not the melatonin CR is a physiological feature associated with healthy longevity. The aMT6s CR was investigated in 10 longevous subjects, 8 of their children and 9 of their grandchildren, all in good health. Control data were obtained respectively from 13 adult subjects and 9 young subjects, in good health, but characterized by a negative family history for longevity. All the subjects were born and living in the same city. The study was performed in the summer of 1996. The aMT6s CR was found to persist in longevous subjects, being characterized by a lower mesor and amplitude. The aMT6s CR was found not to show properties consistently different in children and grandchildren as compared respectively to their adult and young controls. Because of its preservation in longevous subjects, it can be argued that the melatonin CR is a physiological feature associated with healthy longevity. Because of the comparability of aMT6s CR in children and grandchildren, with respect to their controls without a positive family history of longevity, it can be argued that the melatonin CR is not a marker that can be used for an earlier identification of the candidates for longevity.

Slime production and expression of the slime-associated antigen by staphylococcal clinical isolates

The ability to produce slime and to express a slime-associated antigen was examined in a collection of staphylococcal clinical isolates. Slime-producing strains were found among coagulase-negative staphylococci in percentages comparable to those reported in other studies; surprisingly, a high percentage of Staphylococcus aureus strains also were able to produce this extracellular material. In the latter case, this ability was strongly dependent on the presence of an additional carbohydrate source in the growth medium. Expression of the slime-associated antigen appeared to be species specific and confined to the Staphylococcus epidermidis sensu stricto isolates; its strong association with the ability of these strains to produce thicker biofilms indicated slime-associated antigen as a possible virulence marker for S. epidermidis.

[Streptococcus bovis endocarditis. Clinical and microbiological observations and review of the literature]

Fourteen patients (11 men and 3 women) with Streptococcus bovis infective endocarditis have been observed by the Infectious Disease Section of our Department of Clinical Medicine between the years 1988-1998. The mean age was 63.2 years (range 35-85 years); 5 patients previously suffered valvular disease or had a valvular prosthesis, the infection involved the mitral valve in 6 patients, the aortic in 8, the prosthetic valve in 1. No patient developed cardiac failure or died during hospitalization; only 1 episode of major embolism (spleen) was observed. No patient required cardiac surgery. All patients became afebrile after starting antibiotic treatment; no cases of Streptococcus bovis relapse have been observed, during a six-month follow-up after antibiotics discontinuation, in 13 patients fully evaluated. The remaining patient was lost to follow-up. An underlying asymptomatic colonic neoplasm was diagnosed at colonoscopy in 7 of 11 evaluated patients. This study confirms that Streptococcus bovis infective endocarditis is relatively benign, but it stresses the frequency and potential severity of the associated colonic lesions, requiring colonoscopy and making the treatment of high risk lesion mandatory.

Anaerobic bacteria in postsurgical infections: isolation rate and antimicrobial susceptibility

Three hundred clinical samples, obtained from post-surgical infections, were evaluated. 37% of samples were positive for anaerobes, 99 samples (33%) for aerobes and anaerobes in mixed culture, and 13 (4%) only for anaerobes. One hundred forty-nine anaerobic strains were isolated: Bacteroides and Clostridia occurred most frequently (34% and 23% respectively). Antimicrobial susceptibility of the isolates was tested by means of a commercial broth microdilution method. In addition, the standardized agar dilution method was performed to evaluate the susceptibility to 8 antibiotics of the 51 Bacteroides strains.

[Teichoplanin: a clinical study of treatment of serious infections in hospitalized patients]

The study was performed to evaluate the efficacy and the safety of teicoplanin in the treatment of serious Gram positive bacteria infections in hospitalized patients at high risk of complications. In a twelve month period, 13 patients were treated. Six of whom presented generalized infections with bacteremia and seven severe localized infections. Safety evaluation included pre, during and post treatment measurements of haematological and serum chemistry parameters. Clinical successes with microbiological eradication of pathogens were obtained in 11 out of 13 cases (84.6%). One persistence of infection (7.7%) and one Gram negative superinfection (7.7%) presented. Only in one patient we noted a transitory increase of creatinine level. Teicoplanin showed to be useful in the treatment of serious Gram positive infections in hospitalized patients.

[Pheochromocytoma-gastric leiomyoblastoma association. A possible expression of Carney's triad. A case report]

The case of a 28 yrs old female patient affected by pheochromocytoma and gastric leiomyoblastoma was described. The simultaneous presence of these neoplasms in a young woman supported the diagnosis of the clinical syndrome known as "Carney's triad".

[Amyloidosis: state of the art]

Amyloidosis is characterized by a heterogeneous group of diseases due to deposition of a fibrillar, proteinaceous material, in different tissues. In this review pathogenetic mechanisms, clinical and therapeutic findings of the most important aspects of the disease, are described.

Real-time digital control of optical interferometers by the mechanical-modulation technique

We discuss the application of digital systems to the automatic control of dual-wave optical interferometers. We show that, if the mechanical-modulation technique is used for error-signal extraction, digital techniques can be used both for error-signal extraction and for control-signal generation. Therefore, apart from two front/end amplifiers that are necessary to match the dynamics of the detectors and actuators to the dynamics of the analog-to-digital converters and digital-to-analog converters, no other analog devices are required. In particular, the mechanical-modulation technique requires the synchronous demodulation of the photodiode output signal. Hence we need to implement a digital lock-in amplifier whose algorithm is described here. Finally, we describe one of the possible applications of this digital control procedure, such as the control of a classic Mach-Zehnder interferometer in air.

[Antibiotic sensitivity of bacterial strains isolated in the course of lower urinary tract infections. Comparison between two case series in different years]

Antibiotic susceptibility on 803 strains isolated from urine in 1990 and on 500 strains isolated in 1978 have been tested. The comparison between the results on strains of the two periods confirm the utility of urine culture for cost effective treatments.

Infections by ampicillin-resistant enterococci: a case-control study

We identified 17 (20%) of 83 consecutive enterococcal isolates from hospitalized patients with documented infection as high-level ampicillin-resistant enterococci (ARE). Of these, 16 isolates were identified as Enterococcus faecium and 1 isolate as Enterococcus raffinosus. A case-control study found no significant differences with respect to underlying diseases, central venous catheterization, nosocomial acquisition of the infection and sites of infection. Patients with ARE infection were older and had a higher inhospital fatality rate than those with ampicillin-susceptible Enterococcus (ASE) infection. Hospitalization in a surgery service (usually for an abdominal procedure), prolonged hospital stay, prior treatment with antibiotics (in particular imipenem and metronidazole), were also more frequent among patients with ARE infection. ARE isolates were more frequently resistant to imipenem, ciprofloxacin and streptomycin than ASE isolates.

Fringe-counting technique used to lock a suspended interferometer

We implement a digital fringe-counting technique to measure in real time the relative mirror displacement of a suspended Michelson interferometer with modulated optical path length for oscillations much larger than the laser wavelength (λ). This provides the proper error signal for a servo mechanism that reduces the relative displacement within λ/2. The implemented technique does not require extra optics or polarizers and thus can be used for interferometric gravitational wave detectors as a starting procedure to get the system locked.

[Anaerobic bacteria and gynecologic infections]

The normal vaginal flora consists of a wide variety of bacteria and the composition of this microflora is influenced by hormonal, metabolic and pharmacological factors. An increased concentration of a mixed anaerobic flora (Mobiluncus, Prevotellae, Peptostreptococci and Gardnerella vaginalis) appears to be an early stage in the development of bacterial vaginosis or in the infection of the upper genital tract. Women with bacterial vaginosis are at increased risk of bartholinitis, skenitis, pelvic inflammatory disease, postpartum and postabortal endometritis, chorioamnionitis and infections following gynecologic surgery or diagnostic procedure.

High-level aminoglycoside resistance among enterococci: evaluation of an agar screen susceptibility test

Seventy-five enterococci from infected (63 isolates) and colonized (12 isolates) patients hospitalized in various divisions of the Policlinico Umberto I, University of Rome, were in vitro studied for high-level resistance (HLR) to gentamicin (HLRG) and streptomycin (HLRS) with adoption of a standard broth dilution and an agar screen test. The employed procedures provided equal results for 100% of the 75 isolates. Of these, 21 (28%) showed HLRG and 43 (57%) HLRS. Combined HLRG and HLRS were found in 18 (24%) isolates, whereas HLRS or HLRG alone were found in 25 (33%) and 3 (4%) isolates respectively. It is concluded that HLR to aminoglycosides may represent a major problem in Italian institutions. Along with other established procedures, the agar screen test employed in the study may be used to detect this antibiotic resistance in enterococci.

[A clinico-epidemiological study on the efficacy of thymopentin therapy in patients with chronic bronchitis and cellular immunity deficiency]

The immunological in vivo effects of thymopentin (TP5) treatment in eleven hypo-anergic patients affected with chronic bronchitis are reported. Significant improvement of cellular immunity, evaluated by skin tests, and an increase of percentage of CD4+ cells and natural killer activity are demonstrated. The clinical evaluation showed an evident reduction of infectious episodes of acute bronchitis after TP5 treatment.

Anaerobic bacteria and bacterial infections: perspectives on treatment and resistance in Italy

Results of laboratory tests of 2,000 samples obtained from 1984 to 1987 from patients with suspected anaerobic infections and the clinical experience of these patients are reported. Of these samples, 395 were positive for anaerobes; 36.5% of these 395 samples contained single organisms, and 63.5% contained a mixture of anaerobes and aerobes. Abdominal infections were the infections most frequently caused by anaerobes. The Bacteroides fragilis group and strains of Peptostreptococcus were the microorganisms most frequently isolated. In addition, 300 anaerobes isolated from clinical samples at three Italian hospitals were tested for susceptibility to 10 antibiotics (aztreonam, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, clindamycin, imipenem, metronidazole, penicillin, and piperacillin). Imipenem and metronidazole proved to be the most active agents, with low and similar values for the 50% and 90% minimal inhibitory concentrations (MICs). No microorganism showed resistance to these agents. After imipenem and metronidazole, clindamycin was the most effective agent tested. All other antibiotics tested showed elevated MICs against Bacteroides species and Clostridium difficile. In Italy, cefoxitin still maintains satisfactory activity against the majority of anaerobes tested.

[Recurrent vaginitis]

Vaginitis is one of the most frequent infections of the female genital system and, in the United States, represents the main reason for gynecological consultation. Candida albicans, Trichomonas vaginalis and Gardnerella vaginalis are responsible for 90% of cases of vaginal phlogosis. It has been calculated that a percentage varying between 5% and 40% of the female population will suffer, at least once in their lifetime, from an episode of vaginal candidosis. The re-appearance of symptoms after suspension of the antimycotic therapy still represents an unsolved and obscure problem from the etiopathogenetic point of view. The incidence of recurrences in women suffering from various forms of vaginal candidosis, according to the Authors, is between 5% and 25%. Considering the uncertainties existing regarding the clinical and etiopathogenetic definition of recurrent vaginitis we carried out a perspective study, at the General Out-patient Department of the II Obstetrical and Gynecological Clinic of "La Sapienza" Rome University in collaboration with the Bacteriological Laboratory of the III Medical Clinic of "La Sapienza" Rome University, on a group of 60 women suffering from recurrent vaginitis. We included in the study in the period 1 October 1987 - 30 September 1988 60 women reporting to the General Out-Patient Department of the II Obstetrical and Gynecological Clinic of the "La Sapienza" Rome University. These patients complained about the appearance of a leukorrhea or a leukoxanthorrhea in combination with at least one of the following symptoms: burning sensation; itch; dyspareunia; dysuria; recurring cystitis. All the women reported in their case histories having suffered from at least three episodes of recurrent vaginal candidosis in the previous twelve months. Diagnosis had been established on the basis of fresh microscopic examination with determination of the vaginal pH on the occasion of the first episode only; whereas clinical examination only was undertaken on the occasion of the subsequent ones. In 30% of patients (or 18 cases) the diagnosis of the subsequent episodes was "telephonic". In all cases, at each episode, a local therapy with antimycotic drugs had been prescribed. Following the introduction of a sterile speculum sterile swabs were used to remove 2 samples of the fluid present at the level of the posterior vaginal fornix. The first swab was placed in a test-tube containing 2 ml of prereduced transport broth (brain-heart infusion broth oxoid) for the successive aerobe and anaerobe cultures.(ABSTRACT TRUNCATED AT 400 WORDS)

Isolation of Clostridium difficile from human jejunum: identification of a reservoir for disease?

The possibility that the small intestine may represent a reservoir for Clostridium difficile was studied, using segments of human jejunum collected at necropsy. Our results (three of 100 specimens positive for C difficile culture) support the hypothesis that C difficile can be found in human jejunum and that it adheres to the normal mucosa as a resident bacterium. These findings suggest that gastrointestinal disease caused by C difficile has an endogenous origin.