Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:1.4.1.2 (glutamate dehydrogenase)
 4,380 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clostridium difficile infection (CDI) is a disease of varying severity. Its manifestations range from mild diarrhea to life-threatening paralytic ileus, painful distension of the large bowel and sepsis. Another possible manifestation of the disease is recurrent colitis that can exhaust the patient. For establishing the diagnosis, the patient's stool should be examined with two or three different microbiological methods. Immunochemical testing for the presence of clostridial toxins A and B shows good specificity but poor sensitivity. Therefore, it must be combined with other methods: stool testing for glutamate dehydrogenase (Clostridium antigen), anaerobic culture or PCR detection. An alternative way of assessing the etiology is colonoscopic examination; the disease is confirmed if typical pseudomembrane isles are present in the bowel mucosa. The basic drugs to treat CDI are still metronidazole (oral or parenteral) and/or vancomycin (oral or rectal). Fidaxomicin seems to be promising. Stool transplant via a nasojejunal tube is effective in recurrent disease. In the hospital setting, patients suffering from CDI should be isolated for the entire duration of diarrhea. Surveillance rules should also be applied, together with early treatment of symptomatic patients and prevention of the spread of the infection. Higher incidence of CDI in a ward implies that the local antibiotic prescription habits should be revised.
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PMID:[Recommendations for diagnosis and therapy of colitis caused by Clostridium difficile]. 2320 71

Clostridium difficile infection (CDI) is a disease of varying severity. Its manifestations range from mild diarrhea to life-threatening paralytic ileus, painful distension of the large bowel, and sepsis. Another possible manifestation of the disease is recurring colitis that can exhaust the patient. For establishing the diagnosis, the patient's stool should be examined with two or three different microbiological methods (testing for clostridial toxins A and B; testing for clostridial glutamate dehydrogenase, anaerobic culture with specific media, or PCR detection of genes for production of clostridial toxins). An alternative way of assessing the etiology is colonoscopic examination; the disease is confirmed if characteristic patchy pseudomembranes are present in the bowel mucosa. Optimal treatment depends on severity of the disease and on the risk of recurrence. Metronidazole, vancomycin and fidaxomicin are used as basic drugs. Fecal transplantation is effective in recurrent disease. In the hospital setting, patients suffering from CDI should be isolated for the entire duration of diarrhea. Surveillance rules also should be applied, together with early treatment of symptomatic patients and prevention of the spread of the infection. Higher incidence of CDI in a ward implies that the local antibiotic prescription habits should be revised.
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PMID:[Diagnosis and therapy of Clostridium difficile infection: Czech national guidelines]. 2513 41

Intestinal infections caused by the Clostridium difficile (CDI) bacterium currently represent a serious medical problem. They belong to the most frequent nosocomial infections and, in some countries, a community-acquired disease with a significantly increased incidence of community associated CDI is reported. The infection can manifest as mind diarrhea, but also as a life-threatening illness accompanied by paralytic ileus and painful distension of the colon, developing into secondary sepsis. Recurrent forms difficult to manage are a relatively common complication of the disease. Severity of infection may be influenced by the virulence of the causative strain. Severe course of the disease is associated with ribotypes 027, 078, 001. In the Czech Republic, ribotypes 001 and 176 have predominated over the last years. Laboratory diagnosis is based on the detection of C. difficile glutamate dehydrogenase and free clostridium toxins (A,B) in a diarrheal stool sample or culture of C. difficile in anaerobic conditions. Metronidazole, vancomycin and fidaxomicin are the drugs of choice in the treatment of aC. difficile with administration according to the actual treatment guidelines. Fecal bacteriotherapy is recommended in treatment and prevention of recurrent CDI. Surgery is indicated in progressive complicated forms when no response to medication is achieved and the patient is in a critical condition.Key words: Clostridium difficile intestinal infection epidemic ribotypes clostridium colitis treatment.
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PMID:[Clostridium difficile remains a medical challenge]. 2930 6

Clostridium difficile, a causative agent of intestinal infections (CDI) of varying severity, is an important nosocomial pathogen. Microbiological diagnosis, including an appropriate test algorithm and the corresponding interpretation of the results, is crucial for CDI confirmation. This update is based on the European guidance document for CDI laboratory diagnosis, taking into account the current CDI epidemiology and laboratory diagnostic approaches in the Czech Republic. Any diarrhoeal patient should be tested for CDI. The rectal swabs can only be used for testing in patients with paralytic ileus. Currently, a two-step test algorithm is recommended for CDI diagnosis. Due to a low positive predictive value, a single commercial test is not recommended as a stand-alone test for diagnosing CDI. Samples with a positive screening test (glutamate dehydrogenase or toxigenic strain nucleic acid) and a subsequent negative EIA (enzyme immunoassay) test for the presence of free toxins are diagnostically inconclusive. An option is to use a third confirmatory test; however, the current clinical status of the patient along with other laboratory findings should be considered in order to differentiate between ongoing CDI, carriage of a toxigenic strain of C. difficile, and other causes of diarrhoea. In general, when implementing a new diagnostic test, its sensitivity and specificity should be compared against the reference method. Diagnostic tests should refer to the data from published comparative studies and should not rely solely on information provided by the manufacturer. Currently, there is no commercial test available for detection of free C. difficile toxins in stool samples with 100 % sensitivity. Moreover, the pre-analytical conditions (storage and transport temperature of stool samples) and/or the initiation of an empirical therapy prior to the sampling may decrease the sensitivity of the assay.
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PMID:Updated Czech guidelines for the laboratory diagnosis of Clostridium difficile infections. 3012 87