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Fatal Inflammatory Condition in a Patient with a Variant Bacterial Strain
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What is the problem and what is known about it so far?
Pseudomembranous colitis is an uncommon but serious inflammation of the colon that can cause diarrhea, dehydration, and even death. It occurs in some people who have been given antibiotics. These drugs destroy harmless bacteria already in the colon that prevent the growth of disease-causing organisms. Subsequent growth of a particular organism, Clostridium difficile, can cause pseudomembranous colitis. This organism produces A and B toxins that can be measured in stool samples. Doctors usually use stool tests that measure toxin A to diagnose colitis rather than stool cultures because cultures often test positive for this organism in people without colitis. Whether the stool tests that are commonly used to detect clostridium toxins miss important strains (types) of clostridium is not well known.
Why did the researchers do this particular study?
To describe routinely available tests for Clostridium difficile toxins and the type of clostridium toxin that was missed in a patient with fatal pseudomembranous colitis.
Who was studied?
One 86-year-old man who died of pseudomembranous colitis after taking antibiotics for pneumonia. The man had had negative results on repeated stool tests for toxin A.
How was the study done?
The researchers used molecular techniques to analyze the clostridium recovered from the man's stool specimens. They also asked staff members at 67 laboratories in the Chicago area to describe the tests used at their laboratories to detect this organism.
What did the researchers find?
Analysis of stool specimens showed a variant strain of Clostridium difficile that did not produce toxin A. Nearly half of the regional laboratories surveyed were using only stool tests for toxin A to detect this organism.
What were the limitations of the study?
The findings relate to a single patient. The study did not determine whether pseudomembranous colitis is frequently caused by variant strains of this clostridium that are not detected with commonly used laboratory tests.
What are the implications of the study?
Variant strains of Clostridium difficile that are not detected with common stool tests for toxin A can cause pseudomembranous colitis.
Article and Author Information
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The summary below is from the full report titled “Fatal Pseudomembranous Colitis Associated with a Variant Clostridium difficile Strain Not Detected by Toxin A Immunoassay.” It is in the 18 September 2001 issue of Annals of Internal Medicine (volume 135, pages 434-438). The authors are S Johnson, SA Kent, KJ O'Leary, MM Merrigan, SP Sambol, LR Peterson, and DN Gerding.
- Copyright ©2004 by the American College of Physicians
