Discontinuous counterimmunoelectrophoresis in the diagnosis of antibiotic-associated colitis

John F. Fisher, Francis J. Tedesco, David H. Johnson, J. Peter Rissing, Carol A. Walker, Rose C. Trincher, Linda Howard, Thomas Buxton, John F. Agel

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Abstract

Discontinuous counterimmunoelectrophoresis (DOE) was employed to detect the toxin of Clostridium difficile, etiologic antibiotic-associated colitis (AAC), in bacteria-free stool filtrates from 51 patients with diarrhea. Stool samples from 31 patients contained C. difficile toxin as determined by tissue-culture assay. A positive result was obtained by DCIE in 20 of the 31 patients (65%) and was influenced by the titer of toxin present. When toxin was present by tissue-culture assay in a dilution of 10-2 (11 samples), DCIE was positive in only 2 (18%). However, DCIE yielded positive results in 18 of the 20 samples (90%) containing toxin titers ≥10-3. The combination of DCIE and sigmoidoscopy or colonoscopy was superior to either alone in the diagnosis of AAC irrespective of the toxin titer. Nine of 11 patients (82%) whose stool samples contained C. difficile toxin in a dilution of ≥10-2 were recognized by DCIE, endoscopy, or both. In stool samples containing toxin in titers ≥10-3, no falsenegative results were encountered (sensitivity = 100%). Thus, 29 of 31 patients whose stool samples contained C. difficile toxin were identified when the results of DCIE and endoscopical examination were combined (sensitivity 93.5%). Neither endoscopical examination nor DCIE yielded positive results in the 20 patients whose stool samples lacked C. difficile toxin (specificity = 100%). DCIE is a rapid, moderately sensitive, and specific method for detecting C. difficile toxin. When DCIE is combined with endoscopy, the vast majority of patients requiring specific therapy for AAC can be identified.

Original languageEnglish (US)
Pages (from-to)253-256
Number of pages4
JournalJournal of Clinical Gastroenterology
Volume4
Issue number3
DOIs
StatePublished - Jun 1982

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ASJC Scopus subject areas

  • Gastroenterology

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