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Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1996 May;34(5):1161–1165. doi: 10.1128/jcm.34.5.1161-1165.1996

Role of stool screening tests in diagnosis of inflammatory bacterial enteritis and in selection of specimens likely to yield invasive enteric pathogens.

R P Silletti 1, G Lee 1, E Ailey 1
PMCID: PMC228974  PMID: 8727895

Abstract

The Leuko-Test yielded a negative predictive value of 98.4% when it was used to screen 325 patients for inflammatory bacterial enteritis and a negative predictive value of 99.4% when it was used to screen 416 stool specimens for those from which enteric pathogens would likely be recovered when cultured. Neither microscopy for fecal leukocytes nor an assay for fecal occult blood, alone or in combination, allowed for the reliable detection of invasive bacterial enteritis or the reliable selection of specimens for culture. When positive in the Leuko-Test, specimens collected from patients after the third day of hospitalization did not yield enteric pathogens when the specimens were cultured, and specimens collected from inpatients within the first 3 days of hospitalization or from outpatients did not contain Clostridium difficile toxin A. As a screening test, the Leuko-Test has the ability to generate rapidly a result which can support the presumptive diagnosis of inflammatory bacterial enteritis or which can be used to determine the suitability of stool specimens for bacteriologic culture.

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Selected References

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  1. Bojalil R., Calva J. J. Antibiotic misuse in diarrhea. A household survey in a Mexican community. J Clin Epidemiol. 1994 Feb;47(2):147–156. doi: 10.1016/0895-4356(94)90019-1. [DOI] [PubMed] [Google Scholar]
  2. Brown W. J., Hudson M. J., Patrick S., Matthews S. C., Hill M. J., Gent A. E., Grace R. H., Hellier M. D., Swarbrick E. T. Search for enteric microbial pathogens in patients with ulcerative colitis. Digestion. 1992;53(3-4):121–128. doi: 10.1159/000200985. [DOI] [PubMed] [Google Scholar]
  3. Butcher J. D. Runner's diarrhea and other intestinal problems of athletes. Am Fam Physician. 1993 Sep 15;48(4):623–627. [PubMed] [Google Scholar]
  4. Cheney C. P., Wong R. K. Acute infectious diarrhea. Med Clin North Am. 1993 Sep;77(5):1169–1196. doi: 10.1016/s0025-7125(16)30216-4. [DOI] [PubMed] [Google Scholar]
  5. Cimolai N. Fecal leukocytes in Escherichia coli O157:H7 enteritis. J Clin Pathol. 1990 Apr;43(4):347–347. doi: 10.1136/jcp.43.4.347-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cox G. J., Matsui S. M., Lo R. S., Hinds M., Bowden R. A., Hackman R. C., Meyer W. G., Mori M., Tarr P. I., Oshiro L. S. Etiology and outcome of diarrhea after marrow transplantation: a prospective study. Gastroenterology. 1994 Nov;107(5):1398–1407. doi: 10.1016/0016-5085(94)90542-8. [DOI] [PubMed] [Google Scholar]
  7. Fan K., Morris A. J., Reller L. B. Application of rejection criteria for stool cultures for bacterial enteric pathogens. J Clin Microbiol. 1993 Aug;31(8):2233–2235. doi: 10.1128/jcm.31.8.2233-2235.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. 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]
  9. Guerrant R. L., Bobak D. A. Bacterial and protozoal gastroenteritis. N Engl J Med. 1991 Aug 1;325(5):327–340. doi: 10.1056/NEJM199108013250506. [DOI] [PubMed] [Google Scholar]
  10. Guyot J., Gonvers J. J., Pyndiah N., Heitz M. Utilité de la recherche de leucocytes dans les selles en cas de diarrhée aiguë. Schweiz Med Wochenschr. 1984 May 5;114(18):634–636. [PubMed] [Google Scholar]
  11. Harris J. C., Dupont H. L., Hornick R. B. Fecal leukocytes in diarrheal illness. Ann Intern Med. 1972 May;76(5):697–703. doi: 10.7326/0003-4819-76-5-697. [DOI] [PubMed] [Google Scholar]
  12. Huicho L., Sanchez D., Contreras M., Paredes M., Murga H., Chinchay L., Guevara G. Occult blood and fecal leukocytes as screening tests in childhood infectious diarrhea: an old problem revisited. Pediatr Infect Dis J. 1993 Jun;12(6):474–477. doi: 10.1097/00006454-199306000-00004. [DOI] [PubMed] [Google Scholar]
  13. Kandolo K., Wauters G. Pyrazinamidase activity in Yersinia enterocolitica and related organisms. J Clin Microbiol. 1985 Jun;21(6):980–982. doi: 10.1128/jcm.21.6.980-982.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Koplan J. P., Fineberg H. V., Ferraro M. J., Rosenberg M. L. Value of stool cultures. Lancet. 1980 Aug 23;2(8191):413–416. doi: 10.1016/s0140-6736(80)90453-5. [DOI] [PubMed] [Google Scholar]
  15. Korzeniowski O. M., Barada F. A., Rouse J. D., Guerrant R. L. Value of examination for fecal leukocytes in the early diagnosis of shigellosis. Am J Trop Med Hyg. 1979 Nov;28(6):1031–1035. doi: 10.4269/ajtmh.1979.28.1031. [DOI] [PubMed] [Google Scholar]
  16. Marx C. E., Morris A., Wilson M. L., Reller L. B. Fecal leukocytes in stool specimens submitted for Clostridium difficile toxin assay. Diagn Microbiol Infect Dis. 1993 May-Jun;16(4):313–315. doi: 10.1016/0732-8893(93)90081-h. [DOI] [PubMed] [Google Scholar]
  17. Miller J. R., Barrett L. J., Kotloff K., Guerrant R. L. A rapid test for infectious and inflammatory enteritis. Arch Intern Med. 1994 Dec 12;154(23):2660–2664. doi: 10.1001/archinte.1994.00420230043006. [DOI] [PubMed] [Google Scholar]
  18. Peirce J. E., DuPont H. L., Lewis K. R. Acute diarrhea in a residential institution for the retarded: usefulness of fecal leukocyte examination. Am J Dis Child. 1974 Dec;128(6):772–775. doi: 10.1001/archpedi.1974.02110310020004. [DOI] [PubMed] [Google Scholar]
  19. Pickering L. K., DuPont H. L., Olarte J., Conklin R., Ericsson C. Fecal leukocytes in enteric infections. Am J Clin Pathol. 1977 Nov;68(5):562–565. doi: 10.1093/ajcp/68.5.562. [DOI] [PubMed] [Google Scholar]
  20. Quiroga T., García P., Goycoolea M., Potin M., Rodríguez L., Vial P. Fecal lactoferrin as a marker of fecal leukocytes. J Clin Microbiol. 1994 Oct;32(10):2629–2630. doi: 10.1128/jcm.32.10.2629-2630.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Schleupner M. A., Garner D. C., Sosnowski K. M., Schleupner C. J., Barrett L. J., Silva E., Hirsch D., Guerrant R. L. 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. J Clin Microbiol. 1995 Jul;33(7):1755–1759. doi: 10.1128/jcm.33.7.1755-1759.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Seva-Pereira A., Franco A. O., de Magalhães A. F. Diagnostic value of fecal leukocytes in chronic bowel diseases. Sao Paulo Med J. 1994 Jan-Mar;112(1):504–506. doi: 10.1590/s1516-31801994000100006. [DOI] [PubMed] [Google Scholar]
  23. Soave R., Johnson W. D., Jr Cryptosporidium and Isospora belli infections. J Infect Dis. 1988 Feb;157(2):225–229. doi: 10.1093/infdis/157.2.225. [DOI] [PubMed] [Google Scholar]
  24. Talal A. H., Murray J. A. Acute and chronic diarrhea. How to keep laboratory testing to a minimum. Postgrad Med. 1994 Sep 1;96(3):30-2, 35-8, 43 passim. [PubMed] [Google Scholar]
  25. Tepper R. E., Simon D., Brandt L. J., Nutovits R., Lee M. J. Intestinal permeability in patients infected with the human immunodeficiency virus. Am J Gastroenterol. 1994 Jun;89(6):878–882. [PubMed] [Google Scholar]
  26. 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]
  27. Zins B. J., Sandborn W. J., Tremaine W. J. Collagenous and lymphocytic colitis: subject review and therapeutic alternatives. Am J Gastroenterol. 1995 Sep;90(9):1394–1400. [PubMed] [Google Scholar]
  28. Zins B. J., Tremaine W. J., Carpenter H. A. Collagenous colitis: mucosal biopsies and association with fecal leukocytes. Mayo Clin Proc. 1995 May;70(5):430–433. doi: 10.4065/70.5.430. [DOI] [PubMed] [Google Scholar]

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