Systemic and Mucosal Antibody Responses to Toxin A in Patients Infected with Clostridium difficile

• Published in: The Journal of infectious diseases Vol. 166; no. 6; pp. 1287 - 1294
• Main Authors: Johnson, Stuart, Gerding, Dale N., Janoff, Edward N.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.12.1992; University of Chicago Press
• Subjects: Adult; Aged; Antibodies; Antibodies, Bacterial - biosynthesis; Antibodies, Bacterial - blood; Antigens; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Bacterial Toxins - immunology; Biological and medical sciences; Clostridium difficile; Clostridium difficile - immunology; Clostridium difficile - pathogenicity; Cytotoxins; Diarrhea; Diarrhea - immunology; Enterocolitis, Pseudomembranous - immunology; Enterotoxins - immunology; Human bacterial diseases; Humans; Immunoglobulin A - biosynthesis; Immunoglobulin A - blood; Immunoglobulin A, Secretory - biosynthesis; Immunoglobulin G - biosynthesis; Immunoglobulin G - blood; Immunoglobulins; Infections; Infectious diseases; Intestinal Mucosa - immunology; Major Articles; Medical sciences; Middle Aged; Neutralization Tests; Relapse; Secretion; Toxins; Virulence; Human; Antibody; Intestinal juice; Clostridium difficile; Clostridiales; Diarrhea; Infection; Toxin; Immunological investigation; Clostridiaceae; Bacteriosis; Digestive diseases; Bacteria; Intestinal disease; Serum; Humoral immunity
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/166.6.1287

The systemic and mucosal humoral response to toxin A, the primary virulencefactor of Clostridium difficile, was measured in sera and intestinal secretions from 21 patients with C. difficile diarrhea, 9 asymptomatic C. difficile fecal excretors, and 10 noncolonized control subjects. Toxin A-specific IgG was higher in convalescent sera of the patients with diarrhea (mean ± SE, 990 ± 260 ng/rnl.) than in acute sera (620 ± 150 ng/ml.), in sera from asymptomatic excretors (410 ± 140 ng/ml.), or control subjects (320 ± 50 ng/ml.; P < .05 convalescentvs. control). The pattern of toxin A-specific serum IgA and intestinal secretory IgA levelswas similar to that of serum IgG in these groups. Neutralization of toxin A was demonstrated in 5 of 14 convalescent sera but only 1 of 13 acute sera (P = .04). However, the presence of neutralizing activity was independent of the subsequent clinical response. Therefore, most patients convalescent from C. difficile diarrhea demonstrate systemic and mucosal antibodies to toxin A, but these antibodies following natural infection do not appear to alter the clinical course of C. difficile infection.