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

For the diagnosis of Clostridium difficile infection (CDI), it is necessary to obtain microbiological evidence of toxigenic C. difficile with a compatible clinical picture (diarrhoea or ileus). Two gold standards exist: cell culture cytotoxicity neutralization assay (specific, but less sensitive than previously acknowledged) and toxigenic culture (very sensitive but less specific because it also detects asymptomatic colonization). These gold standards are not used routinely because at least 2 or 3 days are needed to get a definitive result. Enzyme immunoassays (EIA) are used by most of the French laboratories for the detection of toxins A and B: they provide a quick answer but their sensitivity is insufficient (only 50%). Molecular assays (targeting tcdA or tcdB genes) and glutamate dehydrogenase (GDH) EIA represent an attractive alternative because their high sensitivity (>85%) allow to definitely rule out CDI in the case of a negative result. The presence of GDH is not specific of toxigenic C. difficile: positive results must be confirmed by another method. In the event of a positive molecular assay without toxin presence assessed by EIA or cytotoxicity assay, other causes of diarrhoea should be ruled out before a definitive diagnosis of CDI can be made.
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PMID:[Laboratory diagnosis of Clostridium difficile infection]. 2390 66

Clostridium difficile is a gram-positive, spore-forming anaerobic bacterium. C.difficile is the leading cause of antibiotic associated diarrhea and colitis. The clinical spectrum of C.difficile infection (CDI) is highly variable, ranging from mild diarrhea to severe forms of intestinal illness including toxic megacolon, ileus, bowel perforation, and pseudomembranous colitis. Advanced age, long duration of hospitalization, and exposure to certain antimicrobial agents are the most common risk factors for CDI. The main virulence determinants of C.difficile are toxin A (enterotoxin) and toxin B (cytotoxin). Diagnosis of CDI is based on the identification of C.difficile toxin A or B in diarrheal stool. Various laboratory tests have been currently developed for the detection of C.difficile or its toxins in stool samples. The cell culture cytotoxicity assay and toxigenic culture have been regarded as the reference standard methods for the detection of C.difficile toxins. However, both of the reference methods are laborious, time consuming, and need expert personnel. Therefore, many microbiology laboratories use enzyme immunoassays, glutamate dehydrogenase antigen tests and real-time polymerase chain reaction (PCR) which are more rapid and practical. First-line antibiotics for CDI treatment are metronidazole and vancomycin. In this review, epidemiology, clinical spectrum, risk factors, pathogenesis, diagnostic methods and treatment of CDI have been summarized.
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PMID:[Clostridium difficile infection: epidemiology, risk factors, pathogenesis, clinical features, diagnosis and therapy]. 2397 35

Guidelines for the diagnosis and treatment of Clostridioides difficile infection have recently been updated. Risk factors include recent exposure to health care facilities or antibiotics, especially clindamycin. C. difficile infection is characterized by a wide range of symptoms, from mild or moderate diarrhea to severe disease with pseudomembranous colitis, colonic ileus, toxic megacolon, sepsis, or death. C. difficile infection should be considered in patients who are not taking laxatives and have three or more episodes of unexplained, unformed stools in 24 hours. Testing in these patients should start with enzyme immunoassays for glutamate dehydrogenase and toxins A and B or nucleic acid amplification testing. In children older than 12 months, testing is recommended only for those with prolonged diarrhea and risk factors. Treatment depends on whether the episode is an initial vs. recurrent infection and on the severity of the infection based on white blood cell count, serum creatinine level, and other clinical signs and symptoms. For an initial episode of nonsevere C. difficile infection, oral vancomycin or oral fidaxomicin is recommended. Metronidazole is no longer recommended as first-line therapy for adults. Fecal microbiota transplantation is a reasonable treatment option with high cure rates in patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes. Good antibiotic stewardship is a key strategy to decrease rates of C. difficile infection. In routine or endemic settings, hands should be cleaned with either soap and water or an alcohol-based product, but during outbreaks soap and water is superior. The Infectious Diseases Society of America does not recommend the use of probiotics for prevention of C. difficile infection.
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PMID:Clostridioides difficile Infection: Update on Management. 3200 51