# Antibody Response to Toxin A Predicts Clostridim Difficile(C-Diff) Diarrhea Recurrenc



## Brandi Guidry (Jul 9, 2000)

Antibody Response to Toxin A PredictsClostridium Difficile Diarrhea Recurrence WESTPORT, CT (Reuters Health) Jan 24 - Patients with a low serum antibodyresponse to toxin A during an episode of Clostridium difficile diarrhea have anincreased risk of recurrence, according to study findings appearing in the January20th issue of The Lancet. To examine the relationship between antibody response to toxin A and recurrenceof C. difficile, Dr. Lorraine Kyne and colleagues at Beth Israel DeaconessMedical Center in Boston followed 63 patients with nosocomial C. difficilediarrhea for 60 days. Antibody measurements were performed on serum samplesdrawn at baseline and then every 3 days until hospital discharge. Episodes of C.difficile diarrhea that occurred after discharge were confirmed by stool toxin tests.Nineteen of the patients (30%) died before the conclusion of the study. C. difficilediarrhea recurred in half of the 44 surviving patients. Dr. Kyne's team reports that low IgM antitoxin A value on day 3, when adjustedfor disease severity, was associated with a 9-fold increased risk of recurrent C.difficile diarrhea. The risk of recurrence was increased 48 times in patients withlow serum IgG concentrations on day 12, according to the report. The results of the study may affect the future treatment of C. difficile diarrhea, Dr.Kyne and her colleagues suggest. They note that "measurement of immuneresponse to toxin A, in conjunction with other independent risk factors identified inthis study, could allow for accurate prediction of risk of nosocomial C. difficilediarrhea and recurrent diarrhea." Immunization, either passive or active, may prevent not only initial but alsorecurrent cases of diarrhea, according to the authors. The researchers point outthat they "have already successfully treated children with chronic recurrent C.difficile colitis by intravenous infusion of normal pooled immunoglobulin thatcontains IgG against toxin A." In an editorial that accompanies the study, Dr. Mark Wilcox and Dr. Jane Mentonof the University of Leeds in England note that preventing recurrent cases of C.difficile diarrhea will be difficult. "Production of a vaccine that is immunogenic in the elderly, especially those inwhom natural challenge with C. difficile does not illicit a protective antibodyresponse, is a daunting challenge," they write. Lancet 2001;357:158-159,189-193.


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## Jeffrey Roberts (Apr 15, 1987)

Thanks Brandi.I posted this at the Yahoo C. Difficile Club as well. http://clubs.yahoo.com/clubs/cdifficilesupportgroup Jeff


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