Correlation of the detection of Clostridium difficile toxins in stools and presence of the clostridia in tissues of children
Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA. Human pathology
(Impact Factor: 2.77).
11/2010; 41(11):1586-92. DOI: 10.1016/j.humpath.2010.04.009
Clostridium difficile toxin is frequently found in the stool of children; however, pseudomembranous colitis is rare. Studying the usefulness of Clostridium difficile toxin assays in pediatrics is required. We performed a correlation between presence of Clostridium difficile toxin in stool and evidence of Clostridium difficile in gastrointestinal pediatric tissue samples using immunohistochemistry (with a pan-clostridial antibody) and polymerase chain reaction (with primers for toxin genes). We studied 11 patients with a median age of 8 years (range, 4 weeks to 17 years); 4 (36%) were female. The median time between detection of Clostridium difficile toxin in stool and obtaining tissue was 3 days. Ten patients survived. Endoscopy was performed in 8 survivors and showed normal mucosa in 2, pseudomembranes in 2, erythema and friability in 1, aphthae in 1, increased mucous production in 1, and colitis in 1. Two survivors underwent laparotomy for either obstruction or resection of necrotic bowel. Histopathologic studies in these 10 surviving patients showed necrosis in 2 samples, granulomatous inflammation in 1, moderate colitis in 1, and mild to minimal pathology in 7. There was no antigenic or molecular evidence of clostridia in the tissue of these patients. Histopathologic evidence of pseudomembranes and immunohistochemical evidence of clostridia were present in postmortem intestinal tissues of the only patient that died. Our findings indicate that Clostridium difficile toxin in stool does not correlate with the presence of clostridia and may not contribute to pathology in intestinal tissues of children. Clostridial antigens were only observed with histopathologic evidence of pseudomembranes.
Available from: Diego T. Santos
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ABSTRACT: Sub-micrometer particles of carotenoids (β-carotene and lycopene) suspended in aqueous media were produced by extraction of the organic solvent from the droplets of an oil-in-water emulsion with supercritical CO2. The influence of the process parameters emulsion flow rate, concentration of surfactant/carrier material and pressure on product characteristics was evaluated. Suspensions containing stabilized carotenoids with final particle size of 344–366nm, encapsulation efficiency of 34–89% and degree of isomerization from carotenoid trans to cis forms in the range of 0.02–15%, were obtained. Independently of the type of carotenoid used, emulsion flow rate influenced the production of suspensions of carotenoids, particularly the encapsulation efficiency and the degree of isomerization. Higher encapsulation efficiencies, but also higher degradations were obtained when β-carotene was employed instead of lycopene. The concentration of surfactant/carrier material was the only process parameter that influenced the final particle size, while the encapsulation efficiency and degree of isomerization were influenced also by the concentration of surfactant/carrier material and by pressure.
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ABSTRACT: Clostridium difficile is the commonest cause of hospital acquired diarrhoea in adults and is associated with significant mortality and morbidity. The clinical significance of C. difficile in children, however, is less certain. In this article we discuss colonisation and infection and describe C. difficile in childhood in terms of risk factors, epidemiology and management.
Available from: cid.oxfordjournals.org
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