PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of iaiPermissionsJournals.ASM.orgJournalIAI ArticleJournal InfoAuthorsReviewers
 
Infect Immun. 1994 February; 62(2): 384–389.
PMCID: PMC186119

Human antibody response to Clostridium difficile toxin A in relation to clinical course of infection.

Abstract

This study investigated whether differences in fecal and serum antitoxin A antibody levels may account for the duration of Clostridium difficile-associated diarrhea (CDAD) and the occurrence of relapses. By an enzyme linked-immunosorbent assay, we tested 40 patients with CDAD including 25 patients without immunodeficiency and 15 patients receiving antineoplastic drugs. Two hundred eighty serum samples and 80 normal stool samples were investigated as controls. In nonimmunocompromised patients, serum immunoglobulin (IgG) and fecal IgA antitoxin A antibody titers were significantly higher in patients who suffered a single episode (n = 21) than in those with relapsing CDAD (n = 4) whose titers were at control levels. Of these 25 patients, eight suffered from diarrhea which lasted for more than 2 weeks. These patients had significantly lower serum- and feces-specific antibody levels than the others who presented symptoms of shorter duration. In cytostatic-treated patients, antitoxin A antibody levels were similar to controls, but relapses occurred in a single case. These data suggest an association between a defective humoral response to toxin A and a more severe form of C. difficile infection. They also indicate that other host-related factors control the severity of CDAD and remain to be elucidated.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Aronsson B, Möllby R, Nord CE. Antimicrobial agents and Clostridium difficile in acute enteric disease: epidemiological data from Sweden, 1980-1982. J Infect Dis. 1985 Mar;151(3):476–481. [PubMed]
  • Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med. 1978 Mar 9;298(10):531–534. [PubMed]
  • Colombel JF, Rambaud JC, Vaerman JP, Galian A, Delacroix DL, Nemeth J, Duprey F, Halphen M, Godeau P, Dive C. Massive plasma cell infiltration of the digestive tract. Secretory component as the rate-limiting factor of immunoglobulin secretion in external fluids. Gastroenterology. 1988 Oct;95(4):1106–1113. [PubMed]
  • Corthier G, Muller MC, Elmer GW, Lucas F, Dubos-Ramaré F. Interrelationships between digestive proteolytic activities and production and quantitation of toxins in pseudomembranous colitis induced by Clostridium difficile in gnotobiotic mice. Infect Immun. 1989 Dec;57(12):3922–3927. [PMC free article] [PubMed]
  • Corthier G, Muller MC, Wilkins TD, Lyerly D, L'Haridon R. Protection against experimental pseudomembranous colitis in gnotobiotic mice by use of monoclonal antibodies against Clostridium difficile toxin A. Infect Immun. 1991 Mar;59(3):1192–1195. [PMC free article] [PubMed]
  • Delacroix DL, Dehennin JP, Vaerman JP. Influence of molecular size of IgA on its immunoassay by various techniques. II. Solid-phase radioimmunoassays. J Immunol Methods. 1982;48(3):327–337. [PubMed]
  • Delacroix DL, Vaerman JP. A solid phase, direct competition, radioimmunoassay for quantitation of secretory IgA in human serum. J Immunol Methods. 1981;40(3):345–358. [PubMed]
  • Delmee M, Homel M, Wauters G. Serogrouping of Clostridium difficile strains by slide agglutination. J Clin Microbiol. 1985 Mar;21(3):323–327. [PMC free article] [PubMed]
  • Delmée M, Laroche Y, Avesani V, Cornelis G. Comparison of serogrouping and polyacrylamide gel electrophoresis for typing Clostridium difficile. J Clin Microbiol. 1986 Dec;24(6):991–994. [PMC free article] [PubMed]
  • Fluit AC, Wolfhagen MJ, Verdonk GP, Jansze M, Torensma R, Verhoef J. Nontoxigenic strains of Clostridium difficile lack the genes for both toxin A and toxin B. J Clin Microbiol. 1991 Nov;29(11):2666–2667. [PMC free article] [PubMed]
  • George WL, Sutter VL, Citron D, Finegold SM. Selective and differential medium for isolation of Clostridium difficile. J Clin Microbiol. 1979 Feb;9(2):214–219. [PMC free article] [PubMed]
  • Hohmann A, LaBrooy J, Davidson GP, Shearman DJ. Measurement of specific antibodies in human intestinal aspirate: effect of the protease inhibitor phenylmethylsulphonyl fluoride. J Immunol Methods. 1983 Nov 11;64(1-2):199–204. [PubMed]
  • Johnson S, Gerding DN, Janoff EN. Systemic and mucosal antibody responses to toxin A in patients infected with Clostridium difficile. J Infect Dis. 1992 Dec;166(6):1287–1294. [PubMed]
  • Jonard PP, Rambaud JC, Dive C, Vaerman JP, Galian A, Delacroix DL. Secretion of immunoglobulins and plasma proteins from the jejunal mucosa. Transport rate and origin of polymeric immunoglobulin A. J Clin Invest. 1984 Aug;74(2):525–535. [PMC free article] [PubMed]
  • Kelly CP, Pothoulakis C, Orellana J, LaMont JT. Human colonic aspirates containing immunoglobulin A antibody to Clostridium difficile toxin A inhibit toxin A-receptor binding. Gastroenterology. 1992 Jan;102(1):35–40. [PubMed]
  • Kim PH, Iaconis JP, Rolfe RD. Immunization of adult hamsters against Clostridium difficile-associated ileocecitis and transfer of protection to infant hamsters. Infect Immun. 1987 Dec;55(12):2984–2992. [PMC free article] [PubMed]
  • Leung DY, Kelly CP, Boguniewicz M, Pothoulakis C, LaMont JT, Flores A. Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J Pediatr. 1991 Apr;118(4 Pt 1):633–637. [PubMed]
  • Libby JM, Donta ST, Wilkins TD. Clostridium difficile toxin A in infants. J Infect Dis. 1983 Sep;148(3):606–606. [PubMed]
  • Libby JM, Jortner BS, Wilkins TD. Effects of the two toxins of Clostridium difficile in antibiotic-associated cecitis in hamsters. Infect Immun. 1982 May;36(2):822–829. [PMC free article] [PubMed]
  • Lyerly DM, Krivan HC, Wilkins TD. Clostridium difficile: its disease and toxins. Clin Microbiol Rev. 1988 Jan;1(1):1–18. [PMC free article] [PubMed]
  • Lyerly DM, Lockwood DE, Richardson SH, Wilkins TD. Biological activities of toxins A and B of Clostridium difficile. Infect Immun. 1982 Mar;35(3):1147–1150. [PMC free article] [PubMed]
  • Meillet D, Raichvarg D, Tallet F, Savel J, Yonger J, Gobert JG. Measurement of total, monomeric and polymeric IgA in human faeces by electroimmunodiffusion. Clin Exp Immunol. 1987 Jul;69(1):142–147. [PubMed]
  • Meng XQ, Kamiya S, Yamakawa K, Ogura H, Nakamura S. Purification and characterisation of intracellular toxin A of Clostridium difficile. J Med Microbiol. 1993 Jan;38(1):69–73. [PubMed]
  • Mitchell TJ, Ketley JM, Haslam SC, Stephen J, Burdon DW, Candy DC, Daniel R. Effect of toxin A and B of Clostridium difficile on rabbit ileum and colon. Gut. 1986 Jan;27(1):78–85. [PMC free article] [PubMed]
  • Pothoulakis C, Sullivan R, Melnick DA, Triadafilopoulos G, Gadenne AS, Meshulam T, LaMont JT. Clostridium difficile toxin A stimulates intracellular calcium release and chemotactic response in human granulocytes. J Clin Invest. 1988 Jun;81(6):1741–1745. [PMC free article] [PubMed]
  • Siffert JC, Baldacini O, Kuhry JG, Wachsmann D, Benabdelmoumene S, Faradji A, Monteil H, Poindron P. Effects of Clostridium difficile toxin B on human monocytes and macrophages: possible relationship with cytoskeletal rearrangement. Infect Immun. 1993 Mar;61(3):1082–1090. [PMC free article] [PubMed]
  • Sullivan NM, Pellett S, Wilkins TD. Purification and characterization of toxins A and B of Clostridium difficile. Infect Immun. 1982 Mar;35(3):1032–1040. [PMC free article] [PubMed]
  • Triadafilopoulos G, Pothoulakis C, O'Brien MJ, LaMont JT. Differential effects of Clostridium difficile toxins A and B on rabbit ileum. Gastroenterology. 1987 Aug;93(2):273–279. [PubMed]
  • Triadafilopoulos G, Pothoulakis C, O'Brien MJ, LaMont JT. Differential effects of Clostridium difficile toxins A and B on rabbit ileum. Gastroenterology. 1987 Aug;93(2):273–279. [PubMed]
  • Viscidi R, Laughon BE, Yolken R, Bo-Linn P, Moench T, Ryder RW, Bartlett JG. Serum antibody response to toxins A and B of Clostridium difficile. J Infect Dis. 1983 Jul;148(1):93–100. [PubMed]
  • Viscidi R, Willey S, Bartlett JG. Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. Gastroenterology. 1981 Jul;81(1):5–9. [PubMed]

Articles from Infection and Immunity are provided here courtesy of American Society for Microbiology (ASM)