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Clostridium difficile culture-positive toxin-negative diarrhea
The American Journal of Gastroenterology
|October 1, 1986
Summary
Clostridium difficile (C. diff) can cause antibiotic-associated colitis. Even without detectable toxin, C. diff in stool may indicate disease, suggesting treatment for persistent diarrhea.
Area of Science:
- Microbiology
- Infectious Diseases
- Gastroenterology
Background:
- Antibiotic-associated colitis (AAC) is typically confirmed by detecting Clostridium difficile cytotoxin in stool.
- Culture of C. difficile has not been routinely required for diagnosis.
- The significance of culture-positive, toxin-negative (CPTN) versus culture-positive, toxin-positive (CPTP) C. difficile infections remains unclear.
Purpose of the Study:
- To clarify the clinical significance of C. difficile culture-positive, toxin-negative (CPTN) results compared to culture-positive, toxin-positive (CPTP) disease.
- To evaluate the role of C. difficile in diarrheal syndromes, even in the absence of detectable cytotoxin.
Main Methods:
- Retrospective review of 45 patients with C. difficile positive stool cultures.
- Prospective analysis of C. difficile isolates for in vitro cytotoxin production.
- Comparison of clinical characteristics between CPTP and CPTN patient groups.
Main Results:
- 16 patients were CPTP and 29 were CPTN; no significant differences in underlying conditions or antibiotic exposure.
- CPTP patients treated for AAC showed a 100% response rate.
- 17 of 29 CPTN patients experienced spontaneous symptom resolution; 67% of C. difficile isolates from CPTN patients produced cytotoxin in vitro (vs. 97% in CPTP patients, p<0.005).
Conclusions:
- C. difficile may be an etiological factor in diarrheal syndromes even without detectable cytotoxin.
- Positive C. difficile cultures warrant consideration for treatment in patients with persistent diarrhea pending further randomized trials.