title: Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin.
abstract: We tested the hypothesis that children with chronic relapsing colitis induced by Clostridium difficile toxin have defective antibody responses to C. difficile toxins as a cause of their underlying illness. Six such children were tested for serum IgG and IgA antibody to C. difficile toxin A. These six children had lower IgG anti-toxin A levels than 24 healthy children (p = 0.026) and 18 healthy adults (p = 0.0008). Five patients treated with 400 mg intravenously administered gamma-globulin per kilogram every 3 weeks had significant increases in IgG (p = 0.01) but not IgA anti-toxin A (p = 0.406) levels, and all five had clinical resolution of their gastrointestinal symptoms as well as clearing of C. difficile cytotoxin B from their stools. These observations suggest that a deficiency of IgG anti-toxin A may predispose children to the development of chronic relapsing C. difficile-induced colitis. In such cases, intravenous gamma-globulin therapy may be effective in producing clinical remission.
authors.affiliation: Division of Pediatric Allergy-Immunology, National Jewish Center for Immunology and Respiratory Medicine, Denver, Colorado 80206.
authors.forename: D Y
authors.initials: DY
authors.lastname: Leung
authors.forename: C P
authors.initials: CP
authors.lastname: Kelly
authors.forename: M
authors.initials: M
authors.lastname: Boguniewicz
authors.forename: C
authors.initials: C
authors.lastname: Pothoulakis
authors.forename: J T
authors.initials: JT
authors.lastname: LaMont
authors.forename: A
authors.initials: A
authors.lastname: Flores
mesh_terms: D000907:Antibodies, Bacterial / Q000032:analysis; D001427:Bacterial Toxins; D002675:Child, Preschool; D002908:Chronic Disease; D016360:Clostridioides difficile / Q000276:immunology; D004761:Enterocolitis, Pseudomembranous / Q000276:immunology / Q000628:therapy*; D004768:Enterotoxins / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000627:therapeutic use; D007136:Immunoglobulins / Q000032:analysis; D016756:Immunoglobulins, Intravenous; D007223:Infant; D012008:Recurrence
chemical_list: D000907:Antibodies, Bacterial; D001427:Bacterial Toxins; D004768:Enterotoxins; D007074:Immunoglobulin G; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C041348:tcdA protein, Clostridium difficile