Lyerly D M, Krivan H C, Wilkins T D
Department of Anaerobic Microbiology, Virginia Polytechnic Institute and State University, Blacksburg 24061.
Clin Microbiol Rev. 1988 Jan;1(1):1-18. doi: 10.1128/CMR.1.1.1.
Clostridium difficile is the etiologic agent of pseudomembranous colitis, a severe, sometimes fatal disease that occurs in adults undergoing antimicrobial therapy. The disease, ironically, has been most effectively treated with antibiotics, although some of the newer methods of treatment such as the replacement of the bowel flora may prove more beneficial for patients who continue to relapse with pseudomembranous colitis. The organism produces two potent exotoxins designated toxin A and toxin B. Toxin A is an enterotoxin believed to be responsible for the diarrhea and mucosal tissue damage which occur during the disease. Toxin B is an extremely potent cytotoxin, but its role in the disease has not been as well studied. There appears to be a cascade of events which result in the expression of the activity of these toxins, and these events, ranging from the recognition of a trisaccharide receptor by toxin A to the synergistic action of the toxins and their possible dissemination in the body, are discussed in this review. The advantages and disadvantages of the various assays, including tissue culture assay, enzyme immunoassay, and latex agglutination, currently used in the clinical diagnosis of the disease also are discussed.
艰难梭菌是伪膜性结肠炎的病原体，伪膜性结肠炎是一种严重的、有时甚至致命的疾病，发生于接受抗菌治疗的成年人中。具有讽刺意味的是，尽管一些新的治疗方法，如肠道菌群置换，可能对伪膜性结肠炎持续复发的患者更有益，但该疾病最有效的治疗方法仍是使用抗生素。该微生物产生两种强效外毒素，分别称为毒素A和毒素B。毒素A是一种肠毒素，被认为是导致疾病期间腹泻和粘膜组织损伤的原因。毒素B是一种极其强效的细胞毒素，但其在疾病中的作用尚未得到充分研究。似乎存在一系列导致这些毒素活性表达的事件，本文将讨论这些事件，从毒素A对三糖受体的识别到毒素的协同作用及其在体内可能的传播。本文还讨论了目前用于该疾病临床诊断的各种检测方法的优缺点，包括组织培养检测、酶免疫检测和乳胶凝集检测。
