scholarly journals Comparison of Culture, Cytotoxin Assay and Two Eia Tests with Clinical Diagnosis ofClostridium difficile-Associated Diarrhea

1994 ◽  
Vol 5 (4) ◽  
pp. 163-167 ◽  
Author(s):  
Marilyn Binning ◽  
Michael A John ◽  
Berend C Schieven ◽  
Thomas W Austin ◽  
Robert Lannigan ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Selective Medium ◽  
Infectious Diarrhea ◽  
Toxin A ◽  
Ofclostridium Difficile ◽  
Clinical Criteria ◽  
Hospital Patients ◽  
Common Etiology ◽  
Stool Specimens ◽  
Single Laboratory

Objective: The most common etiology of infectious diarrhea in hospitalized patients isClostridium difficile. No single laboratory test yields a definitive diagnosis. Four methods were evaluated for their sensitivity and specificity in patients who had clinically definedC difficile-associated diarrhea.Methods: Clinical criteria forC difficile-associated diarrhea were defined. All adult in-hospital patients whose stools were tested forC difficilewere prospectively followed. Stools were examined with culture on a selective medium, a commercial cytotoxicity assay (cta), and two commercially available enzyme immunoassays (eias) for toxin A (Meridian) and toxin AB (cbc).Results: During the study period 235 stool specimens from 185 patients were tested. Fifty-one patients were positive forC difficileor its markers,ctawas most sensitive (80%), whereascbc-eiawas most specific (98%). Differences in the sensitivities ofctaand Meridian-eiawere minor (80% versus 73.3%) and they were equally specific (95.5%).Conclusions: The sensitivity and specificity ofeiafor toxin A is similar to other tests. However, due to rapidity and ease of performance, it may be a more practical test for the diagnosis ofC difficile-associated diarrhea, especially if the cytotoxin assay is not available.

scholarly journals Evaluation of Two Rapid Assays for Detection ofClostridium difficile Toxin A in Stool Specimens

1999 ◽  
Vol 37 (9) ◽  
pp. 3044-3047 ◽  
Author(s):  
Daniel P. Fedorko ◽  
Howard D. Engler ◽  
Elizabeth M. O’Shaughnessy ◽  
Esther C. Williams ◽  
Cynthia J. Reichelderfer ◽  
...  
Keyword(s):  
Predictive Value ◽  
Chart Review ◽  
Laboratory Diagnosis ◽  
Clinical Diagnostics ◽  
Becton Dickinson ◽  
Toxin A ◽  
Ofclostridium Difficile ◽  
Rapid Assays ◽  
Toxigenic Culture ◽  
Stool Specimens

Rapid laboratory diagnosis of Clostridium difficile-associated diarrhea (CDAD) is highly desirable in the setting of hospital cost containment. We tested 654 stool specimens to compare the performance of two assays for rapid detection of toxin A, the Immunocard Toxin A test (Meridian Diagnostics, Inc.) and the Culturette Brand Toxin CD enzyme immunoassay (EIA) (Becton Dickinson Microbiology Systems), with a cytotoxin assay (Cytotoxi Test; Advanced Clinical Diagnostics) and culture on cycloserine-cefoxitin-fructose agar followed by determination of the production of toxins A and B. A chart review was performed for patients whose stool specimens provided positive results on one to three of the assays. With the “gold standard” of all four assays positive or chart review evidence of CDAD, 97 (14.8%) stool specimens were positive by one or more assays and 557 (85.2%) were negative by all methods. Total agreement for all assays was 90.5% (592 of 654). The sensitivity, specificity, positive predictive value, and negative predictive value for toxigenic culture were 94.7, 98.6, 87.1, and 99.5%, respectively, for toxigenic culture; 87.7, 98.6, 86.2, and 98.8%, respectively, for the cytotoxin assay; 71.9, 99.3, 91.1, and 97.3%, respectively, for the Immunocard; and 68.4, 99.1, 88.6, and 96.9%, respectively, for the Culturette EIA. While easy to perform and highly specific, these rapid assays do not appear to be sufficient for accurate diagnosis of CDAD.

scholarly journals Transcutaneous Immunization with Clostridium difficile Toxoid A Induces Systemic and Mucosal Immune Responses and Toxin A-Neutralizing Antibodies in Mice

2007 ◽  
Vol 75 (6) ◽  
pp. 2826-2832 ◽  
Author(s):  
Chandrabali Ghose ◽  
Anuj Kalsy ◽  
Alaullah Sheikh ◽  
Julianne Rollenhagen ◽  
Manohar John ◽  
...  
Keyword(s):  
Cell Culture ◽  
Clostridium Difficile ◽  
Immune Responses ◽  
Neutralizing Antibodies ◽  
Infectious Diarrhea ◽  
Toxin A ◽  
Adjuvant Activity ◽  
Transcutaneous Immunization ◽  
Cell Culture Assay

ABSTRACT Clostridium difficile is the leading cause of nosocomial infectious diarrhea. C. difficile produces two toxins (A and B), and systemic and mucosal anti-toxin A antibodies prevent or limit C. difficile-associated diarrhea. To evaluate whether transcutaneous immunization with formalin-treated C. difficile toxin A (CDA) induces systemic and mucosal anti-CDA immune responses, we transcutaneously immunized three cohorts of mice with CDA with or without immunoadjuvantative cholera toxin (CT) on days 0, 14, 28, and 42. Mice transcutaneously immunized with CDA and CT developed prominent anti-CDA and anti-CT immunoglobulin G (IgG) and IgA responses in serum and anti-CDA and anti-CT IgA responses in stool. Sera from immunized mice were able to neutralize C. difficile toxin A activity in an in vitro cell culture assay. CDA itself demonstrated adjuvant activity and enhanced both serum and stool anti-CT IgA responses. Our results suggest that transcutaneous immunization with CDA toxoid may be a feasible immunization strategy against C. difficile, an important cause of morbidity and mortality against which current preventative strategies are failing.

scholarly journals Rapid detection of Clostridium difficile toxin A in stool specimens

1997 ◽  
Vol 3 (4) ◽  
pp. 480-483 ◽  
Author(s):  
Frédéric Barbut ◽  
Muriel Macé ◽  
Valérie Lalande ◽  
Patrick Tilleul ◽  
Jean-Claude Petit
Keyword(s):  
Clostridium Difficile ◽  
Rapid Detection ◽  
Toxin A ◽  
Clostridium Difficile Toxin ◽  
Clostridium Difficile Toxin A ◽  
Stool Specimens

On the mode of action ofClostridium difficile toxin A: anin vitro study

1991 ◽  
Vol 5 (S1) ◽  
pp. 84-85 ◽  
Author(s):  
C. Fiorentini ◽  
G. Donelli ◽  
P. Nicotera ◽  
P. Mastrantonio ◽  
M. Thelestam
Keyword(s):  
Mode Of Action ◽  
Vitro Study ◽  
Toxin A ◽  
Ofclostridium Difficile

Cloning of the carbohydrate-binding portion of the toxin A gene ofClostridium difficile

1987 ◽  
Vol 16 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Stuart B. Price ◽  
Carol J. Phelps ◽  
Tracy D. Wilkins ◽  
John L. Johnson
Keyword(s):  
Carbohydrate Binding ◽  
Toxin A ◽  
Ofclostridium Difficile

Quantitation of Serum IgG by Solid-Phase Radioimmunoassay

1974 ◽  
Vol 20 (3) ◽  
pp. 376-382 ◽  
Author(s):  
Leo P Cawley ◽  
William L Goodwin ◽  
Marilyn Moeder ◽  
Paulette Dibbern
Keyword(s):  
Human Serum ◽  
Sensitivity And Specificity ◽  
Solid Phase ◽  
Diffusion Method ◽  
Human Igg ◽  
Serum Igg ◽  
Hospital Patients ◽  
Solid Phase Radioimmunoassay ◽  
Set Up ◽  
Gel Diffusion

Abstract Human serum immunoglobulins are most frequently measured by single gel diffusion. Radioimmunoassay by use of antibodies bonded to particles is faster and more sensitive, precise, accurate, and specific. We adopted a solid-phase radioimmunoassay (SPRIA) technique, developed in our laboratory, to measure serum IgG, and compared the results with those of a gel-diffusion method commonly used to measure serum IgG. The SPRIA technique is based on competition set up between antibodies to human IgG chemically bonded to cellulose particles and a purified serum IgG labeled with 125I. The solid phase permits prompt separation of the bound from free labeled reagent. We studied precision, accuracy, sensitivity, and specificity, as compared to gel diffusion; values for the two methods agreed well for 57 sera from hospital patients. The SPRIA procedure is more precise, and can be completed in 3 h, as compared to the 16-24 h normally required for gel diffusion procedures. The possible automation of SPRIA is discussed.

scholarly journals Detection of 13 Enteric Bacteria and 5 Viruses Causing Acute Infectious Diarrhea Using Multiplex PCR from Direct Stool Specimens

2013 ◽  
Vol 16 (1) ◽  
pp. 33 ◽  
Author(s):  
Seungok Lee ◽  
Yeon-Joon Park ◽  
Hae Kyung Lee ◽  
Soo-Young Kim ◽  
Ja-Young Kim ◽  
...  
Keyword(s):  
Multiplex Pcr ◽  
Enteric Bacteria ◽  
Infectious Diarrhea ◽  
Stool Specimens

Changing Epidemiology ofClostridium difficile-Associated Disease in Children

2007 ◽  
Vol 28 (11) ◽  
pp. 1233-1235 ◽  
Author(s):  
Lacey Benson ◽  
Xiaoyan Song ◽  
Joseph Campos ◽  
Nalini Singh
Keyword(s):  
Emergency Department ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Temporal Trends ◽  
Outpatient Setting ◽  
Incidence Rates ◽  
Steady Increase ◽  
Ofclostridium Difficile ◽  
Number Of Patients ◽  
Stool Specimens

Objective.To determine temporal trends in the incidence rate forClostridium difficile-associated disease (CDAD) in a pediatric patient population.Methods.We performed an observational, retrospective cohort study that included children who visited or were admitted to Children's National Medical Center during the period from July 2001 through June 2006. The CDAD incidence rates were determined and examined for changes over time using the Poisson regression method.Results.A total of 513 patients whose stool specimens tested positive forC. difficiletoxin were identified. Of these patients, 61% were children aged 2 years or older. The proportion of patients with CDAD in this age group has steadily increased from 46% in 2001 to 64% in 2006. Largely as a result of an increasing number of cases of community-associated CDAD, the incidence of CDAD increased significantly in the outpatient setting, particularly in the emergency department (1.18 cases per 1,000 visits in 2001 vs 2.47 cases per 1,000 visits in 2006;P= .02). The incidence among inpatients decreased during the study period (1.024 cases per 1,000 patient-days in 2001 vs 0.680 cases per 1,000 patient-days in 2006;P= .004). In the neonatal intensive care unit,C. difficile toxinwas detected in stool specimens collected from 22 patients aged from 15 days to 6 months.Conclusion.This study revealed a steady increase in the number of patients seen in the emergency department with community-acquired CDAD. Findings from this study suggest that the characteristics of CDAD in children—a population that has not been considered to be at high risk for this disease in the past—are changing. Further investigations are warranted to explore deviations from the established burdens of the disease and patient risk factors.

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