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Intravenous immunoglobulin therapy for severe Clostridium difficile colitis

Salcedo, J ; Keates, S ; Pothoulakis, C ; Warny, M ; Castagliuolo, I ; LaMont, J T ; Kelly, C P

Gut, 1997-09, Vol.41 (3), p.366-370 [Periódico revisado por pares]

London: BMJ Publishing Group Ltd and British Society of Gastroenterology

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Título:
Intravenous immunoglobulin therapy for severe Clostridium difficile colitis
Autor: Salcedo, J ; Keates, S ; Pothoulakis, C ; Warny, M ; Castagliuolo, I ; LaMont, J T ; Kelly, C P
Assuntos: Abdomen ; antibiotic ; Antibodies - analysis ; Bacterial Proteins ; Bacterial Toxins - immunology ; Biological and medical sciences ; Clostridium difficile ; Colon ; Diarrhea ; diarrhoea ; Enterocolitis, Pseudomembranous - therapy ; Enterotoxins - immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; IgG ; Immunoglobulin G - analysis ; Immunoglobulins ; Immunoglobulins, Intravenous - chemistry ; Immunomodulators ; immunotherapy ; Intestinal Infection ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Rodents ; toxin
É parte de: Gut, 1997-09, Vol.41 (3), p.366-370
Notas: Dr C P Kelly, Dana 601, Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
PMID:9378393
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Descrição: Background—Many individuals have serum antibodies against Clostridium difficile toxins. Those with an impaired antitoxin response may be susceptible to recurrent, prolonged, or severe C difficile diarrhoea and colitis. Aims—To examine whether treatment with intravenous immunoglobulin might be effective in patients with severe pseudomembranous colitis unresponsive to standard antimicrobial therapy. Patients—Two patients with pseudomembranous colitis not responding to metronidazole and vancomycin were given normal pooled human immunoglobulin intravenously (200–300 mg/kg). Methods—Antibodies against C difficile toxins were measured in nine immunoglobulin preparations by ELISA and by cytotoxin neutralisation assay. Results—Both patients responded quickly as shown by resolution of diarrhoea, abdominal tenderness, and distension. All immunoglobulin preparations tested contained IgG against C difficile toxins A and B by ELISA and neutralised the cytotoxic activity of C difficile toxins in vitro at IgG concentrations of 0.4–1.6 mg/ml. Conclusion—Passive immunotherapy with intravenous immunoglobulin may be a useful addition to antibiotic therapy for severe, refractory C difficile colitis. IgG antitoxin is present in standard immunoglobulin preparations andC difficile toxin neutralising activity is evident at IgG concentrations which are readily achieved in the serum by intravenous immunoglobulin administration.
Editor: London: BMJ Publishing Group Ltd and British Society of Gastroenterology
Idioma: Inglês

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Intravenous immunoglobulin therapy for severe Clostridium difficile colitis

Salcedo, J ; Keates, S ; Pothoulakis, C ; Warny, M ; Castagliuolo, I ; LaMont, J T ; Kelly, C P

London: BMJ Publishing Group Ltd and British Society of Gastroenterology

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