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

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.

Fecal lactoferrin, interleukin-1beta, and interleukin-8 are elevated in patients with severe Clostridium difficile colitis

“…FLF is a reliable marker of intestinal inflammation, since titers of Ͼ1:50 are not seen in healthy controls but are almost always present in highly inflammatory diseases like shigellosis. Recent studies have shown that FLF titers detect bacterial colitis with greater sensitivity than microscopic examination for fecal WBCs (18,25,26,29) and even stool culture (28). In fact, in a multivariate regression model, an elevated FLF titer predicts a positive C. difficile toxin assay in the setting of nosocomial diarrhea better than any other clinical or laboratory parameter (18).…”

PCR Detection of Clostridium difficile Triose Phosphate Isomerase (tpi), Toxin A (tcdA), Toxin B (tcdB), Binary Toxin (cdtA, cdtB), and tcdC Genes in Vhembe District, South Africa

“…[19][20][21] Intestinal inflammation has been reported in cases of CDAD, and the lactoferrin test and oc-cult blood tests have been used for the diagnosis of inflammatory diarrhea including C. difficile infection. 3,[22][23][24] In this study, we determined the prevalence of C. difficile in the Vhembe district population and the profile of toxigenicity of the strains present in the stools by detecting the tcdA (toxin A), tcdB (toxin B), and cdtA and cdtB (binary toxin: CDT) genes using specific PCR protocols in association with diarrhea, lactoferrin, and occult blood. The putative negative regulator for toxins A and B (tcdC) was also studied.…”

Small Animals/Avian

“…The value of indiscriminate bacteriologic culture of feces in human patients has been examined and found to be generally low. [1][2][3] Although similar studies have not been performed in canine patients, some authors warn against routine bacteriologic culture of feces because of suspicion of the same relative yield. 4,5 The organisms most commonly considered to be causes of bacterial-associated diarrhea in dogs are Salmonella spp, Campylobacter spp, Clostridium perfringens, and C difficile.…”