The host immune response to Clostridium difficile
The host immune response to Clostridium difficile
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DOI：
10.1099/jmm.0.030015-0
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发表时间：
2011-08-01
影响因子：
3
通讯作者：
Kyne, Lorraine
中科院分区：
文献类型：
--
作者：
Kelly, Ciaran P.;Kyne, Lorraine
艰难梭菌是西方世界医院内细菌性腹泻的最常见原因。腹泻和结肠炎是由致病性C菌株释放的毒素A和B的作用引起的。很难对这些毒素的适应性免疫反应影响C.艰难梭菌感染（CDi）。无症状的毒素C携带者。difficile和那些有一集CD的人！没有复发的患者比有症状和复发的患者表现出更强的抗毒素免疫应答。已经开发了基于免疫的CDI治疗和预防方法，使用主动疫苗接种或被动免疫治疗靶向C。艰难梭菌毒素先天性免疫反应。艰难梭菌及其毒素也是CDI病理生理学的中心。急性肠道炎症反应伴显著的中性粒细胞浸润和相关组织损伤是CDI的特征。此外，抑制这种急性炎症反应可以保护肠道免受暴露于C。艰难梭菌毒素的动物模型。研究CDI的宿主风险因素已经导致了原发性和复发性疾病风险的有效临床预测工具。还确定了与临床结局较差的严重CDI相关的风险因素，包括外周白色细胞计数显着升高和肌酸酐升高。然而，在这一领域还需要进一步的工作，以指导疾病预防和治疗新方法的临床应用，包括新的抗菌剂以及被动和主动免疫接种。
Clostridium difficile is the most common cause of nosocomial bacterial diarrhoea in the Western world. Diarrhoea and colitis are caused by the actions of toxins A and B released by pathogenic strains of C. difficile. Adaptive immune responses to these toxins influence the outcomes of C. difficile infection (CDi). Symptomless carriers of toxinogenic C. difficile and those with a single episode of CD! without recurrence show more robust antitoxin immune responses than those with symptomatic and recurrent disease. Immune-based approaches to CDI therapy and prevention have been developed using active vaccination or passive immunotherapy targeting C. difficile toxins. Innate immune responses to C. difficile and its toxins are also central to the pathophysiology of CDI. An acute intestinal inflammatory response with prominent neutrophil infiltration and associated tissue injury is characteristic of CDI. Furthermore, inhibiting this acute inflammatory response can protect against the intestinal injury that results from exposure to C. difficile toxins in animal models. Studies examining host risk factors for CDI have led to validated clinical prediction tools for risk of primary and of recurrent disease. Risk factors associated with severe CDI with poor clinical outcomes have also been identified and include marked elevation of the peripheral white blood cell count and elevated creatinine. However, further work is needed in this area to guide the clinical application of new approaches to disease prevention and treatment including new antimicrobials as well as passive and active immunization.