Abstract
A commercially available latex agglutination test for Clostridium difficile was compared with a cell culture cytotoxin assay and bacteriological culture for the laboratory diagnosis of C. difficile-associated diarrhea and colitis (CAD). Stool specimens from 626 patients were tested by the three methods, and specimens from 118 patients (19%) were positive by at least one of the methods. The results of the three tests agreed in 88% of the specimens tested, overall, but they agreed in only 34% of the 118 positive specimens. Ninety-three patients were evaluated to assess the significance of positive and negative results for each assay. Of 40 patients found to have CAD, 70% were positive by the cytotoxin assay, 78% were positive by the latex agglutination test, and 90% were culture positive. Of 53 patients who did not have CAD, 2% were positive by the cytotoxin assay, 8% were positive by the latex test, and 4% were culture positive. The detection of CAD was improved by using the tests in combination, and 97% of specimens positive by two or three methods were from patients who had CAD. Testing of multiple specimens from individual patients also increased the sensitivity of detection of CAD. The results suggest that the latex agglutination test may be useful for rapid diagnosis of CAD, especially in laboratories that lack cell culture facilities. However, the accuracy of CAD detection is improved when the latex test is used in combination with culture or the cytotoxin assay.
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- Aronsson B., Möllby R., Nord C. E. Antimicrobial agents and Clostridium difficile in acute enteric disease: epidemiological data from Sweden, 1980-1982. J Infect Dis. 1985 Mar;151(3):476–481. doi: 10.1093/infdis/151.3.476. [DOI] [PubMed] [Google Scholar]
- Bartlett J. G., Gorbach S. L. Pseudomembranous enterocolitis (antibiotic-related colitis). Adv Intern Med. 1977;22:455–476. [PubMed] [Google Scholar]
- 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]
- Freeman H. J., Rabeneck L., Owen D. Survival after necrotizing enterocolitis of leukemia treated with oral vancomycin. Gastroenterology. 1981 Oct;81(4):791–794. [PubMed] [Google Scholar]
- George W. L., Rolfe R. D., Finegold S. M. Clostridium difficile and its cytotoxin in feces of patients with antimicrobial agent-associated diarrhea and miscellaneous conditions. J Clin Microbiol. 1982 Jun;15(6):1049–1053. doi: 10.1128/jcm.15.6.1049-1053.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gerding D. N., Olson M. M., Peterson L. R., Teasley D. G., Gebhard R. L., Schwartz M. L., Lee J. T., Jr Clostridium difficile-associated diarrhea and colitis in adults. A prospective case-controlled epidemiologic study. Arch Intern Med. 1986 Jan;146(1):95–100. [PubMed] [Google Scholar]
- Keighley M. R., Burdon D. W., Alexander-Williams J., Shinagawa N., Arabi Y., Thompson H., Youngs D., Bentley S., George R. H. Diarrhoea and pseudomembranous colitis after gastrointestinal operations. A prospective study. Lancet. 1978 Dec 2;2(8101):1165–1167. doi: 10.1016/s0140-6736(78)92151-7. [DOI] [PubMed] [Google Scholar]
- Lyerly D. M., Wilkins T. D. Commercial latex test for Clostridium difficile toxin A does not detect toxin A. J Clin Microbiol. 1986 Mar;23(3):622–623. doi: 10.1128/jcm.23.3.622-623.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Peterson L. R., Holter J. J., Shanholtzer C. J., Garrett C. R., Gerding D. N. Detection of Clostridium difficile toxins A (enterotoxin) and B (cytotoxin) in clinical specimens. Evaluation of a latex agglutination test. Am J Clin Pathol. 1986 Aug;86(2):208–211. doi: 10.1093/ajcp/86.2.208. [DOI] [PubMed] [Google Scholar]
- Willey S. H., Bartlett J. G. Cultures for Clostridium difficile in stools containing a cytotoxin neutralized by Clostridium sordellii antitoxin. J Clin Microbiol. 1979 Dec;10(6):880–884. doi: 10.1128/jcm.10.6.880-884.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]