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. 1995 Jul;33(7):1755–1759. doi: 10.1128/jcm.33.7.1755-1759.1995

Concurrence of Clostridium difficile toxin A enzyme-linked immunosorbent assay, fecal lactoferrin assay, and clinical criteria with C. difficile cytotoxin titer in two patient cohorts.

M A Schleupner 1, D C Garner 1, K M Sosnowski 1, C J Schleupner 1, L J Barrett 1, E Silva 1, D Hirsch 1, R L Guerrant 1
PMCID: PMC228263  PMID: 7665642

Abstract

The accurate and sensitive diagnosis of Clostridium difficile-related diarrhea, normally treated with vancomycin, has become increasingly important in light of the emergence of dangerous new strains of vancomycin-resistant enterococci. In order to improve the threshold for C. difficile diagnosis and treatment, a number of commonly used assays for the diagnosis of C. difficile diarrhea were examined. These included an enzyme-linked immunosorbent assay for C. difficile toxin A (ToxA), a CHO cell culture assay for fecal C. difficile (cyto)toxin B, and a lactoferrin latex agglutination assay for fecal lactoferrin (LFLA). We studied 722 fecal specimens submitted by physicians for C. difficile toxin testing at the Salem, Va., Veterans' Affairs Hospital and at the University of Virginia Medical Center in Charlottesville. Charts were reviewed from 123 Veterans' Hospital patients and 114 University of Virginia patients for clinical criteria indicative of C. difficile diarrhea. An increasing titer of CHO cell cytotoxicity was correlated with an increasing likelihood of ToxA positivity (5 to 90%), LFLA positivity (39 to 77%), and clinical agreement (28 to 85%). However, some data indicate that the CHO cell cytotoxicity assay may be nonspecific when positive only at low titers. When the CHO assay result is positive at high titers, it remains the best diagnostic tool. Yet, when it is positive at a low titer, careful interpretation of the results in conjunction with other assays and the clinical setting is warranted, especially in light of new drug-resistant strains of microorganisms.

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Selected References

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  1. Barbut F., Kajzer C., Planas N., Petit J. C. Comparison of three enzyme immunoassays, a cytotoxicity assay, and toxigenic culture for diagnosis of Clostridium difficile-associated diarrhea. J Clin Microbiol. 1993 Apr;31(4):963–967. doi: 10.1128/jcm.31.4.963-967.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bartlett J. G. Clostridium difficile: clinical considerations. Rev Infect Dis. 1990 Jan-Feb;12 (Suppl 2):S243–S251. doi: 10.1093/clinids/12.supplement_2.s243. [DOI] [PubMed] [Google Scholar]
  3. Bartlett J. G. Treatment of antibiotic-associated pseudomembranous colitis. Rev Infect Dis. 1984 Mar-Apr;6 (Suppl 1):S235–S241. doi: 10.1093/clinids/6.supplement_1.s235. [DOI] [PubMed] [Google Scholar]
  4. Chang T. W., Gorbach S. L., Bartlett J. B. Neutralization of Clostridium difficile toxin by Clostridium sordellii antitoxins. Infect Immun. 1978 Nov;22(2):418–422. doi: 10.1128/iai.22.2.418-422.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ehrich M., Van Tassell R. L., Libby J. M., Wilkins T. D. Production of Clostridium difficile antitoxin. Infect Immun. 1980 Jun;28(3):1041–1043. doi: 10.1128/iai.28.3.1041-1043.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Guerrant R. L., Araujo V., Soares E., Kotloff K., Lima A. A., Cooper W. H., Lee A. G. Measurement of fecal lactoferrin as a marker of fecal leukocytes. J Clin Microbiol. 1992 May;30(5):1238–1242. doi: 10.1128/jcm.30.5.1238-1242.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Johnson S., Homann S. R., Bettin K. M., Quick J. N., Clabots C. R., Peterson L. R., Gerding D. N. Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial. Ann Intern Med. 1992 Aug 15;117(4):297–302. doi: 10.7326/0003-4819-117-4-297. [DOI] [PubMed] [Google Scholar]
  8. Kelly C. P., Pothoulakis C., LaMont J. T. Clostridium difficile colitis. N Engl J Med. 1994 Jan 27;330(4):257–262. doi: 10.1056/NEJM199401273300406. [DOI] [PubMed] [Google Scholar]
  9. Lyerly D. M., Krivan H. C., Wilkins T. D. Clostridium difficile: its disease and toxins. Clin Microbiol Rev. 1988 Jan;1(1):1–18. doi: 10.1128/cmr.1.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. McFarland L. V., Surawicz C. M., Stamm W. E. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis. 1990 Sep;162(3):678–684. doi: 10.1093/infdis/162.3.678. [DOI] [PubMed] [Google Scholar]
  11. Mulligan M. E. Epidemiology of Clostridium difficile-induced intestinal disease. Rev Infect Dis. 1984 Mar-Apr;6 (Suppl 1):S222–S228. doi: 10.1093/clinids/6.supplement_1.s222. [DOI] [PubMed] [Google Scholar]
  12. Nachamkin I., Lotz-Nolan L., Skalina D. Evaluation of a commercial cytotoxicity assay for detection of Clostridium difficile toxin. J Clin Microbiol. 1986 May;23(5):954–955. doi: 10.1128/jcm.23.5.954-955.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Rehg J. E. Cecal toxin(s) from guinea pigs with clindamycin-associated colitis, neutralized by Clostridium sordellii antitoxin. Infect Immun. 1980 Feb;27(2):387–390. doi: 10.1128/iai.27.2.387-390.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Triadafilopoulos G., Pothoulakis C., O'Brien M. J., LaMont J. T. Differential effects of Clostridium difficile toxins A and B on rabbit ileum. Gastroenterology. 1987 Aug;93(2):273–279. doi: 10.1016/0016-5085(87)91014-6. [DOI] [PubMed] [Google Scholar]
  15. Wu T. C., Gersch S. M. Evaluation of a commercial kit for the routine detection of Clostridium difficile cytotoxin by tissue culture. J Clin Microbiol. 1986 Apr;23(4):792–793. doi: 10.1128/jcm.23.4.792-793.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Yong W. H., Mattia A. R., Ferraro M. J. Comparison of fecal lactoferrin latex agglutination assay and methylene blue microscopy for detection of fecal leukocytes in Clostridium difficile-associated disease. J Clin Microbiol. 1994 May;32(5):1360–1361. doi: 10.1128/jcm.32.5.1360-1361.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]

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