Identification of Clostridium difficile as a cause of pseudomembranous colitis.

Abstract

rest was instituted and the temperature resolved in 24 hours, while all signs and symptoms disappeared in five days.Subsequent investigations showed no evidence of streptococcal infection (a throat swab grew no pathogens and the antistreptolysin titre was < 125 units/ml both one day after admission and six weeks later).The antibody titre for psittacosis LGV was > 1/1000 on admission and six weeks later was still raised at 1/128.Inquiry later showed that before his illness he had visited regularly a neighbouring house in which a healthy, psittacine bird was kept. DiscussionIn this case there are two major and three minor criteria of rheumatic fever present, but without evidence of a recent streptococcal infection.On the contrary, the presence of a cough and constitutional disturbance associated with patchy shadowing on the chest x-ray film and a signific- ant and changing antibody titre all support a diagnosis of psittacosis.The rashes described in association with this disease include "rose spots,"2 erythema nodosum,2 and a macular scaly rash.3We could find no reports of an exanthem resembling erythema marginatum.Arthritis, which may be migratory,4 is a rare complication of psittacosis in man, though in sheep and cattle polyarthritis it is well recognised.5This case shows that psittacosis may present with minimal respira- tory disturbance and with a clinical picture resembling rheumatic fever with erythema marginatum and polyarthritis.