In Reply.—My colleagues and I thank Drs George and Hartley for contributing their data that suggest that maternally derived antibody could protect the neonate from disease caused by C difficile toxin(s). There are now additional data that suggest interaction of C difficile toxins with the immune system. Using purified toxin in an enzyme-linked immunoadsorbent assay, Viscidi et al1 detected antibody to toxin B (the more potent cytotoxin, and probably the one primarily measured by George and Hartley's method) in serum from more than 50% of adults. Increased antitoxin titers have been demonstrated in serum of patients1 and animals2 recovering from C difficile–induced colitis. After immunization with purified toxoids of C difficile, animals seem to be protected from disease despite prolonged fecal excretion of organism and toxin.2 Surely, antitoxin levels at the site of toxin occurrence to the intestinal epithelium are more important than serum
LONG SS. Antibodies to Clostridium difficile Cytotoxin in a Pediatric Population-Reply. Am J Dis Child. 1983;137(10):1024–1025. doi:10.1001/archpedi.1983.02140360084027
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