title: Clostridium difficile infection in patients with haematological malignant disease. Risk factors, faecal toxins and pathogenic strains.
abstract: Two hundred and forty-eight patients from shared oncology and general medical wards were prospectively studied over a 6-month period for carriage of Clostridium difficile during an outbreak of clinical disease with an epidemic strain of the organism. Risk factors for infection were assessed. Acute leukaemia and/or its treatment were identified as significantly increasing the risk of infection. The relationship between the type of C. difficile isolated (as defined by a typing system based on the incorporation of [35S]methionine into bacterial proteins followed by gel electrophoresis), the presence of faecal toxins A and B and clinical symptoms were analysed. Carriage of the epidemic strain, type X, had a significant association with symptoms amongst oncology patients, with two thirds of these patients having detectable faecal toxin A and one third detectable faecal toxin B. During an outbreak of C. difficile-associated disease, typing the organism and assaying for both faecal toxins in symptomatic patients may be of benefit in determining which patients require specific, urgent treatment.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000032:analysis; D003013:Clostridium / Q000145:classification / Q000302:isolation & purification; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology* / Q000382:microbiology; D004768:Enterotoxins; D005243:Feces / Q000032:analysis / Q000382:microbiology; D005260:Female; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D007938:Leukemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile