Comparison of four methods in the diagnosis ofClostridium difficile disease

Mattia, Anthony R.; Doern, Gary V.; Clark, Jennifer L.; Holden, J.; Wu, Lynn; Ferraro, Mary Jane

doi:10.1007/bf02000416

Cited by 20 publications

(7 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Presence of toxin genes were assessed using multiplex PCR to detect the presence of toxin A ( tcdA ), toxin B ( tcdB ) [11], and the binary toxin ( cdtA and cdtB ) genes [12]. Cytotoxicity of all C difficile isolates was assessed by the degree of rounding of cells from a Chinese Hamster Ovary cell line (CHO-K1, ATCC CCL-61) as previously described [13]. …”

Section: Methodsmentioning

confidence: 99%

Community Environmental Contamination of Toxigenic Clostridium difficile

Alam

Walk

Endres

et al. 2017

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background. Clostridium difficile infection is often considered to result from recent acquisition of a C difficile isolate in a healthcare setting. However, C difficile spores can persist for long periods of time, suggesting a potentially large community environmental reservoir. The objectives of this study were to assess community environmental contamination of toxigenic C difficile and to assess strain distribution in environmental versus clinical isolates.Methods.From 2013 to 2015, we collected community environmental swabs from homes and public areas in Houston, Texas to assess C difficile contamination. All positive isolates were tested for C difficile toxins A and B, ribotyped, and compared with clinical C difficile isolates obtained from hospitalized patients in Houston healthcare settings.Results.A total of 2538 environmental samples were collected over the study period. These included samples obtained from homes (n = 1079), parks (n = 491), chain stores (n = 225), fast food restaurants (n = 123), other commercial stores (n = 172), and hospitals (n = 448). Overall, 418 environmental isolates grew toxigenic C difficile (16.5%; P < .001) most commonly from parks (24.6%), followed by homes (17.1%), hospitals (16.5%), commercial stores (8.1%), chain stores (7.6%), and fast food restaurants (6.5%). A similar distribution of ribotypes was observed between clinical and environmental isolates with the exception that ribotype 027 was more common in clinical isolates compared with environmental isolates (P < .001).Conclusions.We identified a high prevalence of toxigenic C difficile from community environs that were similar ribotypes to clinical isolates. These findings suggest that interventions beyond isolation of symptomatic patients should be targeted for prevention of C difficile infection.

show abstract

Section: Methodsmentioning

confidence: 99%

Community Environmental Contamination of Toxigenic Clostridium difficile

Alam

Walk

Endres

et al. 2017

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…These tests include faecal culture on selective media, detection of a nonspecific antigen (glutamate dehydrogenase, GDH) and direct detection of toxins A and/or B from stools. This latter method can be performed either by the cytotoxicity assay or by a direct enzyme immunoassay (EIA) [11–22]. The cytotoxicity assay is considered by many authors as the standard because of its great sensitivity for the detection of toxin B [23].…”

Section: Introductionmentioning

confidence: 99%

A European survey of diagnostic methods and testing protocols for Clostridium difficile

Barbut

Delmée

Brazier

et al. 2003

Clinical Microbiology and Infection

106

View full text Add to dashboard Cite

The results of this study suggest marked discrepancies between laboratories and also between countries regarding the criteria by which C. difficile is investigated for, and the methods and the strategies that are used for the diagnosis of C. difficile. These discrepancies could be explained by the lack of clear guidelines for C. difficile diagnosis in each country, and by the importance that physicians attach to C. difficile. Precise guidelines for C. difficile diagnosis would be the first step to make possible accurate comparison of the incidence and the epidemiology of CDAD from one hospital to another or from one country to another.

show abstract

“…38 Latex-agglutination tests can detect the bacterial enzyme glutamate dehydrogenase, but they have a low sensitivity and lack specificity because of cross-reaction with other bacteria. 36,37,39,40 In addition, the tests cannot distinguish toxigenic from nontoxigenic strains of C. difficile, since both types of strains produce the enzyme.…”

Section: Clinical Diagnosesmentioning

confidence: 99%

“…The overall specificity of the enzyme immunoassay is 99.6 percent. 40 To improve the sensitivity of detection for specimens with low titers, we use an expanded equivocal zone. Specimens with titers that are just over or just under the positive range are then tested with the cell-culture cytotoxicity assay.…”

Section: Clinical Diagnosesmentioning

confidence: 99%

Case 19-1998

Shmerling¹,

Caliendo²

1998

N Engl J Med

View full text Add to dashboard Cite

A 70-year-old man was admitted to the hospital because of polyarthritis.The patient had been well until 13 days earlier, when he began a 3-day course of treatment with cefixime because of a root-canal operation. Watery diarrhea developed four days later. He took diphenoxylate and then flew to Europe for a one-week vacation. Mild diarrhea continued. Five days before admission, while the patient was still on vacation, his left knee became stiff, painful, and swollen. The next day, these symptoms were worse, and chilliness and night sweats developed. He began a two-day course of treatment with azithromycin. Three days before admission, his right elbow and left thumb became painful and swollen, and he took 2400 mg of ibuprofen in 24 hours, with partial relief of the pain. On the day before admission, he discontinued the ibuprofen. That evening he returned to the United States and found that his temperature was 38.9°C. On the following day, his right knee and left ankle were swollen, and he came to this hospital.The patient was a physician. He had had Reiter's syndrome at the age of 22 years, with monarticular arthritis, urethritis, and conjunctivitis. Physical therapy was administered, and the symptoms subsided within six weeks, without recurrence. He had had mild aortic regurgitation for at least six years. A previous serologic test for syphilis was negative. He took nifedipine and lisinopril for hypertension of 10 years' duration. An operation for prostate cancer had been performed four and a half years before admission, without evidence of recurrence. There was no recent history of nausea, vomiting, abdominal pain or cramps, hematochezia, ocular symptoms, dysuria, rash, ingestion of unusual foods, or exposure to ticks.The temperature was 37.6°C, the pulse was 80, and the respirations were 20. The blood pressure was 130/80 mm Hg.On examination, the patient appeared well. No rash, conjunctival injection, or lymphadenopathy was found. A grade 2 aortic diastolic murmur was heard. The patient could flex his right elbow and extend it over a range of 20 degrees. The left first metacarpophalangeal and interphalangeal joints were swollen, erythematous, and painful. There were effusions in both knees, larger on the left side, with warmth but no erythema; a small effusion was present in the left ankle.The urine was minimally positive for protein. A test for rapid plasma reagin was negative. The prothrombin and partial-thromboplastin times were normal, as were the levels of urea nitrogen, creatinine, glucose, uric acid, calcium, phosphorus, magnesium, electrolytes, and lactate dehydrogenase. The results of other laboratory tests are shown in Tables 1 and 2. A diagnostic procedure was performed.T ABLE 1. H EMATOLOGIC L ABORATORY V ALUES .

show abstract

Comparison of four methods in the diagnosis ofClostridium difficile disease

Cited by 20 publications

References 14 publications

Community Environmental Contamination of Toxigenic Clostridium difficile

Community Environmental Contamination of Toxigenic Clostridium difficile

A European survey of diagnostic methods and testing protocols for Clostridium difficile

Case 19-1998

Contact Info

Product

Resources

About