L. Kyne et al., Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea, LANCET, 357(9251), 2001, pp. 189-193
Citations number
28
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background We have reported that symptom-free carriers of Clostridium diffi
cile have a systemic anamnestic immune response to toxin A. The aim of this
study was to determine whether an acquired immune response to toxin A, dur
ing an episode of C difficile diarrhoea, influences risk of recurrence.
Methods We prospectively studied 63 patients with nosocomial C difficile di
arrhoea. Serial serum IgA, IgG, and IgM concentrations against C difficile
toxin A, toxin B, or non-toxin antigens were measured by ELISA. Individuals
were followed for 60 days.
Findings 19 patients died (30%). Of the 44 who survived, 22 had recurrent C
difficile diarrhoea. Patients with a single episode of C difficile diarrho
ea (n=22) had higher concentrations of serum IgM against toxin A on day 3 o
f their first episode of diarrhoea than those with recurrent diarrhoea (n=2
2, p=0.004). On day 12, serum IgG values against toxin A were higher in pat
ients who had a single episode of diarrhoea (n=7) than in those who subsequ
ently had recurrent diarrhoea (n=9, p=0.009). The odds ratio for recurrence
associated with a low concentration of serum IgG against toxin A. measured
12 days after onset of C difficile diarrhoea, was 48.0 (95% CI 3.5-663).
Interpretation A serum antibody response to toxin A, during an initial epis
ode of C difficile diarrhoea, is associated with protection against recurre
nce.