Abstract
Clostridium difficile made its first appearance in the literature when Hall and O’Toole (1935) described Bacillus dificilis as part of the bacterial flora of the meconium and faeces of infants. Although they postulated that toxins from certain strains, when liberated in the infant gut, might play a role in conditions such as the formation of occult blood and febrile convulsions of the newborn. it was not until 1969 that the first real clue to the pathogenic potential of this organism to mammals in the absence of competing colonic microbiota was provided. In experiments on germ-free rats, it was noted that mono-contamination with C. difficile often led to development of transient diarrhoea, which occasionally caused death (Hnmmarstrom et al. 1969). The significance of this finding remained unappreciated until the mid 1970s.
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References
Al Saif N, Brazier is (1996) The distribution of Clostridium difficile in the environment of South Wales..1 Med Microbiol 45: 133 137
Alonso R, Munoz C, Pelaez T, Cercenado E, Rodriquez-Creixems M, Bouza E (1997) Rapid detection of toxigenic Clostridium difficile strains by a nested PCR of the toxin B gene. Clin Microbiol Infect 3: 145 147
Anonymous (1998) Clostridium difficile in England and Wales. Communicable Disease Report. 9, 7, 12 February 1999
Aronsson B, Molby R. Nord CE (1985) Antimicrobial agents and Clostridium difficile in acute enteric disease: epidemiological data from Sweden, 1980–1982. J Infect Dis 151: 476–481
Arrow SA, C’roese L, Bowman RA, Riley TV (1994) Evaluation of three commercial enzyme immunoassay kits for detecting faecal Clostridium difficile toxins. J Clin Pathol 47: 954 956
Arzese A, Tram G. Riul L, Botta GA (1995) Rapid polymerase chain reaction method for specific detection of toxigenic Clostridium difficile. Eur J Clin Microbiol Infect Dis 14: 716–719
Aspinall ST, Hutchinson DN (1992) New selective medium for isolating Clostridium difficile from faeces. Clin Pathol 45: 812–814
Barbut F, Mario N, Meyohas MC, Binet D, Frottier J, Petit JC (1993) Investigation of a nosocomial outbreak of Clostridium difficile - associated diarrhoea among AIDS patient; by random to iplified polymorphic DNA ( RAPD) assay. J Hosp Infect 26: 181–189
Barhut F, Corthier G, (’harpak Y, Cerf M. Monteil H, Fosse T (1996) Prevalence and pathogenicity of Clostridium difficile in hospitalized patients. Arch Intern Med 156: 1449 1454
Bartlett JG, Onderdonk AB, Cisneros RL, Kasper DL (1977) Clindamycin associated colitis due to a toxin-producing species of Clostridium in hamsters. J Infect Dis 136:70I 71)5
Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB (1978) Antibiotic associated pseudomembranous colitis duc to toxin producing clostridia. N Engl J Med 298: 531 534
Bartlett JO (1988) Introduction. In: Rolfe RD, Finegold SM (eds) Clostridium (Wile: its role in intes-tinal disease. San Diego Academic Press, San Diego
Bartlett JG (1997) Clostridium difficile infection: pathophysiology and diagnosis. Semis Gastrointest Dis 8:12–21
Bartley SL, Dowell VR Jr (1991) Comparison of media for the isolation of Clostridium difficile, from faecal specimens. Lab Med 22: 335 338
Bentley AH, Patel NB, Sidorczuk M, Loy P, Fulcher J, Dexter P, Richards J (1998) Fur J (din Microhiol Infect Dis 17: 788 790
Berry AP, Lovett PN (1986) Chronic diarrhoea in dogs associated with Clostridium difficile infection. Vet Rec 118: 102–103
Blawat F, Chylinski (i (1958) Pathogenic clostridia in soil and faeces of domestic animals in the Gdansk region. Bull lust Marine Med (Gdansk) 9: 117–126
Bolton RP, Tait SK, Dear PRF, Lowsowsky MS (1984) Asymptomatic neonatal colonisation by Clostridium difficile. Arch Dis Child 59: 466 472
Boondeekhun HS, Gurtler V, Odd ML, Wilson VA, MayaIl BC (1993) Detection of Clostridium difficile enterotoxin gene in clinical specimens by the polymerase chain reaction. J Med Microhiol 38: 384–387
Borriello SP, Honour P (1981) Simplified procedure for routine isolation of Clostridium difficile from faeces.J Clin Pathol 34: 1124–1127
Borriello SP, Honour P, Turner T, Barclay F (1983) Household pets as a potential reservoir for Clostridium difficile. J Clin Pathol 36: 84–87
Borriello SP, Kelley.IM, Mitchell TJ, Barclay FE, Welch AR. Price AB (1987) Clostridium difficile a spectrum of virulence and analysis of putative virulence determinants in the hamster model of antibiotic-associated colitis. J Med Microhiol 24: 53–64
Borriello SP, Larson HE, Welch AR, Barclay F, Stringer MF, Bartholomew BA (1984) Enterotoxigenic Clostridium perfringens a possible cause of antibiotic associated diarrhoea. Lancet 1: 305 307
Borriello SP, Vale T, Brazier JS, Hyde S, Chippeck F, (1992) Evaluation of a commercial enzyme im-munoassay kit for the detection of Clostridium c/ifficile toxin A. L(ur J Clin Microhiol Infect Dis 11: 360–363
Bowman RA, Riley TV (1986) Isolation of Clostridium difficile from stored specimens and comparative susceptibility of various tissue culture cell lines to cytotoxin. FEMS Microbiol l,ett 34: 31 35
Bowman RA, Riley TV (1988) Laboratory diagnosis of Clostridium difficile associated diarrhoea. Fur.1 Clin Microbiol Infect Dis 7: 476 484
Bowman RA, O’Neill GL, Riley TV (1991) Non-radioactive restriction fragment length polymorphism (RELP) typing of Clostridium dfilieilc. I’EMS Microbiol Lett 63: 269–272
Brazier JS (1990) Cross reactivity of Clostridium glycolicum with the latex particle agglutination reagent for C. (Wile identification. In: Borriello SP (ed) Clinical and molecular aspects of anaerobes. Wrightson Biomedical Publishing, Peterslield, pp 293 296
Brazier JS (1993) Role of the laboratory in investigations of Clostridium difficile diarrhea. Clin infect Dis 16 [Suppl 4): S228–233
Brazier JS, Delmee M, Tabagchali S, Hill LR, Mulligan ME, Riley TV (1994) Proposed unified nomenclature for Clostridium difficile typing. Lancet 343: 157
Brazier JS, Mulligan ME, Delmee M, Tabagchali S (1997) Preliminary findings of the international typing study on Clostridium difficile. Clin Infect Dis 25[Suppl 21: S199–201
Brazier JS, O’Neill GL, Duerden BI (1997a) Polymerase chain reaction rihotypes of Clostridium difficile in hospitals in England and Wales. Reviews in Medical Microbiology 8[Suppl I I: S55 56
Brazier JS, Stubbs SLJ, Duerden BI (1999) Prevalence of toxin A negative/toxin B positive Clostridium difficile strains. J I losp infect 42: 248 249
Brooks JB, Nunez-Monteil OL, Basta MT, Hierholzer JC (1984) Studies of stools from pseudomembranous colitis rotaviral and other diarrhoea! syndromes by frequency-pulsed electron capture liquid chromatography. J Clin Microhiol 20: 549 560
Buchanan AG (1984) Selective enrichment broth culture for detection of Clostridium difficile and associated cytotoxin. J Clin Microbiol 20: 74–76
Buggy BP, Wilson KH, Fekety R (1983) Comparison of methods for recovery of Clostridium difficile from an environmental source. J Clin Microbiol 18: 348–352
Burdon DW (1982) Clostridium difficile: the epidemiology and prevention of hospital-acquired infection. Infection 10:203204
Byl B, Jacobs F, Strulens MJ, Thys JP (1996) Extraintestinal Clostridium difficile infections. Clin Infect Dis 22: 712
Carroll SM, Bowman RA, Riley TV (1983) A selective broth for lostridium difficile. Pathology 15:165 167 Cartmill TDI, Orr K, Freeman R, Sisson PR, Lightfoot NF (1992) Nosocomial infection with Clostridium difficile investigated by pyrolysis mass spectrometry. J Med Microbiol 37: 352–356
Cartmill TDI, Panigrahi H, Worsley MA, McCann DC, Nice CN, Keith E (1994) Management and control of a large outbreak of diarrhoea due to Clostridium difficile. J Hosp Infect 27: 1–15
Cartwright CP, Stock F, Beckmann SE, Williams EC, Gill VJ (1995) PCR amplification of rRNA intergenic spacer regions as a method for epidemiologic typing of Clostridium dificile J Clin Microbiol 33: 184–187
Chachaty EP, Sauliner P, Martin A, Mario N, Andremont A (1994) Comparison of ribotyping, pulsed-field gel electrophoresis and random amplified polymorphic DNA for typing Clostridium difficile strains. FEMS Microbiol Lett 122: 61–68
Chang TW, Lauermann M, Bartlett JG (1979) Cytotoxic assay in antibiotic-associated colitis. J Infect Dis 140: 765–770
Clabots CR, Peterson LR, Gerding DN (1988) Characterization of a noscomial Clostridium difficile outbreak by using plasmid profile typing and clindamycin susceptibility testing. J Infect Dis 158: 731–736
Clabots CR, Bettin KM, Peterson LR, Gerding DN (1991) Evaluation of cycloserine-cefoxitin fructose agar and cycloserine-cefoxitin fructose broth for recovery of Clostridium difficile from environmental sites. J Clin Microbiol 29: 2633–2635
Collier MC, Stock F, De Girolami PC, Samore MH, Cartwright CP (1996) Comparison of PCR-based approaches to molecular analysis of Clostridium difficile. J Clin Microbiol 34: 1153–1157
Costas M, Holmes B, Gunner M, On SL, Hoffman PN, Worsley MA (1994) Identification of outbreak-associated and other strains of Clostridium difficile by numerical analysis of SDS-PAGE protein patterns. Epidemiol Infect 113: 1–12
Dansinger ML, Johnson S, Jansen PC, Opstad NL, Bettin KM, Gerding DN (1996) Protein-losing enteropathy is associated with Clostridium difficile diarrhea but not with asymptomatic colonization: a prospective, case-control study. Clin Infect Dis 22: 932–937
De Girolami PC, Hanff PA, Eichelberger K, Longhi L, Teresa H, Pratt J (1992) Multicenter evaluation of a new enzyme immunoassay for detection of Clostridium dfficile enterotoxin A. J Clin Microbiol 30: 1085–1088
Delmee M, Homel M, Wauters G (1985) Serogrouping of Clostridium difficile strains by slide agglutination. J Clin Microbiol 21: 323–327
Delmee M, Avesani V (1990) Virulence of ten serogroups of Clostridium difficile in hamsters. J Med Microhiol 33: 85–90
Delmee M, Mackey T, Hamitou A (1992) Evaluation of a new commercial Clostridium difficile toxin A enzyme immunoassay using diarrhoeal stools. Eur J Clin Microbiol Infect Dis 11: 246–249
Department of Health and Public Health Laboratory Service Joint Working Group (1994) Clostridium difficile infection. Prevention and Management. BAPS Health Publication Unit, Heywood Lancashire
Depitre C, Delmee M, Avesani V, L’Haridon R, Roels A, Popoff M, Corthier G (1993) Serogroup F strains of Clostridium difficile produce toxin B but not toxin A. J Med Microhiol 38: 434–441
Devlin HR, Au W, Foux L, Bradbury WC (1987) Restriction endonuclease analysis of nosocomial isolates of Clostridium difficile. J Clin Microbiol 25: 2168–2172
Donta ST, Myers MG (1982) Clostridium dificile toxin in asymptomatic neonates. J Pediatr 100: 431–434
El Mohandes AE, Keiser JE, Refat M, Jackson BJ (1993) Prevalence and toxigenicity of Clostridium difficile isolates in fecal microflora of preterm infants in the intensive care nursery. Biol Neonate 63: 225 229
Elsden SR, Hilton MG, Waller JM (1976) The end products of the metabolism of aromatic amino acids by clostridia. Arch Microbiol 107: 283–288
Fedorko DP, Williams EC (1997) Use of cycloserine-cefoxitin fructose agar and L-proline amino-peptidase (PRO Discs) in the rapid identification of Clostridium difficile. J Clin Microbiol 35: 12581259
Feldman R.I, Kallich M, Wienstein MI’ (1995) Bacteremia due to Clostridium dfficde: case report and review of extraintestinal C. difficile infections. (’lin Infect Dis 20: 1560 1562
Forward KR, Dalton MT, Kerr E, Paisley N, Cooper (i (1994) Comparison of Tech Lab Closiriditau difficile Tux-A enzyme immunoassay and Bartels Prima system toxin A I{IA. Diagn Microbiol Infect Dis 20: I- 5
Frazier KS, Herron AJ, Hines ME, Gaskin.IM, Altman NH (1993) Diagnosis of enteritis and entcrotoxemia due to (Iosnidium difficile in captive ostriches (SIrathin camclus). J Vet Diagn Inyesl 5: 623 625
George WL, Sutter VL, Goldstein EJC, Ludwig SL, Finegold SM (1978) Etiology of antimicrobial agent associated colitis. Lancet 1: 802 803
George WL, Sutter VL, (Citron D, Finegold SM (1979) Sclectivcand differential medium for isolation of Clostridium c/ìffici/c. J Clin Microbiol 19: 214–219
Gerding DN, Brazier JS (1993) Optimal methods for identifying Clostridium difficile infections. Clin Infect Dis 16lSuppl 4]: S439–442
Green GA, Riot B, Monied II (1994) Evaluation of an oligonucleotide probe and an immunological test for direct detection of toxigenic Clostridium difficile in stool samples. Eta J (`lin Microbiol Infect Dis 13: 576–581
Green RH (1974) The association of viral activation with penicillin toxicity in guinea pigs and hamsters. Yale J Biol Med 3: 166–181
Gumerlock PH, Tang YJ, Meyers FJ, Silva J Jr (1991) Use of the polymerise chain reaction for the specific and direct detection of Clostridium difficile in human feces. Rev Infect Dis 13: 1053 1060
Gutnerlock PH, Tang YJ, Weiss JB, Silva J Jr (1993) Specific detection of toxigenic strains of Clostridium difficile in stool specimens. J Clin Microbiol 31: 507–511
Giurtler V (1993) Typing of Clostridium difficile strains by PC’R Ctmplilication of variable length 16S–23S rDNA spacer regions. J Gen Microbiol 139: 3089 3097
Hafiz S (1974) Closvridium difficile and its toxins. (Thesis, POD) Department of Microbiology, Unisersity of Leeds
Hafiz S, McEntegart MG, Morton RS, Waitkins SA (1975) Clostridium difficile in the urogenital tract of males and females. Lancet 1: 420–421
Hafiz S, Oakley CI. (1976) Clostridium difficile isolation and charactertstics..l Med Microbiol 9:129 136
Hall IC, O’Toole E (1935) Intestinal flora in newborn infants with a description of a new pathogenic anaerobe, Bacillus dia fieilis. Am J Dis Child 49: 390 402
Hammarstrom S, Perlmann P, (ìusta sson BE, Lagercrantz R (1969) Autoantihodies to colon in germftee rats monocontaminaled with Clostridium difficile J Exp Mcd 129: 747 756
Hceard SR, Rasburn B, Matthews RC’, Tabagchali S (1986) Immunoblotling to demonstrate antigenic and immunogenic differences among nine standard strains of Clostridium difficile. J (’lin Microbiol 24: 384–387)
Hirschorn LR, Trnka Y, Onderdonk AB, Lee ML, Platt R (1994) Epidemiology of community-acquired Clostridium difficile-associated diarrhea. J Infect Dis 169: 127 133
Holst E, Helin 1, Mardh PA (1981) Recovery of Clostridium difficile from children. Scandinavian.1 Infect Dis 13:41 45:
Infection with Clostridium difficile investigated by pyrolysis mass spectrometry. J Med Microbiol 37:352356; Investigation of a nosocomial outbreak of Clostridium difficile by pyrolysis mass spectrometry. J Med Microbiol 39:345–351
Jacobs J, Rudensky B, Dresner J, Berman A, Sonneblick M, van Dijk Y, Yinnon AM (1996) Comparison of tour laboratory tests for diagnosis of Clostridium difficile-associated diarrhea. Fur J Clin Microbiol Infect Dis 15: 561–566
Johnson S, Clahots CR, Linn FV, Olson MM, Peterson I R, Gerding ON (1990) Nosocomial Clostridium difficile colonisation and disease. Lancet 336: 97–100
Kato N, Ou CY, Kato II (1991) Identification of toxigenic Clostridium difficile by the polymerise chain reaction. J Clin Microbiol 29: 33 37
Kato N, Ou C’Y, Kato II (1993) Detection of toxigenic Clostridium difficile in stool specimens by the polymerise chain reaction. J Infect Dis 167: 455–458
Kato II, Kato N, Watanabe K. Ueno K, Sakata Y, Fujita K (1996) Relapses, or refnfections: analysis of u case of Clostridium difficile associated colitis by two typing systems. Curr Microbiol 33:220 223
Kato H, Kato N. Fukui K, O’Hara A, Watanabe K (1997) IJigh prevalence of toxin A-negativetoxin-13 positive Clostridium difficile strains among adult inpatients. (’lin Microbiol Infect 3iSuppl 2]:S22O
Katz DA, Bates DW, Rittenberg E, Ondcrdonk A, Sands K, Barefoot LA, Snydmau I (1997) Predicting Clo.stridhmi difficile stool cytotoxin results in hospitalized patients with diarrhea..1 Gen Intern Med 12: 57–62
Kauffman L. Weaver RH (1960) Use of neutral red fluorescence for the identification of colonies of clostridia. J Bacteriol 79: 292–294
Killgore GE, Kato H (1994) Use of arbitrary primer PCR to type Clostridium difficile and comparison of results with those by immunoblot typing. J Clin Microbiol 32: 1591 - I593
Kim KH, Fekety R, Batts DH, Brown D, Cudmore M, Silva J Jr (1981) Isolation of Clostridium difficile from the environment of contacts of patients with antibiotic-associated colitis. J Infect Dis 143: 42–50
Knapp CC, Sandie RL, Hall GS, Ludwig M D, Rutherford I, Washington JA (1993) Comparison of vidas Clostridium (Wile toxin-A assay and premier C. difficile toxin-A assay to cytotoxin-B tissue culture assay for the detection of toxins of C. difficile. Diagn Microbiol Infect Dis I7: 7–12
Kuijper EJ, Oudbier JH, Stuifbergen WNHM, Jansz A, Zanen HC (1987) Application of whole-cell DNA restriction endonuclease profiles to the epidemiology of Clostridium difficile induced diarrhea. J Clin Microbiol 25: 751–753
Larson HE, Parry,IV, Price AB, Davies DR, Dolby J. Tyrell DA (1977) Undescribed toxin in pseudo-membranous colitis. Br Med J 1: 1246 1248
Larson HE, Price AB, Honour P. Borriello SP (1978) Clostridium difficile and the aetiology of pseudo-membranous colitis. Lancet 1: 1063–1065
Larson HE, Barclay FE, Honour P, Hill ID (1982) Epidemiology of Clostridium difficile in infants. J Infect Dis 146: 727–733
Levett PN (1984) Detection of Clostridium diTTiede in faeces by direct gas liquid chromatography. J Clin Pathol 37: 117–119
Levett PN (1985) Effect of antibiotic concentration in a selective medium on the isolation of Clostridium difficile from faecal specimens. J Clin Pathol 38233–234
Lovett PN (1986) Clostridium difficile in habitats other than the human gastro-intestinal tract. J Infect 12253 263
Lyerly DM, Wilkins TD (1986) Commercial latex test for Clostridium difficile toxin A does not detect toxin A. J Clin Microbiol 23: 622–623
Madewell BR, Tang YJ„tang S, Madigan JE, Hirsh DC, Gumerlock PH (1995) Apparent outbreaks of (’/ostridium difficile-associated diarrhea in horses in a veterinary medical teaching hospital. J Vet Diagn Invest 7: 343–346
Magee JT, Brazier JS, Hosein 1K, Ribeiro CD, Hill DW, Griffiths A (1993) An investigation of a nosocomial outbreak of Clostridium difficile by pyrolysis mass spectrometry. J Med Microbiol 39: 345 351
Mahony DE, (’low J, Atkinson L, Vakharia N. Schlech WE (1991) Development and application of a multiple typing system for Clostridium (Wile. Appl Environ Microbiol 57:1873–1879 Malamou-Ladas H, O’Farrell SO, Nash,1Q, Tabagchali S (1983) Isolation of Clostridium difficile from the patients and the environment of hospital wards. J Clin Pathol 36: 88–92
Manabe YC, Vintez.IM, Moore RD, Merz C, Charache P, Bartlett JG (1995) Clostridium difficile colitis: an efficient clinical approach to diagnosis. Ann Intern Med 123: 835–840
Martirosian G, Kuipers S, Verburgh H, van Belkum A, Meisel-Mikolajczyk FM (1995) PCR ribotyping and arbitrarily primed PCR for typing strains of Clostridium difficile from a Polish maternity hospital. J Clin Microbiol 33:2016 2(121
Mattia AR, Doern GV, Clark J. Holden J, Wu L, Ferraro MJ (1993) Comparison of four methods in the diagnosis of Clostridium dif/idle disease. Fur J Clin Microbiol Infect Dis 12: 882–886
McBee RH (1960) Intestinal flora of some antarctic birds and mammals. J Bacteriol 79:31 I-312 McCluskey J. Riley TV, Owen ET, Langlands DR (1982) Reactive arthritis associated with Clostridium difficile. Aust N Z J Med 12: 535–537
McFarland LV, Surawicz CM, Stamm WE (1990) Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalised patients..1 Infect Dis 162: 678–684
McMillin DE, Muldrow LL (1992) Typing of toxic strains of Clostridium difficile using DNA finger-printings generated with arbitrary polymerase chain reaction primers. FEMS Microbiol Lett 92: 5–10
Merz CS, Kramer C. Forman M, Gluck L, Mills K, Senft K (1994) Comparison of four commercially available rapid enzyme immunoassays with cytotoxin assay for detection of Clostridium difficile toxin(s) from stool specimens. J Clin Microbiol 32: 1142 1147
Muldrow LL, Archibold ER, Nunez-Monteil OL, Sheeny 12.1 (1982) Survey of the extrachromosomal gene pool of Clostridium dì//icile..1 Infect Dis 16: 637 640
Mulligan ME, Peterson LR, Kwok RY, Clabots (’R, Gerding DN (1988) Immunohlots and plasmid fingerprints compared with serotyping and polyacrylamide gel electrophoresis for typing Clostridium difficile. J Clin Microbiol 26: 41–46
Nakamura S, Mikawa M, Nakashio S, Takabatake M. Okada I, Yamakawa K (1981) Isolation of Clostridium difficile from feces and the antibody in sera of young and elderly adults. Microbiol Immun 25: 345–351
Nakamuara S, Serikawa T, Mikawa M, Nakashio S, Yamakawa K, Nishida S (1981) Agglutination. toxigenicity and sorbitol fermentation of Clostridium difficile. Microbiol Immunol 25: 863 870
O’Neill GL, Beaman M Riley TV (1991) Relapse versus reinfection with Clostridium difficile. Epidemiol Infect 107: 627–635
O’Neill GL, Adams JE, Bowman RA, Riley TV (1993) A molecular characterisation of Clostridium difficile isolates from humans, animals and their environments. Epidemiol Infect I 11: 257–264
O’Neill GL, Ogunsola FT, Brazier JS, Duerden BI (1996) Modification of a P(’R rihotyping method for application as a routine typing scheme for Clostridium difficile. Anaerobe 2: 205–209
Ogunsola FT, Ryley HC’, Duerden BI (1995) Sodium dodecyl sulfate - polyacrylamide gel electrophoresis anlaysis of EDTA-extracted cell-surface protein antigens is a simple and reproducible method for typing Clostridium difficile. Clin Infect Dis 20[Suppl 21: 5327 330
Peerbooms PGH, Kuijt P, Maclaren DM (1987) Application of chromosomal restriction endonuclease digest analysis for use as a typing method for CIavtrridium di/ici/e. J Clin Pathol 40: 771 776
Pepersack F, Labbe M, Nonhoff C, Schoutens E (1983) Use of gas liquid chromatography as a screening test for toxigenic Clostridium difficile in diarrhoea) stools.. Clin Pathol 36: 1233 1236
Phillips KD, Rogers PA (1981) Rapid detection and presumptive identification of Clostridium difficile by p-cresol production on a selective medium. J Clin Pathol 34: 642–644
Potvliege C, Labre M, Yourassowsky E (1981) Gas liquid chromatography as a screening test for Clostridium difficile. Lancet 1: 1 105
Poxton IR, Byrne MD (1981) Immunochemical analysis of the FDTA-soluble antigens of Clostridium difficile and related species. J Gen Microbiol 122: 41 46
Poxton IR, Aronsson B, Molby R, Nord CE, Collee i(ì (1984) Immunochemical fingerprinting of Clostridium difficile strains isolated from an outbreak of antibiotic-associated colitis and diarrhoea. J Med Microbiol 17: 317–324
Renshaw AA, Stelling JM, Doolittle MH (1996) The lack of value of repeated Clostridium difficile cytotoxicity assays. Arch Pathol Lab Med 120: 49–52
Riley TV, Adams JE, O’Neill GL, Bowman RA (1991) Gastrointestinal carriage of Clostridium difficile in cats and dogs attending veterinary clinics. Epidemiol Infect 107: 659–665
Riley TV, Wetherall F, Bowman J, Mogyorosy I, Golledge CL (1991) Diarrhoea) disease due to Clostridium difficile in general practice. Pathology 23: 346–349
Riley TV (1994) The epidemiology of Clostridium diflicite-associated diarrhoea. Rev Med Microbiol 5: 117–126
Riley TV, Cooper M, Bell B, Golledge CL (1995) Community -acquired Clostridium difficile- associated diarrhea. Clin Infect Dis 20[Suppl 21:5263–265 -
Riley TV, Bowman RA, Golledge CL (1995a) Usefulness of culture in the diagnosis of Clostridium difficile infection. Fur.l Clin Microbiol Infect Dis 14:1109–1111
Ryan RW, Kwasnik I, Tilton RC (1980) Rapid detection of Clostridium difficile toxin in human feces. J Clin Microbiol 12: 776–779
Samore MH, Bertin KM, DeGirolami PC, Clahots (`R.. Gerding DN. Karchmcr AW (1994) Wide diversity of Clostridium difficile types at a tertiary referral hospital..1 Infect Dis 170: 615 621
Samore MII, Vankataraman L, De Girolami PC, Arbeit RD. Karchmer AW (1996) Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridiunm difficile diarrhea. Am J Med 100:32–40
Schue V, Green GA, Monteil 1–1 (1994) Comparison of the Tox-A test with cytotoxicity assay and culture for the detection of Clostridium difficile-associated diarrhoea disease..1 Med Microbiol 41: 316–318
Sell TL, Schaberg DR, Fekety FR (1983) Bacteriophage and hacteriocin typing scheme for Clostridium difficile. J Clin Microbiol 17: 1148 1 152
Shanholtzer CJ, Peterson LR. Olsen MM, Gerding ON (1983) Prospective study of grain stained stool smears in diagnosis of Clostridium difficile colitis..1 Clin Microbiol 17: 906 908
Shanholtzer CI, Willard KE, Holier JJ, Olson MM. Gerding DN, Peterson LR (1992) Comparison of VIDAS Clostridium difficile toxin A immunoassay with C. difficile culture and cytoioxin and latex tests. J Clin Microbiol 30: 1837–1840
Sharabadi MS, Bryan LE, Gaffney D, Coderre SE, Gordon R, Pai CH (1984) Latex agglutination test for detection of Clostridium difficile toxin in stool samples. J Clin Microbiol 20: 339 341
Sheretz RJ, Sarubbi MD (1982) The prevalence of Clostridium difficile and toxin in a nursery population: a comparison between patients with necrotizing enterocolitis and an asymptomatic group. J Pediatr 100: 435–439
Silva J Jr, Yajarayma,IT, Gumerlock PT (1994) Genotyping of Clostridium difficile isolates. J Infect Dis 169: 661–664
Smith LDS, King EO (1962) Occurrence of Clostridium difficile in infections of man. J Bacteriol 84: 65–67
Spencer RC (1998) Clinical impact and associated costs of Clostridium difficile-associated disease. J Antimicrob Chemother 4I [Suppl C]: S5 - I2
Staneck JL, Weckbach LS, Allen SD, Siders JA, Gilligan PH, Coppitt G, Kraft JA, Willism DH (1996) Multicenter evaluation of four methods for Clostridium difficile detection: immunocard C. difficile, cytotoxin assay, culture and latex agglutination. J Clin Microbiol 34: 2718–2721
Stevenson JP (1966) The normal bacterial flora of the alimentary canal of laboratory stocks of the desert locust Schistocerca gregario Forskal. J Invertebr Pathol 8: 205–211
Struble AL, Tang YJ, Kass PH, Gumerlock PH, Madewell BR, Silva J Jr (1994) Fecal shedding of Clostridium diffi’cle in dogs: a period of prevalence survey in a veterinary medical teaching hospital. J Vet Diagn Invest 6: 342–347
Stubbs SLJ, Brazier JS, O’Neill GL, Duerden BI (1999) PCR targeted to the 16S–23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. J Clin Microbiol 37: 461–463
Tabagchali S, Holland D, O’Farrell S, Sihnan R (1984) Typing scheme for Clostridium difficile: its application in clinical and epidemiological studies. Lancet 1: 935–938
Talon D, Bailly P, Delmee M, Thouverez M, Mulin B, Iehl-Robert M (1995) Use of pulsed-field gel electrophoresis for investigation of an outbreak of Clostridium difficile infection among geriatric patients. Eur J Microbiol Infect Dis 14: 987–993
Tedesco FJ, Barton RW, Alpers DH (1974) Clindamycin-associated colitis. Ann Intern Med 81:429–433 Thelestam M, Bronnegard M (1980) Interaction of cytopathogenic toxin from Clostridium difficile with the cells in tissue culture. Scand J Infect Dis Suppl 22: 16–29
van Dijck P, Avesani V, Delmee M (1996) Genotyping of outbreak-related and sporadic isolates of Clostridium difficile belonging to serogroup C. J Clin Microbiol 34: 3049–3055
West S, Wilkins TD (1982) Problems associated with counterimmunoelectrophoresis assays for detecting Clostridium difficile toxin. J Clin Microbiol 15: 347–349
Whittier S, Shapiro DS, Kelly WF, Walden TP, Wait KJ, McMillon LT (1993) Evaluation of four commercially available enzyme immunoassays for laboratory diagnosis of Clostridium difficile-assoelated diseases. J Clin Microbiol 31: 2861–2865
Wilcox MH, Smyth ETM (1998) UK survey of the incidence and impact of Clostridium difficile infection 1993–1996 (abstract). In: Programme of the Third Federation of Infection Societies Conference, Manchester, p 20
Wilks M, Tabagchali S (1994) Typing of Clostridium difficile by polymerase chain reaction with an arbitrary primer. J Hosp Infect 28: 231–234
Willey SH, Bartlett JG (1979) Cultures for Clostridium difficile in stools containing a cytotoxin neutralised by Clostridium.cordellii antitoxin. J Clin Microbiol 10: 880–884
Wilson KH, Silva J, Fekety FR (1982) Fluorescent-antibody test for detection of Clostridium difficile in stool specimens. J Clin Microbiol 16: 464–468
Wolfhagen MJHM, Fluit AC, Jansze M, Rademaker CMA, Verhoef J (1993) Detection of toxigenic Clostridium difficile in fecal samples by colony blot hybridization. Eur J Clin Microbiol Infect Dis 12: 463–466
Wolfhagen MJ, Fluit AC, Torensma R, Poppelier MJ, Verhoef J (1994) Rapid detection of toxigenic Clostridium difficile in fecal samples by magnetic PCR assay. J Clin Microbiol 32: 1629–1633
Wren BW, Tabagchali S (1987) Restriction endonuclease DNA analysis of Clostridium difficile. J Clin Microbiol 25: 2402–2404
Wren BW, Clayton CL, Tabagchali S (1990) Rapid identification of toxigenic Clostridium difficile by polymerase chain reaction. Lancet 335: 423
Wust J, Sullivan NM, Hardegger U, Wilkins TD (1982) Investigation of an outbreak of antibiotic-associated colitis by various typing methods. J Clin Microbiol 16: 1096–1101
Yolken RH, Whitcomb ES, Marien G (1981) Enzyme immunoassay for the detection of Clostridium difficile antigen. J Infect Dis 144: 378
Yong WH, Mattia AR, Ferarro MJ (1994) Comparison of fecal lactoferrin latex agglutination assay and methylene blue microscopy for detection of fecal leukocytes in Clostridium difficile associated disease. J Clin Microbiol 32: 1360–1361
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Brazier, J.S., Borriello, S.P. (2000). Microbiology, Epidemiology and Diagnosis of Clostridium difficile Infection. In: Aktories, K., Wilkins, T.D. (eds) Clostridium difficile. Current Topics in Microbiology and Immunology, vol 250. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-06272-2_1
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