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Updated: Jun 16, 2026
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A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
Detection of Clostridium difficile infection: a suggested laboratory diagnostic algorithm
M W D Wren1, R Kinson, M Sivapalan
1Clinical Microbiology, University College London Hospital, London, UK.
British Journal of Biomedical Science
|January 26, 2010
Summary
Diagnosing Clostridium difficile infection (CDI) can be improved using a two-step approach. Screening faecal samples for glutamate dehydrogenase (GDH) and then testing positive samples for toxins and lactoferrin enhances CDI detection.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Gastroenterology
Background:
- Current Clostridium difficile infection (CDI) diagnosis relies on fecal toxin A/B detection, but sensitivity is limited, especially in advanced cases.
- Investigating enhanced diagnostic methods for C. difficile is crucial due to the limitations of existing tests.
Purpose of the Study:
- To evaluate the diagnostic performance of toxigenic culture, immunoassay for toxins AB, and glutamate dehydrogenase (GDH) test for CDI.
- To assess the utility of fecal lactoferrin as an indicator of intestinal inflammation in CDI patients.
- To propose an improved diagnostic algorithm for C. difficile detection.
Main Methods:
- Analysis of 1007 fecal samples using toxigenic culture, toxin AB immunoassay, and GDH testing.
- Fecal lactoferrin testing on samples positive by any initial method.
- Follow-up of patients with negative toxin AB tests but positive lactoferrin for clinical outcomes.
Main Results:
- Glutamate dehydrogenase (GDH) demonstrated high sensitivity and specificity for C. difficile detection (NPV 99.3%).
- Fecal lactoferrin was positive in 40.3% of tested samples, indicating inflammation.
- A two-step algorithm involving GDH screening followed by toxin AB and lactoferrin testing is proposed.
Conclusions:
- A GDH screening followed by toxin AB and lactoferrin testing offers a more sensitive approach to CDI diagnosis.
- Lactoferrin positivity in conjunction with negative toxin tests suggests advanced CDI and warrants further investigation.
- Development of more sensitive toxin detection assays or rapid toxigenic strain tests is needed for challenging cases.
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