Potential of Sahelian Native Shrub Materials to Suppress the Spiral Nematode Helicotylenchus dihystera.

Pearl millet (Pennisetum glaucum) is a drought-tolerant cereal commonly grown for grain and fodder in arid areas throughout the world. Senegalese millet fields are infested with Helicotylenchus. The native evergreen woody shrub Piliostigma reticulatum is widely distributed in sub-Saharan Africa. Its coppiced residues are used by small farmers as mulch in crop fields. The shrub's nematicidal effect on the spiral nematode Helicotylenchus dihystera was evaluated in a pearl millet pot experiment. The abundance of nematodes decreased by 64% after application of either leaf powder or a pulverized mixing of leaves and stems, suggesting the use of aboveground materials of P. reticulatum as a potential nematicide. The results show promise for use of a local resource by subsistence farmers in the Sahel. Further research is needed on application to fully develop this approach as a biopesticide.

Methane production, nutrient digestion, ruminal fermentation, N balance, and milk production of cows fed timothy silage- or alfalfa silage-based diets.

The objective of this study was to investigate the effects of changing forage source in dairy cow diets from timothy silage (TS) to alfalfa silage (AS) on enteric CH4 emissions, ruminal fermentation characteristics, digestion, milk production, and N balance. Nine ruminally cannulated lactating cows were used in a replicated 3 × 3 Latin square design (32-d period) and fed (ad libitum) a total mixed ration (TMR; forage:concentrate ratio of 60:40, dry matter basis), with the forage portion consisting of either TS (0% AS; 0% AS and 54.4% TS in the TMR), a 50:50 mixture of both silages (50% AS; 27.2% AS and 27.2% TS in the TMR), or AS (100% AS; 54.4% AS and 0% TS in the TMR). Compared with TS, AS contained less (36.9 vs. 52.1%) neutral detergent fiber but more (20.5 vs. 13.6%) crude protein (CP). In sacco 24-h ruminal degradability of organic matter (OM) was higher for AS than for TS (73.5 vs. 66.9%). Replacement of TS with AS in the diet entailed increasing proportions of corn grain and bypass protein supplement at the expense of soybean meal. As the dietary proportion of AS increased, CP and starch concentrations increased, whereas fiber content declined in the TMR. Dry matter intake increased linearly with increasing AS proportions in the diet. Apparent total-tract digestibility of OM and gross energy remained unaffected, whereas CP digestibility increased linearly and that of fiber decreased linearly with increasing inclusion of AS in the diet. The acetate-to-propionate ratio was not affected, whereas ruminal concentration of ammonia (NH3) and molar proportion of branched-chain VFA increased as the proportion of AS in the diet increased. Daily CH4 emissions tended to increase (476, 483, and 491 g/d for cows fed 0% AS, 50% AS, and 100% AS, respectively) linearly as cows were fed increasing proportions of AS. Methane production adjusted for dry matter intake (average=19.8 g/kg) or gross energy intake (average=5.83%) was not affected by increasing AS inclusion in the diet. When expressed on a fat-corrected milk or energy-corrected milk yield basis, CH4 production increased linearly with increasing AS dietary proportion. Urinary N excretion (g/d) increased linearly when cows were fed increasing amounts of AS in the diet, suggesting a potential for higher nitrous oxide (N2O) and NH3 emissions. Efficiency of dietary N use for milk protein secretion (g of milk N/g of N intake) declined with the inclusion of AS in the diet. Despite marked differences in chemical composition and ruminal degradability, under the conditions of this study, replacing TS with AS in dairy cow diets was not effective in reducing CH4 energy losses.

Methane production, digestion, ruminal fermentation, nitrogen balance, and milk production of cows fed corn silage- or barley silage-based diets.

This study evaluated the effects of replacing barley silage (BS) with corn silage (CS) in dairy cow diets on enteric CH4 emissions, ruminal fermentation characteristics, digestion, milk production, and N balance. Nine ruminally cannulated lactating cows were used in a replicated 3 × 3 Latin square design (32-d period) and fed (ad libitum) a total mixed ration (TMR; forage:concentrate ratio 60:40; dry matter basis) with the forage portion consisting of either barley silage (0% CS; 0% CS and 54.4% BS in the TMR), a 50:50 mixture of both silages (27% CS; 27.2% CS and 27.2% BS in the TMR), or corn silage (54% CS; 0% BS and 54.4% CS in the TMR). Increasing the CS proportion (i.e., at the expense of BS) also involved increasing the proportion of corn grain (at the expense of barley grain). Intake and digestibility of dry matter and milk production increased linearly as the proportion of CS increased in the diet. Increasing dietary CS proportion decreased linearly the acetate molar proportion and increased linearly that of propionate. Daily CH4 emissions tended to respond quadratically to increasing proportions of CS in the diet (487, 540, and 523 g/d for 0, 27, and 54% CS, respectively). Methane production adjusted for dry matter or gross energy intake declined as the amount of CS increased in the diet; this effect was more pronounced when cows were fed the 54% CS diet than the 27% CS diet. Increasing the CS proportion in the diet improved N utilization, as reflected by decreases in ruminal ammonia concentration and urinary N excretion and higher use of dietary N for milk protein secretion. Total replacement of BS with CS in dairy cow diets offers a strategy to decrease CH4 energy losses and control N losses without negatively affecting milk performance.

Effects of increasing amounts of corn dried distillers grains with solubles in dairy cow diets on methane production, ruminal fermentation, digestion, N balance, and milk production.

The objective of this study was to examine the effects of including corn dried distillers grains with solubles (DDGS) in the diet at the expense of corn and soybean meal on enteric CH4 emissions, ruminal fermentation characteristics, digestion (in sacco and apparent total-tract digestibility), N balance, and milk production of dairy cows. Twelve lactating Holstein cows were used in a triplicated 4×4 Latin square design (35-d periods) and fed (ad libitum intake) a total mixed ration containing (dry matter basis) 0, 10, 20, or 30% DDGS. Dry matter intake increased linearly, whereas apparent-total tract digestibility of dry matter and gross energy declined linearly as DDGS level in the diet increased. Increasing the proportion of DDGS in the diet decreased the acetate:propionate ratio, but this decrease was the result of reduced acetate concentration rather than increased propionate concentration. Milk yield increased linearly (up to +4kg/d) with increasing levels of DDGS in the diet and a tendency was observed for a quadratic increase in energy-corrected milk as the proportion of DDGS in the diet increased. Methane production decreased linearly with increasing levels of DDGS in the diet (495, 490, 477, and 475 g/d for 0, 10, 20, and 30% DDGS diets, respectively). When adjusted for gross energy intake, CH4 losses also decreased linearly as DDGS proportion increased in the diet by 5, 8, and 14% for 10, 20, and 30% DDGS diets, respectively. Similar decreases (up to 12% at 30% DDGS) were also observed when CH4 production was corrected for digestible energy intake. When expressed relative to energy-corrected milk, CH4 production declined linearly as the amount of DDGS increased in the diet. Total N excretion (urinary and fecal; g/d) increased as the amount of DDGS in the diet increased. Efficiency of N utilization (milk N secretion as a proportion of N intake) declined linearly with increasing inclusion of DDGS in the diet. However, productive N increased linearly with increasing proportions of DDGS in the diet, suggesting better efficiency of N use by the animal. Results from this study show that feeding DDGS to dairy cows can help to mitigate enteric CH4 emissions without negatively affecting intake and milk production.

Replacing alfalfa silage with corn silage in dairy cow diets: Effects on enteric methane production, ruminal fermentation, digestion, N balance, and milk production.

The objective of this study was to determine the effects of replacing alfalfa silage (AS) with corn silage (CS) in dairy cow total mixed rations (TMR) on enteric CH4 emissions, ruminal fermentation characteristics, apparent total-tract digestibility, N balance, and milk production. Nine ruminally cannulated lactating cows were used in a replicated 3×3 Latin square design (32-d period) and fed (ad libitum) a TMR [forage:concentrate ratio of 60:40; dry matter (DM) basis], with the forage portion consisting of either alfalfa silage (0% CS; 56.4% AS in the TMR), a 50:50 mixture of both silages (50% CS; 28.2% AS and 28.2% CS in the TMR), or corn silage (100% CS; 56.4% CS in the TMR). Increasing the CS proportion (i.e., at the expense of AS) in the diet was achieved by decreasing the corn grain proportion and increasing that of soybean meal. Intake of DM and milk yield increased quadratically, whereas DM digestibility increased linearly as the proportion of CS increased in the diet. Increasing the dietary CS proportion resulted in changes (i.e., lower ruminal pH and acetate:propionate ratio, reduced fiber digestibility, decreased protozoa numbers, and lower milk fat and higher milk protein contents) typical of those observed when cows are fed high-starch diets. A quadratic response in daily CH4 emissions was observed in response to increasing the proportion of CS in the diet (440, 483, and 434 g/d for 0% CS, 50% CS, and 100% CS, respectively). Methane production adjusted for intake of DM, and gross or digestible energy was unaffected in cows fed the 50% CS diet, but decreased in cows fed the 100% CS diet (i.e., quadratic effect). Increasing the CS proportion in the diet at the expense of AS improved N utilization, as reflected by the decreases in ruminal NH3 concentration and manure N excretion, suggesting low potential NH3 and N2O emissions. Results from this study, suggest that total replacement of AS with CS in dairy cow diets offers a means of decreasing CH4 output and N losses. However, the reduction in fiber degradation and the resulting increase in volatile solids content of the manure may lead to increased CH4 emissions from manure storage.

Plant-available and water-soluble phosphorus in soils amended with separated manure solids.

Physical, chemical, or biological treatment of animal liquid manure generally produces a dry-matter rich fraction (DMF) that contains most of the initial phosphorus (P). Our objective was to assess the solubility and plant availability of P from various DMFs as a function of soil P status. Eight different DMFs were obtained from liquid swine (LSM) and dairy cattle (LDC) manures treated by natural decantation, anaerobic digestion, chemical flocculation, composting, or mechanical separation. The DMFs were compared with mineral P fertilizer in a pot experiment with oat ( L.) grown in four soils with varied P-fixing capacities and P saturation levels. The DMFs were added at a rate of 50 mg P kg soil and incubated 14 d before seeding. Soil water-extractable P (P) at all water:soil extraction ratios (2:1, 20:1, and 200:1) was slightly higher when DMFs were derived from LDC rather than LSM. Soil P at the 2:1 ratio was lower with anaerobically digested LSM. At the 2:1 extraction ratio, DMF P was less soluble than mineral P as P saturation in soils increased. In soils with a lower P-fixing capacity, DMF P appeared less water soluble than mineral P under 20:1 and 200:1 extraction ratios. After 72 d of plant growth, DMFs produced yields comparable to mineral P fertilizer. Although the plant availability of P from DMFs was comparable to mineral P fertilizer, P from DMFs could be less vulnerable to leaching or runoff losses in soils with a high P saturation level or low P-fixing capacity.

Evaluation of molecular methods used for establishing the interactions and functions of microorganisms in anaerobic bioreactors.

Molecular techniques have unveiled the complexity of the microbial consortium in anaerobic bioreactors and revealed the presence of several uncultivated species. This paper presents a review of the panoply of classical and recent molecular approaches and multivariate analyses that have been, or might be used to establish the interactions and functions of these anaerobic microorganisms. Most of the molecular approaches used so far are based on the analysis of small subunit ribosomal RNA but recent studies also use quantification of functional gene expressions. There are now several studies that have developed quantitative real-time PCR assays to investigate methanogens. With a view to improving the stability and performance of bioreactors, monitoring with molecular methods is also discussed. Advances in metagenomics and proteomics will lead to the development of promising lab-on chip technologies for cost-effective monitoring.

Psychrophilic anaerobic digestion biotechnology for swine mortality disposal.

The objective of this study was to investigate the feasibility of using psychrophilic anaerobic digestion in sequencing batch reactors (PADSBRs) to co-digest grinded swine carcasses and swine manure slurry at 20 degrees C and 25 degrees C. The PADSBRs were operated on two-week and four-week treatment cycle lengths, which included the fill, react, and draw phases. Two carcass loading rates (CLRs) were tested, that is 20 and 40g of carcass per litre of manure, which were equivalent to 4 and 8 times, respectively, the normal mortality rate on commercial farms. The PADSBR performance was compared to that of PADSBRs operated at 25 degrees C and fed manure only. The addition of swine carcass to PADSBR feed did not affect the stability of the bioreactors at both CLRs. The performance of the PADSBRs co-digesting swine carcasses was not statistically different from the control in terms of biogas production and quality. There was no accumulation of volatile fatty acids in the bioreactors at the end of the treatment cycle. The mixed-liquor pH and alkalinity remained within acceptable ranges for the anaerobic microflora. Also, there was no operational problem caused by the formation of foam and scum in the system.

Use of electrodialysis and reverse osmosis for the recovery and concentration of ammonia from swine manure.

This project aimed at producing a concentrated nitrogen fertilizer from liquid swine manure using electrodialysis (ED) and reverse osmosis (RO), as a mean to help resolve the excess nutrient problem faced by many swine producers, and offer an alternative to chemical nitrogen fertilizer production. Different types of ED membranes were evaluated based on the NH4+ transfer rate, current efficiency and membrane stability. A combination of CMB/AMX membranes was retained due to its high NH4+ transfer rate and chemical stability. The maximum total ammonia concentration (NH3-N) achievable by ED was limited by water transport from the manure to the concentrate compartment, and ammonia volatilization (17%) from the open concentrate compartment. Results suggested that, under the conditions of this experiment, a maximum total NH3-N concentration of about 16g/L could be reached with the ED system. An ED concentrate (8.7g/L of total NH3-N) was also fed to TFC-HF reverse osmosis membranes. A mass balance analysis revealed that the RO permeate, which represented 49.6% of the initial volume, contained 8.6% of the ammonia. However, the RO concentrate contained only 66.6% of the initial total NH3-N, suggesting that 21.2% of the ammonia was volatilized during the concentration test with RO membranes. Ammonia concentration in the RO concentrate reached approximately 13g/L, which is similar to the maximum concentration that could be achieved by ED. These results suggest that the use of ED and RO membranes to recover and concentrate ammonia is potentially interesting but the process must include an approach to minimize ammonia volatilization or trap volatilized ammonia.

The fate of crop nutrients during digestion of swine manure in psychrophilic anaerobic sequencing batch reactors.

The objectives of the study were to measure the levels of manure nutrients retained in psychrophilic anaerobic sequencing batch reactors (PASBRs) digesting swine manure, and to determine the distribution of nutrients in the sludge and supernatant zones of settled bioreactor effluent. Anaerobic digestion reduced the total solids (TS) concentration and the soluble chemical oxygen demand (SCOD) of manure by 71.4% and 79.9%, respectively. The nitrogen, potassium, and sodium fed with the manure to the PASBRs were recovered in the effluent. The bioreactors retained on average 25.5% of the P, 8.7% of the Ca, 41.5% of the Cu, 18.4% of the Zn, and 67.7% of the S fed to the PASBRs. The natural settling of bioreactor effluent allowed further nutrient separation. The supernatant fraction, which represented 71.4% of effluent volume, contained 61.8% of the total N, 67.1% of the NH4-N, and 73.3% of the Na. The settled sludge fraction, which represented 28.6% of the volume, contained 57.6% of the solids, 62.3% of the P, 71.6% of the Ca, 89.6% of the Mg, 76.1% of the Al, 90.0% of the Cu, 74.2% of the Zn, and 52.2% of the S. The N/P ratio was increased from 3.9 in the raw manure to 5.2 in the bioreactor effluent and 9.2 in the supernatant fraction of the settled effluent. The PASBR technology will then substantially decrease the manure management costs of swine operations producing excess phosphorus, by reducing the volume of manure to export outside the farm. The separation of nutrients will also allow land spreading strategies that increase the agronomic value of manure by matching more closely the crop nutrient requirements.

Impact of mash feeding versus pellets on propionic/butyric acid levels and on total load in the gastrointestinal tract of growing pigs.

Feed characteristics may influence the bacterial community composition and metabolic activities in the pig gastrointestinal tract, known to be associated with positive effects on the gut. Use of mash feed is associated with reduced excretion, but little is known of its effect on the population or of the mechanism of action. Our objectives were to assess the effect of feed texture combined with feed particle size on VFA profiles and levels, total count, and the presence of genes encoding virulence factors of pathogenic strains in the digestive tract along with their impact on pig performance of fattening pigs. Pigs ( = 840) on a commercial farm received mash or pellet diets of different particle sizes during the fattening period. Caecal and colon contents from 164 pigs were sampled at the slaughterhouse for enumeration of by quantitative PCR (qPCR) and for VFA quantification by capillary gas chromatography. The gene was used to enumerate total . Improved pig performances associated with pellet texture and a 500-µm size were observed. Caecal ( = 0.02) and colon ( < 0.01) propionic acid concentrations were lower for pigs receiving pellet rather than mash feed. Similarly, caecal ( = 0.01) and colon ( < 0.001) butyric acid concentrations were also lower for pigs receiving pellet rather than mash feed, as determined by capillary gas chromatography. Moreover, caecal ( = 0.03) and colon ( < 0.001) butyric acid concentrations were higher for pigs receiving a feed with a 1,250-µm particle size rather than a 500-µm particle size. On the other hand, total caecal and colon levels were higher for pigs receiving pellet feed than for those receiving mash feed. For total enumeration, caecal ( < 0.01) and colon ( < 0.01) gene copies were higher for pigs receiving pellet rather than mash feed. No effect of particle size on fatty acid concentrations or on numbers was observed. Virulence gene quantification revealed no trend. Taken together, results showed that mash feed is associated with lower growth performance but with favorable intestinal changes linked to VFA levels and reduction in the intestine.

The effect of temperature on slaughterhouse wastewater treatment in anaerobic sequencing batch reactors.

High strength slaughterhouse wastewater was treated in four 42 l anaerobic sequencing batch reactors (ASBRs) operated at 30 degrees C, 25 degrees C and 20 degrees C. The wastewater contained between 30% and 53% of its chemical oxygen demand (COD) as suspended solids (SS). The ASBRs could easily support volumetric organic loading rates (OLRs) of 4.93, 2.94 and 2.75 kg/m3/d (biomass OLRs of 0.44, 0.42 and 0.14 g/g volatile SS (VSS)/d) at 30 degrees C, 25 degrees C, and 20 degrees C, respectively. At all operating temperatures, the total COD (TCOD) and soluble COD (SCOD) were reduced by over 92%, while average SS removal varied between 80% and 96%. Over the experimental period, 90.8%, 88.7% and 84.2% of the COD removed was transformed into methane at 30 degrees C, 25 degrees C and 20 degrees C, respectively. The decrease in the conversion of the COD removed into methane as operating temperature was lowered, may be partly explained by a lower degradation of influent SS as temperature was reduced. The reactors showed a high average methanogenic activity of 0.37, 0.34 and 0.12 g CH4-COD/gVSS/d (22.4, 12.7 and 11.8 l/d) at 30 degrees C, 25 degrees C and 20 degrees C, respectively. The average methane content in the biogas increased from 74.7% to 78.2% as temperature was lowered from 30 degrees C to 20 degrees C.

Ocular counter-rolling during active head tilting in humans.

Human ocular counter-rolling has been measured by means of an infra-red video based system: EMIRAT. This method of three-dimensional eye angular displacement recording has an overall precision of 0.5 degrees, is calibrated and is completely non-invasive. Dynamic counter-rolling gain is about 0.5, increasing with head roll oscillation frequency from 0.3 at 0.1 Hz, to 0.7 at 1 Hz. Otolithic contribution to this reflex has been taken into consideration.

Ocular Counter-rolling during Active Head Tilting in Humans.

Human ocular counter-rolling has been measured by means of an infra-red video based system: EMIRAT. This method of three-dimensional eye angular displacement recording has an overall precision of 0.5°, is calibrated and is completely non-invasive. Dynamic counter-rolling gain is about 0.5, increasing with head roll oscillation frequency from 0.3 at 0.1 Hz, lo 0.7 at 1 Hz. Otolithic contribution to this reflex has been taken into consideration.

Radiation protection for an ultra-high intensity laser.

Radiological characterisation of an experimental chamber and other areas of an ultra-high intensity laser facility (-terawatt) revealed significant levels of X ray, gamma and neutron radiation. Different techniques were used to detect and measure this radiation: TLD. photographic film, bubble detectors and germanium spectrometry. A test series of radiological measurements was made for 150 laser shots (300 femtoseconds) with energies in the 1 to 20 J range and a target illuminance of 10(19) W.cm2. Gamma dose equivalents in the vicinity of the chamber varied between 0.7 and 73 mSv. The dose equivalent due to the neutron component was evaluated to be 1% of the gamma dose equivalent. The amount of radiation generated depends on the laser energy and the nature of the target. No activation or contamination of the chamber or target holder were observed. Ultra-high intensity lasers are being extensively developed at the present time and the investigations performed demonstrate that it is necessary to take radiological risks into consideration in the design of ultra-high intensity laser facilities and to define personnel access conditions.

Usefulness of TAO model to predict and manage the transformation in soil of carbon and nitrogen forms from West-Africa urban solid wastes.

The TAO model of Transformation of Added Organic materials (AOM) calibrated on AOMs and substrates of temperate areas was used to assess the transformations in soil of carbon and nitrogen forms of AOMs: raw materials, selected mixtures and composts from Ouagadougou urban wastes. AOMs were studied in terms of chemical and biochemical contents and for their C and N mineralization during incubations in a typical Ferric Lixisol of the sub-urban agriculture of Ouagadougou. The TAO model was used to predict the transformations of C (very labile, resistant and stable organic C) and N (very labile, resistant and stable organic N, produced and immobilized inorganic N) forms driven by AOM biochemical data. Without any change in calibration formulae, TAO predicted accurately the C transformations and inorganic N production of most of the tested AOMs, with a tendency to slightly overestimate C mineralization of previously well-composted materials and re-mineralization of immobilized N. Complementary adjustments using more complete data from laboratory experiments are suggested, but the model agrees with other data collected in the field and appears as a promising tool to optimise the management of urban wastes in the tropical area as well as for agro industrial organic fertilizers of the temperate zone. This application suggests ways to improve the management of urban wastes aiming to optimize agricultural yields, system sustainability and C sequestration in soil.

Potential of low-temperature anaerobic digestion to address current environmental concerns on swine production.

Environmental issues associated with swine production are becoming a major concern among the general public and are thus an important challenge for the swine industry. There is now a renewed interest in environmental biotechnologies that can minimize the impact of swine production and add value to livestock by-products. An anaerobic biotechnology called psychrophilic anaerobic digestion (PAD) in sequencing batch reactors (SBR) has been developed at Agriculture and Agri-Food Canada. This very stable biotechnology recovers usable energy, stabilizes and deodorizes manure, and increases the availability of plant nutrients. Experimental results indicated that PAD of swine manure slurry at 15 to 25 degrees C in intermittently fed SBR reduces the pollution potential of manure by removing up to 90% of the soluble chemical oxygen demand. The process performs well under intermittent feeding, once to 3 times a week, and without external mixing. Bioreactor feeding activities can thus be easily integrated into the routine manure removal procedures in the barn, with minimal interference with other farm operations and use of existing manure-handling equipment. Process stability was not affected by the presence of antibiotics in manure. The PAD process was efficient in eliminating populations of zoonotic pathogens and parasites present in raw livestock manure slurries. Psychrophilic anaerobic digestion in SBR could also be used for swine mortality disposal. The addition of swine carcasses, at loading rates representing up to 8 times the normal mortality rates on commercial farms, did not affect the stability of SBR. No operational problems were related to the formation of foam and scum. The biotechnology was successfully operated at semi-industrial and full commercial scales. Biogas production rate exceeded 0.20 L of methane per gram of total chemical oxygen demand fed to the SBR. The biogas was of excellent quality, with a methane concentration ranging from 70 to 80%. The recovery of green energy, the production of a value-added odorless fertilizer, the elimination of manure pathogens, and the proper disposal of swine mortalities will substantially reduce the carbon and environmental footprints on products of swine origin.

[Isolation of Clostridium difficile from the stools of hospitalized patients with diarrhea]. / Isolement de Clostridium difficile dans les selles diarrhéiques de patients hospitalisés.

408 stool samples from 354 hospitalized patients with diarrhea were evaluated for the presence of Clostridium difficile. C. difficile was detected in stools of 42 patients (12%), 19 of them being hospitalized in neurosurgery units. The strains were cytotoxigenic in 31 cases and non cototoxigenic in 11 cases. The diagnosis of C. difficile induced diarrhea was based on the clinical setting [presence of diarrhea that could be attributed to antimicrobial therapy and endoscopy for detection of pseudomembranous colitis (PMC)], laboratory studies (cytotoxigenic strains of C. difficile) and therapeutic response (oral vancomycin or metronidazole). C. difficile was implicated as a cause of PMC (2 cases) and antimicrobial associated diarrhea (8 cases) (PMC not documented). The pathogenic role of C. difficile was questionable in 24 cases (no specific therapy) and unlikely in 8 cases. In fact C. difficile could be implicated as a cause of diarrhea in 24% of the cases.