Clostridium difficile. A review on an emerging infection.

Clostridium difficile causes antibiotic-associated diarrhoea and pseudomembranous colitis. The main virulence factors of C. difficile are the toxins A (TcdA) and B (TcdB). A third toxin, binary toxin (CDT), which pathogenetic role had been remained largely overlooked until few years ago, nowadays have been detected in 5%-23% of strains. C. difficile has spread around world. Clostridium difficile infection (CDI) is one of the most common health-care associated infections and a significant cause of morbidity and mortality among older adult hospitalized patients. Diagnosis of CDI is often difficult and has a substantial impact on the management of patients with disease. It is usually based on a clinical history of recent antimicrobial usage and diarrhoea in combination with laboratory tests. Although the conventional methods are crucial for the diagnosis and the subsequent treatment of CDI, a timely laboratory diagnosis is essential for the detection of toxigenic strains providing either to an effective and immediately treatment or to the prevention of further disease transmission. In this review we provide general recommendations for testing of samples collected from patients with suspected CDI.

Natural evolution of sleep apnoea syndrome: a five year longitudinal study.

We wanted to investigate the natural evolution of Obstructive Sleep Apnoea Syndrome (OSAS). We therefore followed 58 patients who refused any treatment at the time of diagnosis. Of the eligible patients 32 subjects enrolled in instrumental follow-up. The effects on daytime somnolence, daytime lung function and nocturnal respiratory disturbances were retrospectively evaluated by repeating Multiple Sleep Latency Test (MSLT), spirometry and polysomnography after a follow-up period of at least 5 years (5.7 +/- 0.2 SEM yrs). In the patient group as a whole the mean Apnoea+Hypopnoea Index (AHI), the mean low arterial oxygen saturation (Sao2) and the mean Body Mass Index (BMI) did not change over time. The only significant differences were the increase in mean duration of apnoeas (21.0 vs 23.5 s) and hypopneas (13.5 vs 16.3 s) and the decrease in AHI < 80% (13.3 vs 7.9). No correlations were found between the changes in AHI or mean low Sao2 and age, BMI, AHI, mean low Sao2, pulmonary function tests or arterial blood gases at baseline. No significant changes were observed in systemic blood pressure, pulmonary function tests, blood gases analysis or MSLT. "Improved" (n = 6) and "worsened" (n = 7) groups were defined by a reduction or increase in AHI over 35% of baseline value. At baseline the "worsened" group tended to have lower AHI and higher mean low Sao2 compared with the "improved" group. In the "worsened" group the BMI rose significantly from 26.0 to 29.2, AHI rose significantly from 14.1 to 51.3 and mean low Sao2 decreased from 92 to 90 (NS).(ABSTRACT TRUNCATED AT 250 WORDS)