Pathogenesis and diagnosis of clostridium difficile enterocolitis

Area of Science:

• Microbiology
• Infectious Diseases
• Gastroenterology

Background:

• Antibiotic-associated enterocolitis caused by Clostridium difficile presents with varying severity, from mild diarrhea to severe colitis.
• The carrier rate of C. difficile in the general population is low, but significantly higher in patients with antibiotic-associated diarrhea.

Purpose of the Study:

• To investigate the prevalence of C. difficile and its toxins in different patient groups.
• To identify the role of specific C. difficile strains in hospital outbreaks.
• To evaluate diagnostic methods for C. difficile enterocolitis, including enterotoxin detection and antibody response.

Main Methods:

• Epidemiological data collection on C. difficile presence in general population and patients with diarrhea.
• Strain typing using immunochemical fingerprinting to track outbreaks.
• Development and application of a "sandwich" enzyme-linked immunosorbent assay (ELISA) for enterotoxin detection.
• Immunoassays to detect circulating antibodies to C. difficile toxins.

Main Results:

• C. difficile or its toxin was found in 18% of patients with antibiotic-associated diarrhea (1980-1982).
• A single C. difficile strain was identified as the cause of a hospital ward outbreak.
• Enterotoxin was detected in 80% of patients with cytotoxin-positive stools; immunoassay detected enterotoxin in 5 colitis patients negative for cytotoxin.
• Antibody response to C. difficile toxins was observed in about half of infected patients, often after recovery from recurrent episodes.

Conclusions:

• Nosocomial spread of C. difficile occurs among patients on antibiotic treatment, necessitating infection control measures.
• Enterotoxin detection assays show promise, especially in cases where cytotoxin is not detected.
• Antibody response may not be a reliable early diagnostic marker for C. difficile infection, particularly in recurrent cases.